444 Mr. Cooper’s Observations on the 
Case 4. Mr. Brandon, of Upper Clapton, sent a person to 
me in January last, who had received a blow upon his head, 
which had occasioned symptoms of concussion of the brain, 
and was attended with a discharge of blood from each ear. 
From the effects which the blow had occasioned on the brain, 
he speedily recovered ; but the deafness, which had immediately 
followed from the accident, continued. I cleared the meatus 
from the blood it contained, without any relief being derived to 
the patient ; and, suspecting that a quantity of blood was lodged 
in the tympanum, and the vibration of the membrane thus pre- 
vented, I some days after punctured the membrana tympani. 
Upon withdrawing the instrument, some dark-coloured blood 
appeared on its point ; and, whenever I examined his ear after- 
wards, there was the same appearance of blood mixed with the 
wax of the ear, which continued to discharge for about ten days 
after the operation, during which period the hearing was gra- 
dually restored. I have formerly known instances of permanent 
deafness from this cause; and I think it not improbable that the 
blood thus effused has become organised, and continued to fill 
the cavity of the tympanum. 
The operation to remedy the species of deafness here described, 
consists in passing into the ear a canula, of the size of a com- 
mon probe, in which a trocar is concealed ; the canula is to rest 
upon the membrana tympani, and the trocar is then to be thrust 
through the membrane. 
The trocar should be so adjusted as not to pass more than 
i of an inch beyond the canula, to prevent its reaching the op- 
posite side of the cavity of the tympanum. Should it however 
touch the periosteum of the tympanum, it can be productive of 
no serious harm. The aperture should be made in the anterior 
