ably, in asking your attention for the few moments that will be required for their enumeration and consideration.

From earliest time till recent an importance more or less weighty has been attached to the secretion of the external auditory canal. I think we may say that importance has varied all the way from supremum to nihilosus; all the way from Thomas Buchanan's (the Scotchman) regard to that of the modern school. Mr. Buchanan (who wrote several books in which he calls especial attention to the great significance of the cerumen), in his regard for the significance of the cerumen, might be classed with Janz, in his regard for the significance in the form of auricle physiognomically considered. Janz says, "Show me your ear, and I'll tell you who you are, where you came from, and whither you are going."

As is well known, the external auditory canal has a cutaneous covering continuous with and in all respects like the common integument of the body. It was probably the ignorance of this fact, or an ignoring of it, that led to the undue stress put upon the secretion of this canal. When we once bring ourselves to give a proper regard to the identity of the skin of the auditory canal with that of the general integument, it will require no great stretch of fancy to see that the secretions of the two should commonly be regarded as identical, I say commonly, for just as the fluid that lubricates the eye-ball and eyelid is by no means secreted entirely by the lachrymal gland, but by the mucous membrane and meibomian glands also, so the cerumen is a mixed secretion from the proper cerumenous gland and the other secretory parts of the skin; and the so-called ear-wax is made up of cerumen proper, sebaceous matter, little dead hairs, and scales of epidermis. This special integument, then, and the general, having such an anatomical identity, it would be reasonable to suppose that the secreting powers of the two will have a close relation, and such seems now to be regarded an accepted fact. At the present day little regard is paid to the absence or presence of cerumen, or its greater or less abundance.

It is well known that previous to the discovery of the ophthalmoscope, every thing beyond the iris that caused blindness was put upon the nerve, till the present improved means of effecting an examination and making out a diagnosis. Of necessity the secretion and the nerve must be at the foundation of deafness. So then, so far as any relation of the secretion, absence or superabundance,

goes as a cause of deafness, or so far as it is an index of any inflammatory cause, its value or importance is to be ignored.

In one point of view, however, it is a matter of the highest moment. I mean in a mechanical one. Were any one to find in the external canal a tumor of any description, osseous, fibrous, or mucous, he would undoubtedly regard it a matter worthy of his deepest attention.

I have two cases to present in description to-night, to illustrate how this, so in itself unimportant secretion, may become a matter of deep and even of the most serious import.

Mr. B. presented himself at my office a few days since for a trouble in the ear. For five or six years he had a ringing and thumping noise in one ear, the right; and recently he began to have them in the other, the left. Shortly after the tinnitus began in the left, he experienced attacks of dizziness, and now and then a sharp piercing pain and constant disagreeable heaviness in the head, apparently, as he described it, passing from one ear to the other. and amounting almost to a pain. These symptoms, and the increasing deafness, led him to have a consultation.

An examination showed the hearing on both sides to be impaired, the watch not being heard at all on the right auricle, though quickly on the bones of the head; on the left, four inches from auricle, and on the bones. The tuning fork, on center of cranial ridge, indicated both nerves to be healthy, and also the middle

ears.

After softening the collection in the left ear, it was readily removed by syringing, and inspection showed the membrana tympani to be normal in color and position, and testing by the voice and watch showed the hearing power to be normal. The accumulation in the right ear was removed with difficulty, inasmuch as all touching with forceps and all attempts at syringing produced dizziness and pain, deep in the ear. So it was not till after two or three days, during which the ear had been many times filled with warm water, could a perfect removal be effected. After the meatus was freed, an examination showed the membrana tym. pani to be somewhat thickened, dull, and drawn in, light spots and hazy. And while the watch was heard at three feet, and the voice quite well, still it sounded muffled, affording a marked contrast with the other ear.

The abnormal concavity of the membrana tympana was an indi

cation for the inflation of the drum by means of the catheter. After which the membrane assumed a better position, and the hearing distance increased to five feet.

The inflations were repeated to the fifth sitting, in as many days, at the end of which the membrane had improved very much in its appearance, assuming a more normal color, the light spot becoming more brilliant, and the hearing about normal. Watch, ten feet.

