Besides the diseases of the brain already enu merated, there are several diseased secretions, such as calcareous depositions, scrofulous tumours and abscesses, and globular vascular tumours, some of which are evidently scirrhous, and all of which are described by Platerus, Bonetus, Baader, Ander son, J. Bell, Bateman, Yellowly, and Baillie. These tumours produce acute or obtuse pain of the head, either constant or intermitting; occasionally the pupils appear dilated with more or less strabismus; now and then convulsive or epileptic fits, commonly transitory; and not unfrequently paralysis of one or more extremities: and in the last stage, symptoms of compression. In most cases the side opposite to the tumour is affected with paralysis, according to a principle generally prevalent in effusion of blood or matter in the brain. When these tumours are situated in the region of the optic nerves, vision is impaired; when on the tuber annulare or medulla oblongata, convulsions manifest them selves. Such tumours are beyond the reach of surgery. Fungoid tumours occasionally grow from the dura mater, in consequence of the latter being injured in a general concussion of the brain, and of then healing apart from the cranium, which is absorbed by the pressure, and allows the fungus to protrude. These tumours are also generated when the cranium is rendered carious, and the dura mater separates slowly from the bone. They excite either epilepsy, or palsy, in which the bone remains firm, and forms a resistance to the tumour; and when pressed upon, pain,. tremors, and con vulsions are excited. Instances are detailed by Baader, Sivert, Le Grand, Chopart, Marignes, Hill, and J. Bell. These tumours when opened, imme diately prove fatal, so that the patient's sufferings can only be palliated. In the Edin. Medico-Chir. Trans. vol. iii, an interesting case is described by Dr. Stewart, Physician to the Forces. These tu mours seemed to originate in the diploe. The air of particular countries and hospitals has been considered to be more prejudicial to injuries of the head than other wounds, by Lusitani, Phiora Yanti, Donatus, Saviard, La Moue, Petit and De sault; but this is evidently to be ascribed to the importance of the organ injured. The rapid putre faction of those who die of such affections is also taken notice of, which is to be accounted fOr, by the centre of the nervous energy being injured in its organization.
The ear is subject to many diseases which are commonly left to the aurist. The auricle is af fected in early life particularly with a herpetic ulceration, which sometimes spreads over the scalp, producing tinea capitis, and is to be treated in the same manner, preceding it, however, with anodyne fomentations and poultices, until all inflammatory action is subdued. The cerumen of the auditory tube is sometimes too copious, and slightly impairs the hearing, and is readily checked with the same astringent lotions and ointments, as mentioned under tinea capitis, together with a blister behind the auricle. When the secretion of the cerumen is scanty, deafness is occasionally the result, and is to be ri•medied by electricity gently administered, and an ointment of iodine applied at bed time, and washed away in the morning with soap and water. Children often insert pease and other foreign bodies into the auditory tube, the removal of which, although tedious, may be accomplished by a com mon probe, having the eyed-end bent. When cotton or wool has been inserted in the tube, and allowed to remain surrounded with cerumen sometimes for years, deafness is gradually pro duced, in which case the cerumen becomes ex ceedingly hard, and should be softened with oil of olives for six or eight nights, before attempting to remove it by syringing the ear with warm water and soap. Various insects sometimes get into the tube, and produce a terrific noise resembling thunder, and occasionally convulsions. They are easily killed by dropping oil of olives into the ear, or a decoction of tobacco, and afterwards, if small, syringed out, and if large, removed with the forceps or probe. These various objects are easily discovered by means of Buchanan, Le Roy or Segala's speculum, delineated in Fig. 25, Plate DXVI., or simply by placing the ear affected in the rays of the sun, and taking hold of the auricle with the thumb and forefinger, and gently raising or elongating it.
Polypus not unfrequently grows from either the sides of the tube or the membrane of the tympanum, impairing the hearing, and sometimes destroying the membrane, the tympanic cavity, and extending its irritation to the dura mater and proving fatal.
It generally produces a copious discharge of foetid matter from the tube; and is to be treated as Polypus in the nose, with fully more caution, as they are liable to excite inflammation and suppu ration of the dura mater and prove fatal. Children are seldom born with a septum shutting up the auditory tube, but when such occurs, it ought first to be punctured with a very small trocar, for it might be the membrana tympani; and if found to be an adventitious septum, it ought to be en tirely removed with forceps and knife or scissors. The membrana tympani is sometimes so relaxed that it. cannot receive the aerial impulsions, and hence more or less deafness results; and is to be treated with electricity and the iodine oint ment. It is sometimes ruptured from blowing the nose too forcibly; and occasionally thickened after measles and other acute diseases, and likewise in syphilis; when it is consequent. on measles, &c. electricity and iodine ointment are applied to the tube, with blisters or moxas around the root of the auricle. When it occurs in the syphilitic constitution, these are to be combined with mer cury, &c. The threads of the facial nerve sup plying the ear and the chorda tympani are subject to neuralgia, which is here termed otalgia, and is to be treated in the same way. If dependent on a carious tooth, this should be extracted, and a decoction of tobacco dropped into the tube. The Eustachian tube becomes obstructed from many causes, some of which are mentioned under diseases of the nose; it is easily distinguished by making the patient shut his mouth and compress his nostrils, while he attempts to breathe through the latter with a gentle force, when, if the tube be pervious, the air will rush along it, and cause a crackling sound of the membrana tympani, whereas, if the tube be shut up, no sound is heard; also, by putting a watch between his teeth, when its sound will be heard if the auditory nerve be healthy. It is extremely difficult to insert bougics along the nares into the tube to dilate it, unless by means of the speculum, Fig. 25, Plate DXVI.; and there fore the menibrana tympani should be punctured with the trocar by inserting it sheathed in the canula until the latter meets with resistance from the membrane, which is known by the yielding and springing vibration felt, and then the trocar is to be pushed along the canula, and the membrane punctured. In this little operation, the rays of the sun should be directed along the tube, and the auricle held as in inspecting the car. When the obstruction is recent, it is most probably from mucus, and may then be removed by injections of warm water. Inflammation of the. internal organ named otitis has been already described in MEDICINE. Otorrhcca is a discharge of fetid ichorous matter from the mucous membrane investing the tympanum, and occasionally even from the vesti bule, cochlea, and semicircular canals, the bone being occasionally carious. Sometimes it begins in the ear itself, on other occasions within the cranium, and succeeds various acute febrile af fections, particularly in scrofulous constitutions. Air rushes out from the pharynx at the ear, and water injected by the tube flows into the pharynx; and the ossicula auditus, especially the malleus and incus, are generally discharged. This affection should be treated as ophthalmia. An abscess some times takes place in the mastoid cells in children, the communication with the tympanic cavity being shut up with coagulable lymph, in which case the application of a small trephine is necessary, otherwise the disease proves fatal. The labyrinth is subject to many affections, the greater number of which are beyond our compre hension, partly from our ignorance of the physiology of this most in teresting and most important organ, and partly from the difficulties encountered in examining mor bid cases, in consequence of the prejudices of the public. There are diseases of the auditory nerve, of the fenestra ovalis et rotunda, and of the secretion of the labyrinth. For further information on this interesting branch of pathology, the reader may consult hard, Trade des maladies des oreilles. Saunders On the Ear. Buchanan On the Ear, and M'Crae's interesting inaugural dissertations he Morbis ?aris, 1828.