sults in reducing the diffuse inflammation. In treating the ulcerations, if they are shallow, I found that the best results were obtained by touching them daily with solid nitrate of silver fused on to the end of an aluminium probe. Great care must, however, be exercised not to touch any other part of the mucous membrane but that which is ulcerated. The silver forms a thick white coating over the ulcers, and they disappear in a comparatively short time without leaving any trace behind. them.

The deep ulcerations are much more difficult to remove and require more energetic treatment. Nitrate of silver, in my experience, has very little if any effect upon them, and I found that of all other caustics which have been recommended the acid nitrate of mercury and galvano-cautery give the most satisfactory results. In applying either, the thick coating of grayish pus covering the ulcer should first be removed by washing it off with a spray of a solution of bichloride of mercury, gr. j to glycerine and water each two ounces, and if that is not sufficient, as is often the case, by removing it with a soft camel's-hair brush moistened with a saturated solution of bicarbonate of soda. When a clean surface has thus been obtained, the galvano cautery instrument is introduced into the larynx and the raw surface is thoroughly cauterized with the glowing platinum loop. If the acid nitrate of mercury is to be used a brush is moistened with a solution of one part of acid nitrate of mercury in four parts of water. In some cases I have also found a saturated aqueous solution of iodine diluted one-half with glycerine to act very satisfactorily in healing the ulcerations. If loose pieces of necrosed cartilage are found in the cavities made by the ulcerations, they should be at once removed with the laryngeal forceps, so as to avoid the danger of their falling into the trachea. Under such treatment the ulcerations usually heal up within a few weeks and do not leave so dense a cicatricial tissue as when they are left to take their course, nor will the destruction and loss of tissue be as great.

As the purpose of this communication is to throw out a few suggestions in regard to the diagnosis and treatment of syphilitic laryngitis, and give rise to a discussion of this interesting topic, I will not consider the evil consequences of cicatricial contractions nor enter into the microscopical pathology of the morbid processes giving rise to the formation of the inflammation and ulcerations in this disease.

TWITCHING OF THE TENSOR TYMPANI MUSCLE, THE CAUSE OF ANNOYING TINNITUS.

BY JULIAN J. CHISOLM, M.D.,

MARYLAND.

My object at this time is not to read an essay on tinnitus, in its various subjective forms. The text-books on aural surgery are sufficiently explicit on these many buzzings or noises in the ear. I desire to call, more especially, attention to a peculiar variety of tinnitus, which may not have been brought so forcibly to my notice, had it not occurred in my own person. Some time afterwards it was complained of in one of the cars. of my hospital assistant, and since that time I have detected it in patients who have consulted me for a similar annoyance; I refer to an ear noise caused by a rapid rhythmical contraction of the tensor tympani muscle, which, like similar twitchings in the face muscles, may be kept up for minutes, hours, or days, recurring at varied intervals; and although very annoying, from the fluttering occasioned in the ear, does not materially impair the hearing power, even when the buzzing occasioned by the muscular contractions is most noisy.

In the month of July, 1876, I detected one day, immediately after dinner, a queer noise in my right ear, which I had never experienced before. It was not a continuous sound, but consisted of a note, rapidly and rhythmically repeating itself, with perceptible intermissions between every individual sound. Dining late, with my professional day's work finished, I was stretched out on a reclining chair, about twilight in the evening, when my attention was attracted to the peculiar sensation in the ear just referred to. It did not continue more than half an hour, and with its disappearance I thought no more of it. The following evening again, soon after dinner, my companion of the day before resumed its curious buzzing. It was of longer duration, but had disappeared by bedtime, leaving no unpleasant effect behind. On the third day the fluttering noise was resumed after

dinner, and I now commenced to investigate its curious phenomena. I first compared it with the pulse-beat, and found it much more frequent, showing that it was not of vascular origin. My heart beat was 70 to the minute; the ear noise varied from 130 to 160 distinct sounds to the minute, being quicker at some periods than at others. Accompanying it was a peculiar thrill in the ear, seemingly located at the drum head. It appeared to me identical with the twitching that I had experienced in the face, under the eye, in parts of the orbicular muscle. Upon further observation, I felt that I could safely locate the thrill in the frequent, but rhythmical action of the tensor tympani muscle, and could frequently count by the watch the number of its contractions and alternate relaxations. On the third accession of this peculiar tinnitus, it continued for several hours. When bedtime came it was still hard at work. When I woke in the morning, the ear was quiet again, and so continued during the day, to reappear after dinner, as it had done on the three previous evenings. The right ear was the exclusive seat of the noisy muscular twitchings. The left ear continued free from any annoyance.

By the fourth repetition, the novelty had worn off, and the fluttering, with its buzzing noise, had become an annoyance which I would have gladly dispensed with. I commenced, therefore, a series of experiments for its control and final removal. I first commenced with the Valsalvian method of inflation, then with the Politzer air bag, neither of which produced any impression. I then threw chloroform vapor through the Eustachian tube into the drum cavity, and finding no relief from it, applied the electric current, faradic and galvanic, and all failed to quiet the muscle. The noisy contraction of the right tensor tympani continued its active work until I forgot it in sleep. The next morning found it vanished.

As this sound came only after dinner, and at no other period of the twenty-four hours, I naturally concluded that something I took at dinner might be the cause of it. Coffee I used at both meals, breakfast and dinner, but I never had the buzzing after breakfast. I had long been in the habit of using claret at dinner, and yet this sound had only appeared for the previous four evenings. As it was very hot weather, I fancied that the wine may have had something to do with the muscular twitching. On the fifth day I dispensed with the claret, and I had no noise.

I

On the sixth, I resumed the wine, and the noise returned. soon found that in controlling the use of the wine, I could bring on at pleasure the muscular contraction, or escape its annoyance. I abandoned the wine for the hot weather, and have not been. visited by the muscular twitchings since that time.

Having frequently spoken of this queer form of tinnitus to my professional friends, my hospital assistant, himself a specialist in eye and ear diseases, mentioned that he had been annoyed by a tinnitus in one ear, which he now traced to muscular rhythmical action of the tensor tympani, and which he recognized from the description I had previously given him.

Within a month an old gentleman came to me for relief from a buzzing in his left ear, which he said was intermittent. For hours at a time he would have none of it; then it would commence, usually with a slow tick, the speed of recurrence of which would rapidly quicken, until it would become nearly continuous, so momentary would be the interval between each successive contraction. IIe likened the sound in the ear to the noise made by a distant locomotive, starting out on its course. The escape steam would be rhythmically slow at first, but with the increased rapidity of the piston-rod, the interval between the escape of steam would be shortened until the car, in full motion, would make a nearly continuous noise. In the case of this old gentleman, the muscular contractions came on at no special period of the day. Sometimes they would disappear in the night, or being absent at bedtime, would be found present on rising in the morning. In the cases met with, the fluttering sound would come on suddenly, and would stop as suddenly. There was no gradual slowing off, or fading out. Its daily duration was also quite varied, as would be also the frequency of its return. In this last case referred to, tonics of bromide of potassium, in large doses, were the controlling agents. May not this muscular cause of tinnitus euter much more largely into the pathology of ear noises than has been recognized?