50 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 93 



" causes still largely speculative "; Moller-Holst (1932), " subject in 

 many points not satisfactorily cleared." 



Notwithstanding this general pessimistic attitude, there are many 

 beliefs and theories as to the causation of the tumors. They will be 

 reviewed in the following sections. 



" SPONTANEOUS ", NUTRITIVE 



There are a number of remarks in otological writings to the effect 

 that an exostosis in the meatus commenced spontaneously without an 

 apparent reason. As late as 1930 Alexander says that some " originate 

 spontaneously, as an abnormality." 



Dupuytren (q. by Sabroux, 1901) suggested a nutritive disturbance. 

 He believed that they depended on a modification in the nutrition of 

 the bone, on some sort of aberration in the distribution of the bone 

 juices, comparing the tumors to the outgrowths which develop as a 

 result of irregularity in distribution of sap. 



Masini ( 1882) believed also in disturbed nutrition. He thought the 

 growths " may l)e comprehended as exaggerated nutritive ' lavosio '." 



CONGENITAL 



A number of authors have advanced the idea that some of the ear 

 exostoses may be " congenital ", though none have taken the trouble 

 to state precisely what they meant by that term. In some cases it 

 probably stands loosely for " hereditary ". 



Thus Dalby ( 1876) says, " that small bony enlargements in the 

 external auditory canal are sometimes congenital I feel tolerably 

 confident." Delstanche (1878). a little more explicit, believes that 

 the exostoses " may develop both before and after the ossification of 

 the canal." For Roosa (1892) "there may be congenital cases." 

 Velpeau (q. by Le Double) believed some to be "congenital." For 

 Goldstein (1898) exostoses in American Indians belong apparently 

 to "congenital" growths. Sabroux (1901, p. 24) accepts, though 

 rather loosely, the "congenital" nature of some of these growths: 

 " we call therefore congenital all exostoses whose origin is unknown 

 and which seem to be transmitted by heredity ; exostoses whose pres- 

 ence coincides with the development of some congenital tumors or 

 malformations ; and finally all those exostoses that characterize one 

 race more than another." 



In Bezold and Siebenmann's textbook ( 1908, p. 102) we read on this 

 subject as follows : " The exostoses in the bony meatus which Virchow 

 found in many Mexican [should be Peruvian] skulls and which he 



