Cleveland morning leader. [volume] (Cleveland [Ohio]) 1854-1865, 1859-09-02
MORNING LEADER.
rRtnAY MonNINn. sNpr. 2, 1s5O
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struction Of tho Membrane Tympani being tho
consequence Of so many maadcs to which the
Ear is subjected, that was led to attempt the
struction Of an artificial membrane tympani, which
It was hoped might serve as a substitute for tho
natural membrane 80 far, at least, as its function
Of closing the tympanum and Of rendering its
walls resonant was concerned.
my hopos Of success were strengthened by the
result Of some observations had mado upon
sts of poffOrnto membrane tympani Whom these
cases are not complicated with any other serious
lesion of tho organ, il must have bocn remarked,
by others as well as myself, that the patient, from
some iuexphcablo cause, nt times suddonly hears
perfectly well, or nearly 80. This improved hear
ing sometimes remains few minutes ouiy, at
otheis for ono or more honrs. Having found this
Improvement to follow tho useof syringe and
tepid water or even Of tho pocket handkerchief
1 examined tho ear in certain PATIENTS after thee
operations had been effected, aud f und In the
former case that bubo of water, and in the lat
ter of discharge filed up the ori6ee Ia the mcm-
brana tympani. Upon destroying the bubble, the
improvement in henrng at once disappeared. In
one patient l was able to keep up tho improved
hearing, but the use, from time to time, Of sOlu-
ton of gum acuoia 10 water. Upon reconsidering
these facts, since completed the observations up
ON the closed state Of the iympanio cavity, have
arrived at the conclusion that the bubble OF water,
discharge or mucloge, acted beno6cially, by again
oonlining sonorous undulatiOns to the tympanum,
and this conclusion has been strengthed by subse-
quent obsoryatiOns)
After some experiments L tried vulcanizod india
rubber and gutta percha making use OF the thin
nest layers OF them that were procurable. with
both these substances | succeeded in making
rudO kind of Artificial membrane tympani, by cut
ting portion about the size oi the natural mem
brane, and passing through it piece of thread, by
means of which ant tiue tube it could bo passed
down to its proper situation. The tube was then
withdrawn and the thread .alono left in the extor-
nal meatus, by which the artificial membrane
could be Withdrawn at the pleasure of the patient
or the operator. The disadvantages attaching to
this apparatus were, difficulty of applying it ON the
part of tho patient; liability Of the material to bo
torn by the thread and uns ghtlinoss Of the latter
hanging down from the m0atus. Tho experiment
however, was sufficiently satisfactory to induce me
to request Messrs. Weiss TO construct one the cen
tro OF which should consist of two very fac plates
of silver, having II diameter of about three quar-
ters of line, between which the layer of yalcn>
nzed india rubber or gutta percha might DO placed
and to the outer surface of ono of these plates a
silver wire was to be attached. The artificial nom
brana tympani made by Mossrs. W eiss, from these
directions has hitherto been perfectly successful.
As supplied by them, the portion OF yulohnlzed IN
dia rubber or gutts perCha is about three quarters
margin for the surgeon TO cut out membrane Of
any shape that may seem to him desirable, and to
leave the silver plato, either in tho contre or to
wards the circumference, at his discretion. (lnow
invariably use vueanized india rubber, not much
thicker than ordinary brown paper) The silver
wire Ia Of sufficient length to admit Of tho mem-
brane being introduced or withdrawn by tho patien',
but is not perceived externally except upon es-
pecial observation, second kind Of artificial
membrane is nude by fixing the layer Of gutta
poreha or ovuleani2cd india rubber between two
very delicate silver rings from tho eighth to tho
sixth of inch in diameter; these rings are rivet
ted together, leaving a portion Of the membrane
drawn moderately tonHe in their centre margin
of the membran is also left beyond tho circum.
ferance Of tho rings to prevent the latter bo-
ing in contact with and irritating ths tube Of lho
ear To the surface Of one of these rings the sill
YER wire is fixed by two branches, and they should
be ioned go that the outer surface of the rings
should look obliquey Cutwards and forwards in
stead of directly outwards, thus Initiating tho di-
roclion of the natural membrane tympani. This
kind Of membrane is often preferable to that pIevi-
ousy described ii the mentus is sufficiently large
to admit of It's passage A pair of f0tceps is made
whereby the artificial membrane can DO moro
easily introduced aud Withdrawn.
