NO. 6 EAR EXOSTOSES — HRDLICKA 57 



played a part in multiplying the cases of ear exostoses. But inbreed- 

 ing means essentially intensified heredity. It could augment but hardly 

 create the exostoses. As these abnormalities are so widespread over 

 the earth, inbreeding, if it was their cause, would have to be equally 

 generalized, which of course it is not. Harmful inbreeding is rare in 

 any race of men. It did not exist in America, where exogamy was 

 the rule. It did exist in Egypt, but only in the Pharaohs and perhaps 

 in the highest families. It took place only very exceptionally in whites. 

 ]\Iore closely inbred communities, whether in the Old World or the 

 New, have never been reported as especially subject to ear exostoses. 

 In fact, the more closely the subject of inbreeding is examined the 

 more it eludes as a ^xissible cause of ear exostoses. 



SOCIAL STATUS : OCCUPATION 



There are but a few references to social or occupational causes of 

 ear exostoses, but these few are suggestive. Von Troeltsch (1881, 

 p. 142) states that his cases predominated in those of middle years 

 " who liked to eat well and drink." Bezold in 24 years of hospital 

 and private practice found ear exostoses in 116 patients and says 

 (1895, p. 49) : " In only a few instances have I found the exostoses 

 in the dispensary patients ; my observations come almost all from 

 private practice. The occurrence of the exostoses is therefore over- 

 whelmingly a disease of the better situated." And the same is reas- 

 serted in Bezold and Siebenmann (1908, p. 102). 



Korner (1904), in dispensary practice at Rostock, found ear exos- 

 toses in but I.I percent of his ear patients^^ — a relative rarity in the 

 poor. For Tod ( 1909) the growths appeared more frequently in 

 the " more favorably circumstanced than in the labouring class." 

 Moodie (1930) mentions that the exostoses are more frequent " among 

 the sedentary groups than among the more active ", although he does 

 not state the basis for this conclusion. In Moller-Holst (1932, p. 69) 

 we find the following statement, though it is perhaps not original : 

 " Usually [the ear exostoses] will, curiously, be found almost ex- 

 clusively among the well-to-do and but seldom in the poor." 



Remarks. — Both the social and the occupational factors are of such 

 breadth and complexity, as well as potency, that some influence by 

 them on any pathological or abnormal process may safely be assumed. 

 Such influence may be of direct or indirect nature, primary or secon- 

 dary. Given the existence of a widespread oto-exostotic diathesis, it 

 is conceivable that its manifestations might be favored or hindered l)y 

 what is embraced in the term " social status ", or occupation. Either 