The second case I beg to present is one of vastly greater importance. A lady of sixty-five, presented herself at my office, a week ago, for, as she said, “to have her ear examined." Her story was brief, for she has had her mind "so deeply employed on," to use her own words, "the great truth of the day, which the world is trying to keep back, but which is certain to advance till it dispels with its genial warmth all the chill that greeted it at its early dawn," (the spiritualistic ring of this, will probably be perceived by all), that she paid little regard to the noises in her ear, though she confessed they had been there for a great many years. Of late there was something more than tinnitus-a very disagreeable feeling, not only in her ear but in all that side of her headthat, she said, rendered her quite miserable. On examination, I found she was unable to hear the watch at all, on either side, either against the auricle, or on the bones. In the right, the hearing for the voice was still quite good; so she protested it was perfect, The membrana tympani was opaque and very concave, drawn in against the promontory, indicating a chronic inflammation of the cavity of middle ear and closure of the Eustachian tube. In the left, I found the meatus filled to within a short distance of the entrance, with impacted cerumen. As a preparation for syringing, I began to remove the wax, as far as possible, with a pair of small forceps. Before penetrating far, I felt something hard between the blades of the forceps, and on examining it I found it to be a small piece of bone. The entire removal required a good deal of patience and care, as the ear became very sensitive. During the removal, several small pieces of bone were found, and on examination with a probe, showed there had been absorption of the covering of the bony canal at its beginning, upward and outward, and corresponding necrosis. The patient said she remembered, now and then, on putting her finger in the ear, to have felt hard particles; so she probably had come in contact with similar small pieces of bone.

GENERAL REMARKS-I need not dwell on the importance of these two cases, but perhaps a few general remarks may not be out of place. Of course, such cases present no difficulties in the way of diagnosis; for an examination by means of the speculum would at once, to the most inexperienced eye, show what the difficulty was; and, of course, the only thought could be about the removal. As you have seen in these cases, the removal is no swift matter; were it so, as is usually the case, it would need no special mention. I always think it a very good plan, when the plug seems hard, to remove the surface with the forceps; then begin syringing with warm water, or as hot as the patient can stand, beginning gently and increasing the force of the stream till it can be decidedly felt. It is not wise to continue the sitting too long, especially if the patient becomes dizzy, as is often the case, or complains at all of pain. It is better to stop; advise the use of warm water several times in the ear, during the day, and glycerine during the night, and then continuing the syringing the next day, when probably the collection will come away readily. It is always advisable for one's own reputation, that the hearing power be tested before the attempt at removal begins, and before any prognosis is made; for, of course, if there is any existing middle ear trouble, the hearing may be improved, but not made perfect; or possibly the effect may be nil. I will speak more in full of the methods of treating the hearing power, in the future. Again, I would have you bear in mind that such a condition of the parts, as was presented in the first case reported, viz: the abnormal concavity of the membrana tympani, and consequent impairment of the hearing, and its relief by the inflation, I feel that too little attention has been paid to this point, for though the concavity of the membrane was entirely the result of the pressure from the plug of cerumen, the membrane could not return to its proper position from partial anchylosis of one or more of the joints of the little bones. So the cavity of the drum being narrowed, or entirely obliterated, there must remain a corresponding dullness of hearing. That the plug of cerumen was the cause of the abnormal concavity of the membrane in my first case, was demonstrated by the fact that the Eustachian tube was perfectly open; the sounds were normal, and the position and hearing both almost perfectly returned by the inflation. Again, that a plug of cerumen can cause such a pressure, is shown by the fact that a perforation of the membrane has been so caused, and also an ulceration of

that of the periosteum and necrosis of the bony walls of the external canal, as has been seen in the second case I have presented. Such results as have here been presented, will not seem so strange if we will regard such collections as veritable tumors that slowly but surely increase, and increase in importance with time, and to do the work of a true tumor need only time and non-interference. Both the dizziness and noises, in my first case, could readily be accounted for by the direct pressure upon the nerve, communicated through the little chain of bones to the fluid in the labyrynth.

Editor's Table.

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OPENING OF THE SCHOOLS.-Our exchanges note the beginning of another winter's campaign of medical teaching throughout the country. We are scarcely permitted to hope that as yet there is to be any very marked improvement in the kind of teaching. There is undoubtedly an advance; a larger proportion of medical teachers are enthused with zeal for teaching's sake, and a pride in the continuous elevation of the profession: so we are, in many the schools of the land, having more complete appointments and accessory means of illustration-more reference to permanency in plans of organization and plans of requirement-a better system of utilizing clinical material. Still, we find a great many schools anxious for classes, and willing to grant an indefinite extent of favoritism to secure full benches and large graduating classes. So, too, we have students seeking these favors, rather than earnest in seeking for all the best and completest advantages for their professional training. It is come to be well understood that in certain schools "graduation is easy;" and a very large number of preceptors positively advise their students to elect such schools. The argument with such men is, that fees are moderate; requirements moderate; sure to get through; and one diploma for the mass is quite as good as another!

The Miami Medical College opened its present course on Tuesday evening, October 5, with an introductory by Prof. Sidney A.