BY CARROLL DUNHAM, M. D., NEWBURGH, N. Y.

G. W. W., aged 17 years, small, but well proportioned and of good constitution, healthy since his 9th year, has been deaf since he was 4 years old. When 3 years of age, he had an eruptive disease of the whole scalp, which, after resisting for a year all the milder methods of allopathic treatment was finally caused to disappear, in the following manner: — A tar-cap was placed upon the head, and, when firmly adherent to the scabs, was violently torn off. The scabs came with it, leaving the whole scalp raw. This raw surface was moistened with a saturated solution of nitrate of silver. The eruption did not reappear; but from that time, the child was deaf.

“The condition of the youth now excites the earnest solicitude of his friends, if is inability to move in society, or to get a situation in business, on account of his deafness, has produced a morbid state of mind. He broods over his infirmity, and secludes himself even from his own family.”

Under these circumstances, he applied to me to be cured of his deafness. His present condition is as follows: — He is quite unable to hear ordinary conversation, and has never heard a sermon in his life. A loud-ticking lever watch can be heard at a distance of 3 1-2 inches from either ear. On application of the watch to his forehead, or to the teeth, he hears it distinctly. Occasional buzzing noises in front of the ears. A physical examination of his ears reveals the following condition: — The external meatus is abundantly supplied with soft, normal wax. The membrana tympani is white, opaque, and evidently thickened. When the patient attempts to inflate the middle ear, (which he accomplishes, with great difficulty, by closing both mouth and nose and making a forcible expiration,) the membrana tympani becomes but very slightly convex, and it is impossible to distinguish its distended blood vessels. There has evidently been a deposit in the substance of the membrane. On examination of the throat, it appears that the orifice of the eustachian tube is free.

Feb. 3, 1857. Patient received a powder containing 3 globules of Mezereum 30, to be taken on retiring.

Feb. 24. Thinks he hears better — “every sound seems much louder than before.” Hears my watch at a distance of 4 1-2 inches from the right ear, and 4 1-4 from the left ear. Sac. lactis.

March 1. Has not improved during the last week. Mez. 30, 3 gl.

March 27. Hears my watch, with the right ear, 6 1-2 inches, and with the left ear, 7 inches. Sac. lactis.

April 20. Hears my watch, with the right ear, at a distance of 10 inches, and with the left, at a distance of 14 inches. Hears ordinary conversation easily, with attention. Sac. lactis.

Sept. 28. Has been steadily improving until three weeks ago, when he became more deaf again, without apparent cause. Mez. 30, 3 gl., on retiring.

Jan. 26, 1858. Hears my watch at a distance of 14 inches from the right ear, and 24 inches from the left ear. Deafness returns when he takes cold, but disappears with the cold. Mez. 30, 3 gl., on retiring.

March 19. To his surprise, on going to church, although seated at the extreme end of a very large building, he distinctly heard the whole sermon — for the first time in his life. On physical examination, the opacity of the membrana tympani is found to have disappeared, and its elasticity to have sensibly increased.

May 24. Patient writes me that he has obtained, without difficulty, a situation in a store, and that he is no longer conscious of being deaf. His sole difficulty is that, as he has the reputation of being deaf, everybody shouts at him. His father writes, that the son's hearing is “perfectly restored.”

Remarks. — The success of the treatment resorted to in this case, warrants a few remarks upon its rationale. Here was a case which presented to the practitioner apparently nothing on which to base a prescription. There was a thickened membrana tympani — nothing more. The work of thickening had probably been accomplished years ago. Here was a pathologico-anatomical condition, but no pathological process and, consequently, there were no abnormally performed functions — or, in other words, no symptoms of disease — from which to draw indications for treatment. The pathologico anatomical condition threw no certain light on the pathological process which had produced it — just as a knowledge of the town, at which a traveler has arrived, gives no certain clue to the road by which he reached it.

But, as Hahnemann advised his disciples, the history of a case is often of the utmost importance in determining the treatment. In the case before us, the coincidence between the violent removal of the tinea capitis, by nitrate of silver and the appearance of the deafness, was too marked to escape notice. It could not fail to occur to the practitioner that the scalp disease was one phase of a psoric affection, as Hahnemann would have called it — or of a dyscrasia, as the modern school of German pathologists would say (for the doctrine of the dyscrasias is but a re-hash of Hahnemann's psora theory,) and that this affection, disturbed in its localization upon the scalp, had transferred itself to the tissues of the ear. It further occurred to me that, since in this latter localization there were no sufficient indications for a prescription, I might find such indications in the phenomena of the former localization upon the scalp. I accordingly addressed myself to the task of getting a complete picture of this affection, which had disappeared thirteen years before. By good fortune, the mother of the patient was possessed of a good memory, and of very excellent powers of description, and from her I learned that “thick, whitish scabs, hard and almost horny, covered the whole scalp. There were fissures in the scales, through which, on pressure, there exuded a thick, yellowish pus, often very offensive. There was great itching, and a disposition to tear off the scabs with the finger nails — especially troublesome at night.”

The remedy which corresponds most closely, in its pathogenesis, with the above group of symptoms, is undoubtedly Mezereum. In the introduction to the proving of that drug, in the Chronic Diseases, Vol. IV, Hahnemann recommends it for moist eruptions of the scalp. In the proving, in the Archiv., Vol. IV, many symptoms point to a similar eruption — itching, especially, at night; but the conclusive group of pathogenetic symptoms, is the following, from a new proving of Mezereum, by the late Dr. Wahle, of Rome, of which the manuscript was shown me by his son, the present Dr. Wahle:

“Head covered over with a thick leather-like crust, under which thick white pus collects here and there and the hair is glued together; on the head, great elevated irregular white scabs under which pus collects in quantity and becomes offensive and breeds vermin. The child keeps scratching its face and head at night, and continually tears off the scabs.”

The resemblance between these groups of symptoms was so striking that Mezereum was at once selected, as the remedy for this case of deafness, just as if the scalp affection had been still in its original form, and had been the immediate object of the prescription. —

It not unfrequently occurs that we are called upon to prescribe for what seem rather results, of morbid actions, than active diseases — In such cases, it would seem that we may often successfully base a prescription upon the symptoms of a diseased condition which no longer exists but which form in reality a part of the case. It may not be amiss to call attention to the completeness of the corroboration which this case affords/were any needed,) of Hahnemann's psora theory. It is hardly necessary to say that Hahnemann had no idea of restricting the appellation psora to itch, as we understand that term, that is to the disease caused by the acarus. On the contrary in his Chronic Diseases Vol. IV, he expressly includes under it various forms; as “Itch, Tinea Capitis, Herpes, &c.”

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