Before proceeding to speak Of the mode In which
tho artificial membrane tympani shond bo applied,
il is necessary to premise few words ON the dis
]
tion of the natural membrane, and upon tho cons
dition Of the structures which romain. The most
freauent of these diseases is catarrahl inlamma-
tion of the mucus membrane lining tympnnio cav-
ity' This disease generally follows an attack ol
scarlet fever searlatina measles, or any ordinary
cold aud it usually occurs ia children having a
| tendency to enlargement Of the glands. The tym-
I panic mucus membrane become thickcned, and
secretes 70 large quantity Of mucus OF 80 viaoid
a character, that il cannot escape through the
Eustnchian tube; consequently, It gradualiy dis
tends tho tympnnic cavity and presses upon the
| inner surface of the membrane tympani, portion
of which, generally posteriOr to tho malleus, be-
| gins to ulcerate, and an npernluro il az length
| produced, through which the mucus exudes into
! The external mcatus. This orlcC Ia in some eases
not larger than Il small Plus head, in others it ia
| line In diameter while in many cases tho entire
membrane is destroyed, with tho exception Of q
| margin Mt the cireunitrenee about hall line IN
diameter, which being composed of tho combined
nbres Of tho thickest portion Of the circular and
radate aminm, generally remains. This margin
is deepest at the upper part. In some rare cases
| tho long process Of the mallous continues entire
utter the complete destruction Of tho membrane Ia
which il was attached but, ns general rule, the
whole Of this process is gradually absorbed, leay-
ing merely the head Of the bone which Hrtlculatot
with the ncus, the neck, and the GOdy which re-
ceiyes tho attachment Of tho ensOr tymponl liga'
ment inlernallyj anteriorly and posteriorly the
abres Of tho remnant Of the membrane are attach
| cd, aud externally the prOeessus breyis remains
| Ii will therefore be understood that Ia cnf0s OF
so called destruction Of the membfana tympani, o
margin IL generally left, to which the body Of the
malltus remains fixed, and 20 the innor part OF
which tho teIsor tympani iigament and muscle eof
attached, aiTurdmg the moans by which the small
homes and musclos Of tho tympanum are still ena-
Rbled 10 perform their hneli ms, la cases Of gem
| eral tlceratiOa Of the mucous membrane Of The
tympanum, which fortunately seldom Occurs, III,
incus is generally discharged, and sometimes the
malous also but even in these cases, il tho at
taohmont Of tho stapos to tho circumference OF the
feBestra OYas remain uninjurcd, the power o
hearing may be much improved should tho stape
however be removed total and ireunediablo deaf
ness ensues.
The other disease through which nm OriGce il
the membrane Is mpnni Is usually effected, is Hice
ration Of the fbFOuS iGnlnGe. Tho diseHse itself il
commonly the result Of Inflammation Of tho der
mold layer which spreads first TO tho radiato e.
brous aud thence the circular lamma. Tho lnni
nae, being weakened by the uooratiye process
fall inWards AS far ns tho pfOmontOry 10 whlol
they often ultimately adhere and, when an orfe,
has been thus produced, it, margins are not un-
frequently drawn into the shape of q funnel whose
inner part adhere 10 the tympanie wallis In ul-
ceraton Of the mombTaDa tympaui, proceeding
from the dermod layer, the entire organ is verJ
rarely destroyed, but an ori6co merely is pro-
dueed.
The cases in which the artificial membrnnr
tympani Is Of Tho greatest benefit are those wher,
there Is we'll defined aperture ia the natura
membrane or, il it bo entirely absent, whcro lhor
il simple hypertrophy Of the mucous membrane o
1.-The tympanum, with OF without discharge from III
surface. Ia these eases, IL will be found that th
organ has by no means entirely lost It's power o
discerning soundsl ns general rule, the humai
voice Is heard when tho month Of the speaker j
situated within about foot Of the patients car
and wht n tho words arc spoken slowly aud dis