DEAFNESS, 
Ha a with the inftrument propofed by Mr. 
Coo 
cafes related by Mr. Cooper may be found in the 
Phile oval TranfaGtions for 1802. See Saunders on the 
Ear, p. 41, ef fg. 
S. Desfuafi s from Diforders of the internal Ear.—Then 
of the deafnefs which arifes from difeafes of the internal a 
of the ear is much more dificult to #{certain, than in the 
preceding inftances, in coufequence of our inability to exa- 
minethe morbid changes, which are the immediate caufe of 
thedefet. If wer eles on the 
ey we are led t 
embranes on anich the nerve is ex- 
the properties of that fluid, which 
membranes, and is t 
in the flru@ure of the m 
anded ; or in achange in 
is enn in the 
Tn diffeGting 
n born deaf, Mr. Clive found that the laby- 
ca inttead of its sae eous fluid, contained a thick cafeous 
ubftance. This t have been incapable of undulating 
in the cavities of re labyrinth and its exiftence is fully ade- 
quate to 1 or the abfence of the fenfe. Ex- 
amples have been ceroiel by writers of hydatids in the 
cavities of the intern:i ear, and olleGtions of pus and 
blood in thofe parts, producing deafnefs; alfo of eg 
and other alterations of the internal fru€iure of the organ 
occafioned by the virus of {mall- Pox, {crofula, &c. 
Portal, Anatomie Medicale, tom 
But it has been afcertained by diffetion, that total deaf- 
nefs may exift, without any defe&i in the mechanifm o 
the exterior parts of the ear; and without any defe@ in the 
membranous ftru€ure on which the nerve is expanded, in the 
water it contains, or inthe nerve itfelf; in (hort, without any 
morbid appearance that can betraced by the eye. Such cafes 
may be confidered as examples of nervous deafnefs, dependent 
on fome morbid infenfibility in ce nerve itfelf, The patient 
can inflate t 
~~ 
mn ri atients complain of a beating 
noife, cor re{ponding oi the pulfe, dare by bodily ‘ex- 
ertion in the fame degree as the a&tion of the heart e 
caufe of this fie on is doubtlefs the pulltion of the arte 
ries; although it may be difficu h 
plai ha 
is, which renders the organ fufceptible of this impreffion ; 
or to determine whether the fmall arteries, which ramify in 
the interior of the ree haer 9 are the im Sail or the 
or by mere fullnels 
hence deafnefs of 
dicale-—Callifen Syft, Chirurg. tlodiern. tom. ii. par. 3595- 
and 551. 
Where there are fymptoms of plethora, fuch as intimate 
a probable occurrence of hemiplegia, or where local inflam- 
mation in the head has preceded the deafnefs, evacuants, a 
cia ee ones, will be cored to; {uch as thea 
cupping wlan tot e parts ; ; and the general antiphlo- 
gittic plan will be nae: more or lefs, according to the urs 
gency of the oe fymptoms. Where thefe fymptoms are 
abfent, and a fufpicion of the thickening and enlar 
the eae es ae in confequence of fyphilitic or {cro 
fuloue affe iftss the tutional remedies r 
or 
that the fenfibility of the auditory nerves is impaired 
feeble and imperfe& action of the circulation, the local fti- 
mulus of electricity, or galvanifm, may be applied; ftimu- 
lating liquids may be dropped into the external meatus, or in- 
troduced on lint, and iternutatories employed, together with 
the external ftimulus of veficatoties and rubefacients. 
Confirmed nervous deafnefs is, in truth, generally hope- 
2 mpts 
d 
tion of the difeafe, but on the degree of mifchief done to the 
organ; and ue a at whic ecomes in-~ 
curable mutt be vari the re aie it would 
appear, from — ee aed b r. Saunders, cat the 
nervous deafnefs may be relieved by the antiphlogiftic regi- 
men, purgatives, and biiftering. On the Anat. and Difeafes 
of the Ear, p. 49, et/eg. 
Another ree of the internal ek producing deafnefs, 
is a puriform difcharge from the tympanum, of an ichorovs 
nature, fometimes tinged with blood, and imparting a yellow 
colour to a fiver inffrument. This difeafe is attended with 
a lofs of hearing proport: a to the injury which the ma- 
eae of the tympanum has fuftained; and hence the 
fenfe is ia ee impaired, from the flighteft degree up to 
total deafne 
In eet when the patient blows ftrongly, with the 
nofe and mouth clofe, air will be expelled at the meatus ex- 
ternus. Whenever this circumftance is obferved, it is clear 
that the difcharge proceeds from, or is conneGed with, an 
injury or deftruction of the membrane of the tympanum 3 
but the reverfe by no means proves that the m 
pani is found, and the difcharge therefore confined to the 
external paflage. For it often occurs, that the fame inflam- 
mation, which terminates in a {uppuration of the tympanum, 
remains 
a into the tympanum, the bony faperBces of which is fill 
more diftinguifhable. He, therefore, who will inftitute a pro- 
er examination, cannot fail of arriving at a certain know- 
ledge of this difeafe, and will not confound it with the her- 
petic ulcerous ftate of the meatus externus, before men- 
tioned. In the latter fuccefs is certain, and as foon as the 
ulceration is cured, hearing is perfeétly reftored ; but in the 
former, however perfectly the difcharge may be {uppreiled, 
the event is very dubious. 
This ftate of the tympanum is produced ate various caufes. 
In the fcarlatina maligna, inflammation of t num 
attacks the patient, and advances to gangre Ute 
vives the fever, the machinery of the ear oan floughs fo 
extenfively, that the membrana tympani and the whole chain 
of bones are evacuated, and the patient is perfeQly deaf. 
Moft commonly this dileate fucceeds the ear-ache, which is, 
in fact, an acute inflammation of the tympanum, If the in- 
fiammation fhould not fubfide fpontancoufly, or be affluaged 
by art, the tympanum and mattoid cells form a large quan 
tity 
+ 
