SECT. XXIV.—ON SUBSTANCES THAT HAVE FALLEN INTO THE MEATUS AUDITORIUS.
Not only do stones fall into the meatus, but also glass, beans, and the stones of carob nuts. Of these the stones and glass retain their original magnitude, but the beans and stones of carobs being swelled with the natural moisture of the body, occasion very severe pains. They must therefore be extracted by an earpick, a hook, or tweezers, or by using powerful shaking of the head, while the ear is placed upon some circular board. In like manner we extract bodies frequently by sucking them through a reed; and do the like with water when it falls into the ear, covering up the outside of the reed with wax when it is applied to the ear in order that there may be no outlet to the breath. Stones and such like bodies we extract by wrapping wool around an earpick, and smearing it with turpentine-rosin, or some glutinous substance and introducing it gently into the meatus auditorius. If it does not yield we introduce a sternutatory into the nose and close the mouth and nostrils. If it yield to none of these, before inflammation, convulsions, and dangerous symptoms supervene, we must bring it away by a surgical operation. Wherefore, having placed the patient in a proper position with his ear turned upwards, at the base of the ear, behind what is called the lobe, we make a small lunated incision, and with the circular part of an earpick we extract the body which is lodged there. After the extraction the wound is to be sewed up, and the cure completed by the treatment applicable in cases of recent wounds.
Commentary. See Celsus (vi, 7); Aëtius (vi, 87); Alexander Trallianus (iii, 6); Oribasius (Loc. Affect. iv, 36, 39); Galen (de Med. sec. loc. iii); Avicenna (iii, 5, 1, 23); Mesue (ii, 7, 8); Serapion (ii, 12); Rhases (ad Mansor. ix, 36; Contin. iii); Haly Abbas (Pract. ix, 31.)
Celsus gives nearly the same directions as our author, recommending us to use wool wrapped round a specillum, and smeared with turpentine-rosin, or a hook slightly bent, or an ear-syringe, or sternutatories, or shaking the patient’s head. The last-mentioned operation he directs us to execute in the following manner: “Tabula quoque collocatur, media adhærens, capitibus utrinque pendentibus, superque eam homo deligatur in id latus versus, cujus auris eo modo laborat, sic, ut extra tabulam non emineat: tum malleo caput tabulæ, quod a pedibus est, feritur: atque ita concussa aure, id quod inest excidet.”
The treatment recommended by Aëtius is exactly the same as our author’s. Alexander and Oribasius also deliver similar directions. However, Aëtius, Oribasius, Alexander, and our author, copy from Galen, who in his turn acknowledges his obligations to Archigenes and Appollonius. (De Comp. Med. sec. loc. iii.)
Albucasis’s directions are so judicious that we regret our limits do not allow of our giving them fully. For the extraction of a piece of stone he recommends us among other means to use a slender forceps, of which he gives a drawing. It resembles the modern dissecting forceps. He also gives a drawing of a hook slightly bent, which he commends; and also of a brazen tube to be used for sucking out bodies. When other means do not succeed, he directs us to make an incision at the under part of the ear, having previously let blood in order to avert inflammation and convulsions. Animals are to be sucked out with a tube narrow below and wider externally, or they are to be extracted with a forceps or hook. When these means do not succeed, an oil, to which some substance destructive of these animals has been added, is to be injected with an instrument, of which he gives a drawing.
The reader may likewise consult Mesue with advantage. Serapion also recommends the same remedies as the Greeks. Avicenna supplies no new views. Haly recommends incision when other means have failed.
Rhases directs us to pour tepid oil into the ear, and to put the patient into a warm bath in order to lubricate and produce relaxation. His translator, however, remarks that if the substance lodged in the ear be a bean or a pea there may be danger of the water occasioning a swelling of it.