IT'S MY EARS, DOC!

THE DOCTOR'S BAG

the blog about the medicine and surgery of yesteryear

Dr Keith Souter  aka Clay More

Beyond seeing an oldster nursing a drink with a hearing trumpet held to his ear, usually only for comedic effect, you don't come across ear problems very often in western novels or film. Yet ear problems would have been all too common, as indeed they are today.

Infections
Infections would have been common. Nowadays a family doctor will see three or four cases in virtually every clinic session. We divide them up into inner, middle and outer infections.

Inner ear infections affect the inner ear, which anatomically is where the labyrinth, the structure that contains the cochlea, the organ of hearing and the semi-circular canals, the organs of balance. These  infections are often viral in origin and make the person very dizzy, sometimes so badly that they cannot stand up. Some hearing loss can also occur. Nowadays we have drugs that can help, but in the Old West it was a waiting game, or some bland drug containing small amounts of quinine may have been given.

Middle ear infections affect the chamber containing the ossicles, the three tiny bones which transmit sound from the ear drum to the organ of hearing. They are usually secondary to a common cold or other upper respiratory infection. The middle ear chamber becomes inflamed and the Eustachian tube,  which links the chamber and the throat, collapses or gets filled with mucus. The main symptom that they produce is pain. The doctor diagnoses it upon inserting an ear speculum and seeing an inflamed ear drum. These infections are exceeding common in childhood. The majority of case are viral, but some are bacterial, for which an antibiotic could be given nowadays (although, because of the threat of antibiotic resistance, the tendency nowadays is to treat symptomatically).

Antique otoscope. The speculum on the left is inserted into the ear and the doctor looks into the eyepiece on the right. There is a small mirror inside, angled to reflect light  shone into the horn.

A modern medical bag (well, the author's!) with a modern otoscope in the centre.

In the 19th century the treatment  for earache usually consisted of applying an external poultice, Linseed-meal was advocated, sprinkled with 20 to 30 drops of laudanum. If this failed to relieve, then a paste of belladonna and glycerine could be rubbed over the area around the ear. Or a few drops of chloroform on a handkerchief held against tear (not near the nose and mouth!) would be an alternative.

An outer ear infection usually takes the form of an infection of the skin of the ear canal. These can be fungal or bacterial and today would be treated with ear drops or various topical creams. In the old days a common testament was to use glycerine of tannin and instil that in the ear and plug with cotton wool.This would be replaced every day until settled.

Ear wax
This was the commonest cause of deafness and all doctors would be used to testing with an ear syringe.  The presence of wax would be confirmed by using a speculum, as above. If it was hard, then some olive oil would be used fora few days to soften it, before syringing with lukewarm water.

Ear syringe

A small bowl is held under the ear and a towel wrapped around the neck, barber fashion, to prevent water running down under the clothes. The technique is to draw the ear upwards and slightly backwards, so as to straighten the ear canal. Then the nozzle off the syringe is gently inserted and a jet of water directed at the roof of the canal, to get past the wax and push it to with the water.

Hopi ear candles 
Nowadays many natural therapists offer to clear the ears of wax and treat tinnitus, congestion, balance problems and to improve general well-being, by using Hopi ear candles. These are purported to have been used by the Hopi for centuries.

Hopi ear candles

It involves using a cylinder or cone of waxed cloth, often impregnated with honey, beeswax and  various essential oils. The cylinder  s inserted into the ear with the patient lying on there side. The end of the candle is lit and allowed to burn down to 2-4 inches away from the ear. The theory is that a vacuum is created which draws the wax and toxins out of the ear.

Researchers have found no evidence of the use of these by the Hopi. Experiments fail to demonstrate the vacuum effect and a survey of 122 otolaryngologists (ENT specialists) identified 21 ear injuries resulting from ear candle use.

In short, do not use these in your stories, because it seems their pedigree is pure fiction!

Ear trumpets
Several types of ear trumpet were available, as shown in this diagram from The Family Physician on 1884. The top is a speaking-tube, advocated for conversation. It could be directed at the speaker. The second and third ones were metallic, of the type alluded to in the opening to this article.

Ear trumpets

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 If you have enjoyed, or found some of these medical blogs interesting or helpful, you may like to know that THE DOCTOR'S BAG - MEDICINE AND SURGERY OF YESTERYEAR has been published by Sundown Press, available on ebook or paperback.

THE DOCTOR'S BAG

Also recently published, this medieval novella  of the Order of the Black Rose in ebook

THE APOTHECARY'S QUEST

Or writing as Keith Moray, there is a  short story about Sherlock Holmes and Professor Moriarty in this anthology

MAMMOTH BOOK OF THE ADVENTURES OF PROFESSOR MORIARTY

and a short story about the identity of Jack the Ripper in this anthology

MAMMOTH BOOK OF JACK THE RIPPER STORIES