44° .Mr, Cooper’s Observations on the 
As this fever occurs particularly in young persons, who are 
but little subject to a defective state of the nerves of the ear, the 
greater hope of relief may be entertained from the operation 
already mentioned. 
Thirdly, A venereal ulcer in the fauces, by the cicatrix it pro- 
duces, often occasions a closure of the Eustachian tube, causing 
a deafness which nothing but the operation here spoken of can 
relieve. 
Fourthly, I have known this closure of the tube produced by 
an extravasation of blood in the cavity of the tympanum. 
Lastly, I have seen one instance of a stricture in the tube, 
which, although it did not entirely obstruct the passage of the 
air, yet rendered it extremely difficult. To enable himself to 
hear, the gentleman who was the subject of this disease, was 
under the necessity of forcing air, from the mouth, into the 
cavity of the tympanum, which pushed the membrana tympani 
towards the meatus ; then, pressing gently upon the ear, he 
forced out a part of the air which the tympanum contained ; 
thus giving the membrane liberty to vibrate, and producing an 
immediate increase in the power of hearing. 
The above mentioned are the most common causes of the 
closure of the Eustachian tube ; and I have reason to think, from 
the experience I have already had, that they may all be remedied 
by puncturing the membrana tympani. 
I was led to this operation by reflecting that, as an aperture 
in this membrane did not appear to injure the power of the ear, 
and a small opening would be sufficient to admit a free passage 
of air to and from the tympanum, perhaps a substitute might be 
thus easily found for the Eustachian tube, and the membrane, 
by such an aperture, be restored to its natural functions. Oppor- 
