A manual of diseases of the ear / by Albert H. Buck.

  • Buck, Albert H. (Albert Henry), 1842-1922.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the ear / by Albert H. Buck. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    patient's own statements, especially if he be a man of intelligence and not given to imagining. The Use of the Tuning Fork. It is only in exceptional cases that we derive valuable informa- tion from the tuning-fork test. Nevertheless, it is a good plan to make its use a matter of routine practice in at least the majority of cases. The ordinary forks employed for the purpose of giving a tone of a certain pitch, are of very little use to the aural surgeon. The sound is so feeble in intensity and dies away so quickly that, even if the patient should be able to hear it, the duration of the sound is so very brief that he can scarcely reach a correct conclu- sion in regard to the auditory sensations which it may have produced before the vibra- tions will have ceased altogether. The surgical instrument-makers now sell a heavy prismatic fork, of low pitch and provided with movable clamps attached to each arm, which will be found admirably adapted to medical purposes (Fig. 1). By striking one of the arms of the instrument lightly upon the knee, one can call forth sonorous vibrations which continue audible for a period of several seconds—long- enough to enable the surgeon to place the han- dle of the fork on the patient's forehead, just above the bridge of the nose, and to permit the patient to observe calmly in which ear the sound preponderates. If the preponderance of sound is in the affected ear we may exclude at once any serious disease of the labyrinthine structures or of the auditory nerve at some other point in its course; or, in other words, we may safely assume that the disease is located either in the middle ear or Eustachian tube, or in the external auditory canal. On the other hand, it is not always safe to draw the conclusion that the nervous structures of the affected Fl Tu^ni^Foi-kr'Sh ear are at fault when the Patient refers the Movable ciamps. preponderance of sound to the unaffected ear. (Halt natural size.) The ^^ ^ ^.^ he gupposes to be un_ affected, may happen to be plugged with inspissated cerumen ; in which case it will not be surprising if the phenomena