PLATE 38.













1. Normal Drumhead (Right) from an Individual with Normal Power of Hearing (B.).













2. Normal Drumhead (Left) Showing the Articulation Between the Incus and Stapes, the Promontory, and the Fenestra Rotunda.-From a boilermaker forty years of age, who was hard of hearing. Whispered conversation not heard on the right side; on the left, heard close to the ear. Rinne positive. Schwabach shortened. Upper tone limit diminished.













3. Normal Drumhead (Right) with the Bulb of the Jugular Vein Shining Through.













4. Two Spheric Exostoses on the Posterior, and One on the Anterior, Bony Wall of the Auditory Meatus.-The right drumhead was normal. From an individual with normal power of hearing.













5. Chronic Serous Catarrh of the Middle Ear.-Retraction of the drumhead with accumulation of serous exudate in the tympanic cavity. The level of the exudate lies in front of the umbo. From a fifteen-year old boy the subject of recurrent attacks of catarrh. Whispered conversation heard at 1 m. Rinne partially negative up to c. Schwabach prolonged.













6. Acute (Serous) Catarrh of the Middle Ear.-Accumulation of serous exudate in the tympanic cavity. Level of exudate below the manubrium.From a man thirty-two years of age the subject of coryza. Whispered conversation heard at 3 m. Rinne partially negative up to c. Weber in the diseased car. Schwabach prolonged. Upper tone limit normal.













7. Chronic Catarrh of the Middle Ear (Catarrhal Adhesions).-Retraction of the drumhead with prominence of short process of the malleus, and foreshortening of manubrium. Marked posterior fold in the drumhead; punctate reflex in the antero-inferior quadrant and in Shrapnell's membrane. From a man twenty-seven years of age the subject of hypertrophic rhinitis. Whispered conversation beard at 1 m. Rinne partially negative up to el. Schwabach prolonged. Upper tone limit normal. Gelle positive.













8. Chronic Catarrh of the Middle Ear: Adhesion of Shrapnell's Membrane.-Marked retraction of the drumhead. The manubrium appears so greatly foreshortened that its extremity lies on a level with the short process of the malleus, which is very prominent. Marked posterior fold in the tympanic membrane. Light reflex distorted. Shrapnell's membrane adherent to the neck of the malleus. From a man thirty-five years of age who bad been hard of hearing for four years, and a sufferer from chronic rhinitis. Whispered conversation heard at 20cm. Weber in leftear. Rinne partially negative up to c'. Schwabach prolonged. Upper tone limit normal. Gelle positive.













9. Chronic Catarrh.of the Middle Ear (Catarrhal Adhesions).-The drumhead is opaque and milky, with a more intense, semilunar intermediate opacity in the posterior half. From a woman fifty-two years of age who had been hard of hearing for eight years. Whispered conversation heard at 30 cm. Weber in right ear. Rinne partially negative up to c'. Schwabach prolonged. Upper tone limit normal. Gelle positive.













10. Chronic Catarrh of the Middle Ear: Calcareous Deposits Drumhead opaque; caleareous deposit in front of manubrium and in posterosuperior quadrant. From a man thirty-two years of age who had be n hard of hearing for eight years. Whispered conversation at 1 m.














11. Chronic Catarrh of the Middle Ear: Calcareous Deposits (Nervous Deafness) -Drumhead opaque; horseshoe-shaped calcareous deposit. From a. woman fifty years of age who had been hard of hearing for ten years. Rinne partially negative up to c. Whispered conversation heard at i m. Weber in head. Duration of sound perception from vertex shortened. Upper tone limit reduced. Gelle positive.














12. Ankylosis of the Stapes (With Partial Nervous Deafness).Normal right drumhead. Behind the manubrium the hyperemic promontory shines through. From a woman thirty years of age who had been hard of hearing for ten years. Whispered conversation heard close to the ear. Rinne absolutely and totally negative up to c2 inclusive; C heard only through the bone. Weber in the right ear. Duration of sound perception from vertex shortened. Upper tone limit reduced. Gelle positive.














13. Acute Myringitis.-Vesicle on the posterior half of the drumhead, which is reddened and presents small hemorrhages in the anteroinferior quadrant. From a man thirty years of age. The affection developed after the entrance of water into the ear. Whispered conversation heard at 6 m.














14. Chronic Granular Myringitis. -Small granules on the upper half of the drumhead, The membrane is opaque. From a man twenty-three years of age.Whispered conversation heard at 6 m.














15. Traumatic Rupture.-The anterosuperior quadrant of the drumhead presents a perforation with hemorrhagic edges; punctate hemorrhages in the immediate vicinity. The tympanic mucous membrane is of a pale-yellow color. The patient, a man twenty-eigbt years of age, bad his ears boxed from behind three days ago. Whispered conversation heard at 1.5 m. for high-pitched, and i m. for low-pitched, words. Rinne partially negative to c'. Weber in the right ear. Schwabach prolonged. Upper tone limit normal.














16. Traumatic Rupture with Labyrinth Disease. -Perforation with hemorrhagic edges in the lower half of the drumhead. After a plug of cerumen had been removed the membrane was found to be hyperemic. The patient, a man thirty years of age, had his ears boxed three days before. Whispered conversation heard up to 1/2 m. The ticking of a watch is heard close to the ear, but not when applied to the mastoid process. Rinne, partially negative up to C. Weber in the sound right ear. Schwabach shortened. Upper tone limit diminished. Gaps in the scale.














17. Simple Acute Otitis Media.-Injection of the radial vessels and of the vessels of the manubrium in an otitis media developing after acute middle-ear catarrh. The patient was a man forty years of age; the attack was brought on by a Russian bath.














18. Simple Acute Otitis Media.-The manubrium is indistinct; the epidermis is macerated; the drumhead is injected and the surface irregular. From a man thirty years of age. The condition, which followed an attack of angina, had lasted three days.














19. Simple Acute Otitis Media. -Ecchymosis on the reddened drumhead; in the anterosuperior quadrant the short process projects as a yellow spot. From a man thirty years of age. The trouble followed a severe attack of sternutation.














20. Acute Suppurative Otitis Media (With Hyperemia of the Labyrinth). -Vesicular bulging of the posterosuperior quadrant of the drumhead. The manubrium is not visible. Ecchymoses are seen on the reddened membrane. From a girl eighteen years of age. The condition developed on the second day of an attack of influenza. Whispered conversation heard at 11 m. Rinne partially negative up to C. Weber in the diseased ear.Schwabach somewhat prolonged. Upper tone limit reduced.














21. Acute Suppurative Otitis Media.-Dusky red bulging of the posterior half of the drumhead. The manubrium is obscured. The condition developed in a boy twelve years of age after an attack of sore throat.














22. Acute Suppurative Otitis Media.-Villous bulging of the posterosuperior quadrant of the drumhead. A droplet of pus exudes at the apex. Manubrium not visible. Developed in a child five years of age after an acute attack of coryza. intense suppuration with great seusitiveness to pressure in the mastoid process. Recovery in eight weeks.














23. Acute Suppurative Otitis Media.-Diffuse reddening of the drumhead. The anubrium is not visible; the antero-inferior quadrant contains an abscess. Developed in a boy eleven years of age after coryza, three days before the appearance of measles.














24. Acute Suppurative Otitis Media.-Drumhead reddened; the only parts of the malleus that are visible are the short process and the upper portion of the manubrium. The antero-inferior lower quadrant contains a perforation the size of a hemp-seed, and shows pulsating pus. The condition developed in a man thirty-two years of age on the twelfth day after influenza.