NO. 6 EAR EXOSTOSES HRDLICKA 59 



two classes: I, appears with congestion of the mucous memhrane 

 of the ear. Most of the patients who have consulted me on account 

 of it were in the habit of partaking freely of stimulating food and 

 beverages." Hedinger (1881), on the basis of about 40 cases, found 

 it necessary to deny abuse of liquor as an etiological factor. Heiman 

 (1890) mentions alcohol, but the question is " hard to decide." Ac- 

 cording to Alexander (1930), food has possibly also "a releasing 

 effect on the exostoses." Moller-Holst (1932, p. 102) says " efTect of 

 nutrition is not determinable." 



Habits. — Hal:)its in the main imply occupations. With the possible 

 exception of those of sea divers (see under Salt Water), and that of 

 carrying heavy ear pendants (see under Mechanical) no attempts 

 have thus far been made to connect occupational or other habits with 

 ear exostoses. 



CONSTITUTIONAL DERANGEMENTS 

 GOUT, ARTHRITIC DIATHESIS 



In dealing with the obscure etiology of ear exostoses it was in- 

 evitable that much thought should be given to the possible connection 

 of these abnormalities with those constitutional derangements or dis- 

 eases that are known to be the cause of osteoblastic disturbances. 

 The foremost of such conditions are the arthritic or gouty diathesis, 

 and syphilis. 



The view that rheumatic or arthritic diathesis and resulting localized 

 osteitis or periostitis were the causes of ear exostoses was suggested 

 as early as 1856 by Rau, but was especially fathered by Toynbee 

 (i860), who believed that " it is principally in individuals of rheu- 

 matic or gouty temperament that one encounters these bony tumors " ; 

 and " they appear to be the result of a rheumatic or gouty diathesis." 



Roosa (1866, p. 428), is the first to raise a partial objection — some 

 influence of rheumatic dyscrasia cannot be denied, but must not be 

 overestimated. For Delstanche (1878) the influence of rheumatic or 

 gouty diathesis is not well established. Von Troeltsch (1881) did not 

 see arthritic signs in his cases. For Dalby (1885) the views of 

 Toynbee and similar views are "fallacious"; for Kessel (1889), 

 ascribing the growths to rheumatic or gouty diathesis is untenable. 



Virchow (1889, p. 395) is uncertain — "there exists a certain re- 

 lation between these formations and arthritis deformans " ; and in 

 1893 he is still in doubt — there is " possibly some connection." Jacque- 

 mart (1889, p. 192), however, returns to the old view and believes 

 ear exostoses result " from the species of plethora which characterizes 

 arthritism ; are found principally in individuals of rheumatic and 



