On the True Value of those Aids to Hearing Usually Termed Artificial Tympanic Membranes
Authors: W. L. Purves
Journal: BMJ (1888)

interesting as a factor in the production of the otitis, for no other cause could be set down in the history of the case.This contribution may be justified by the rarity of such cases in otological literature.The latest specimen, anid one of the most interesting and important, consisting as it does of a sequestrum of the whole 'labyrinth, has been described by the President of this Section in the pages of the Gla.gow vMedical Journal for April Ot lass-year.Tw"o years before (JOURNAL, June 13th, 1885) that ocontribution was made we were indebted to Air.I'ye, of London, for ela.borate notes of a case of the same kind.Mr. Phillips, of the Bolton Infirmary, had also a siniilar case about the same date.'hlese form the most recent memoirs on the subject in the annals of otology in England.But members will have observed with great interest the most elaborate paper on necrosis of the labyrinth by Bezold, of Munich, that appeared in the Archives of Otology for December of last year, in the course of which a comparatively complete list is given of all the reported cases accessible to ihim, including five of his own.These amount to forty-six, of which he gives a very critical analysis.In addition to these forty-six there are about eight others of which he had not heard or had not obtained particulars while preparing his paper.One of these was reported by Hartmann, of Berlin, in the previous number of the Archives, the sequestrum described by ,lim consisting of a portion of the cochlea, including about the two upper turns.Seeing that the records of aural surgery in this country and the Continent only contain notes of over fifty cases of the separation of sequestra of the labyrinth in whole or in part, perhaps the members of this Section will not grudge me the few minutes I have occupied in reading my notes of a recent additional case.Notes regarding an unusually larye Auricular Appendage.-M1.Q., aged 29, weaver, came to the Glasgow Ear Institution, last ;!eptember, for the purpose of inquiring whether a very unsightly appendage, projecting in front of her riglht ear, could be removed wxithout danger.Apparently, matrimonial prospects had sug- gested the iliquiry withi a view to improving her appearance.In the position of the tragus, there were found a very minute nodule aiid the appendage now shown, in front of it-and on a 3lightly higlher planie.The large projection was directed forwards and upwards.Its base measured half an inch, and its length from base to apex was over an inch.The crest of the helix approxi- mated very closely to its upper border, and it extended down- wards to the incisura intertragica.A small nodule could be felt lust below the crista helicis.Another was present at the lower border of the base of the large appendage.The hearing was perfect.Under chloroform, the wlhole of the large projecting structure was removed from its very base by one snip of large scissors.The stump of cartilage wlhich appeared slightly above the level of the skin was pared away as deeply as possible, and the edges of the vound brought together by a wire suture.It was dressed with dry boric lint, and healed perfectly by first intention.Small nodules, projecting from various l)arts of the auricle, areCommon enough, and Virchow has described such auricular ap- pendages; but I had never seen one so large as the one shown.r'l'hat is my reason for bringing it before the notice of the Section.Such specimens as these form examples of the collection of curiosities which every man makes who has the opportunity of o(xamining a very large number of cases in one special depart- ment of disease, and no doubt members have many remarkable -s)ecimenls in their possession.Practising as the most of us are in large towns, Nwe have not the opportunity of exhibiting them except at meetings of societies of general practitioners, where their importance is not sufficiently appreciated.It is exceedingly rare that we can have such an opportunity as the present occasion.It seems to me, therefore, that the President's suggestion of a com- bination of otologists is most worthy of practical adoption.There might be a Society in Scotland, consisting of the aurists in Edin- burgh and Glasgow, which could meet a number of times a year in either of those cities.Similar associations might be formed in England and Ireland.Such meetings would do very much to facilitate the inter-communication of experience and information on the part of individuals, which could not fail to benefit the whole of those surgeons working in this department of disease.THE Camberwell Guardians have increased the salary of Dr. Samuel Hague, medical officer for the St.