56 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 93 



Convincing as the above statements are, they are supplemented by 

 the sustaining evidence of actual observations on the heredity of the 

 abnormalities. The reported cases, as far as it was possible to gather 

 them, are as follows : 



Reports of Cases of Evident Inheritance of Ear Exostoses 



Blake (1880, 1888) : In two families father and son successively affected. 



Masini (1882) : In one case, adult male, mother "deaf" through occlusion of 

 both ears when about 40. 



Boyer (q. by Hartmann, 1897, p. 43) : Treated a woman whose father, brother, 

 three sisters, two nephews, and all of her own children were affected by 

 ear " hyperostoses." 



Kirchner (1883) : Observed a man with bilateral ear exostoses, in whose son 

 he later found a similar condition. 



Kessel (1889, p. 288) : Like Blake, saw in two families bony growths in ears 

 of a father and a son. 



Moore (1900) : Had two cases, in two brothers, in one in the right, in the 

 other in the left ear. 



Korner (1904, p. 102) : Treated, I, a father, 63, with bilateral marked hyper- 

 ostoses ; in his first son, 26, the same ; in the second son, 20, the same ; in 

 his daughter, 22, a hyperostosis in the right ear; II, father, 55, bilateral 

 marked hyperostosis ; son, 7, hyperostosis in the left ear ; III, man, 42, 

 bilateral marked hyperostoses .... brother 38, the same ; sister, 30, 

 meatus normal: their cousin, 19, in right ear a completely occluding, 

 coffee-bean-size exostosis. 



Kessel (1924) : Presents a heredity-tree of three generations of a family with 

 ear exostoses. 



Alexander (1930) : Had three male patients with ear exostoses, the father 

 of each of whom was affected by similar growth ; another male whose 

 brother and sister were effected ; and still another male with " ear troubles " 

 in a brother and three children of another brother. 



Discussion. — In view of the above data, it cannot be doubted that 

 direct heredity plays a part in the etiology of ear exostoses. But there 

 is no light as yet on the problems of how large and important this 

 part is, whether it is generalized or restricted to individual families, 

 whether it is progressive or regressive, and how it originates. Also, 

 nearly all that is said relates to direct inheritance in families and not 

 to heredity in a wider sense. The subject will receive due attention in 

 our final chapter. 



An item that calls for some consideration in this place is that of 

 inbreeding. Inbreeding as a cause of ear exostoses was brought up 

 recently ( 1932) by Moller-Holst, but without comment or any attempt 

 at an explanation. Inbreeding is known to be capable of accentuating 

 and spreading different pathological conditions. In limited localities, 

 in small human groups, and especially in single families, it might have 



