fatal to the patient! It was these considerations which made us cautious in the use of the forceps in the first instance, and ready to abandon it afterwards, in favour of a safer method of proceeding.

The foregoing observations are of course intended to apply only to cases like the present, in which the foreign body is lodged in the bronchus or in one of its subdivisions. When it is impacted in the trachea itself, there can be no doubt that it ought to be removed by the forceps, and that this may be safely and easily accomplished. But under all circumstances, we have a right to conclude, that an artificial opening in the trachea must contribute to the security of the patient, and that the establishment of it at an early period, is the first and most important duty of the surgeon.

SECOND SERIES

OF

OBSERVATIONS

ON THE

PATHOLOGY OF THE EAR.

BASED ON ONE HUNDRED AND TWENTY DISSECTIONS OF

THAT ORGAN.

BY JOSEPH TOYNBEE, F.R.S.,

SURGEON TO THE ST. GEORGE'S AND ST. JAMES'S DISPENSARY.

READ JUNE 27TH, 1843.

ALTHOUGH the organ of hearing consists of several distinct parts, and exhibits much structural variety, but few successful attempts have hitherto been made to trace the local causes of deafness.

In a former paper, published in the Transactions of this Society,* I gave descriptions of several dissections of the human ear, as evidence of the fact, that the lining membrane of the tympanic cavity is frequently in a diseased condition. Subsequent dissections, and a careful investigation of numerous cases of deafness in living subjects, have led me to

* Vol. xxiv. 1841.

the conclusion that the most prevalent cause of deafness is chronic inflammation of the mucous membrane which lines the tympanic cavity; and that by far the greater majority of cases commonly called nervous deafness ought more properly to be attributed to this cause. This opinion derives support from an observation made to me by Mr. Swan, that in the whole course of his multiplied aural dissections he has not encountered one single instance of disease in the internal ear; an observation which embodies the result of repeated examinations to which I have myself subjected that part of the organ.

At the same time that I advance this opinion as an inference fairly deducible from more than a hundred dissections, I am far from denying the necessity of more extended researches previous to its validity being admitted.

In the present communication it will be my endeavour to elucidate the different stages of this disease of the mucous membrane, and to point out the various morbid conditions to which it gives rise. In so doing, reference will be made as well to the cases published in my former paper, as to those which are appended to the present. And, bearing in mind the comparative novelty of the subject, it has appeared to me more desirable to state, briefly but accurately, the particulars rather than the general results of the dissections; that the very interesting facts which they will be found to contain,

may serve as a basis on which to ground future researches.

It is worthy of observation, that though some of the persons from whom the specimens were taken, were known to have been afflicted with deafness during life, and others died of diseases which produced affections of the ear, yet the greater number, while living, were not supposed to be deaf.

This frequent occurrence of pathological conditions in the organs of persons not ordinarily esteemed to be deaf during life, loses some portion of its singularity when more closely investigated. Slight defects of hearing are so common as scarcely to excite even a passing observation, and more serious cases, from the very frequency of the disease,-perhaps the most common to which man is subject,— make but a slight impression. It may therefore be presumed that the ear is often in a pathological condition, though disease may not have proceeded so far as to produce such an extent of functional derangement as would cause serious inconvenience to the person affected, or reveal his infirmity to others.

As this paper is designed to treat principally of the pathological condition of the ear, it is not my intention to enter, at present, upon the causes of the great prevalence of deafness, nor to suggest the means which might be adopted for its prevention and cure. These important points I reserve for subsequent communications, with the simple expres

sion of my conviction, that when we shall arrive at a more accurate appreciation of the causes of deafness, the means of alleviating or eradicating the disease will more readily suggest themselves, and aural surgery, freed from the uncertainties which now beset it, will yield to no branch of professional investigation either in interest or importance.

On Inflammation of the Mucous Membrane lining the Cavity of the Тутрапит.

The tympanic cavity is lined throughout by a fine membrane, forming externally the interior layer of the membrana tympani; from which it can sometimes be detached without much difficulty.* In this situation it also serves as a partial investment to the chorda tympani nerve, and as a tubular sheath to the tendon of the tensor tympani muscle. Internally it covers the surface of the promontory and the membrana propria of the fenestra rotunda ; passes on to the margin of the fenestra ovalis, where it is reflected on the surface of the stapes; and, lastly, surrounds the tendon of the stapedius muscle, and envelopes the ossicula auditus, with their connecting ligaments.

In the healthy state, this membrane is so remarkably thin and transparent, that its presence is not easily detected. It is composed of extremely fine

* In Dissection No. 47, this mucous membrane was found entire after the complete destruction of the membrana tympani.

For a detailed account of this membrane, see Dissections Nos. 1 & 2, Medico-Chirurgical Transactions, vol. xxiv.