Prof. Leon Le Fort has recently presented to the Academy of Medicine, in the name of Dr. Rattel, a new otoscope, which we illustrate herewith.
The first person to whom the idea occurred to illuminate the ear was Fabricius d'Acquapendentus (1600). To do this he placed the patient in front of a window in such a way as to cause the luminous rays to enter the external auditory canal. It was he likewise who conceived the idea of placing a light behind a bottle filled with water, and of projecting its concentrated rays into the ear.
In 1585 Fabricius de Hilden invented the speculum auris. This instrument was employed by him for the first time under the following circumstances: A girl ten years of age had in playing introduced a small glass ball into her left ear, and four surgeons, called in successively and at different times, had been unable to extract it. Meanwhile the little patient was suffering from an earache that extended over almost the entire head, and that increased at night and especially in cold and damp weather. To these symptoms were added strokes of epilepsy and an atrophy of the left arm. Finally, in November, 1595, De Hilden, being called in, acquainted himself with the cause of the trouble, and decided to remove the foreign body. To do this, he selected, as he tells us, "a well lighted place, caused the solar light to enter the ailing ear, lubricated the sides of the auditory canal with oil of almonds, and introduced his apparatus." Then, passing a scoop with some violence between the side of the auditory canal and the glass ball, he succeeded in extracting the latter.
At the beginning of the 17th century, then, physicians had at their disposal all that was necessary for making an examination of the ear, viz.: (1) a luminous source; (2) a means of concentrating the light; and (3) an instrument which, entering the auditory canal, held its sides apart.
The improvements which succeeded were connected with each of these three points. To solar light, an artificial one has been preferred. D'Acquapendentus' bottle has given way to the convex lens, and to concave, spherical, and parabolic mirrors, etc. De Hilden's speculum has been replaced by cylindrical, conical, bivalve, and other forms of the instrument.
The apparatus that we illustrate herewith offers some arrangements that are all its own as regards the process of concentrating the light. It is lighted, in fact, by a small incandescent lamp of 2 candle-power, placed within the apparatus and supplied by an accumulator. The reflector is represented by a portion of an ellipse so calculated that one of the foci corresponds to the lamp and the other to the extremity of the instrument. A commutator, B, permits of establishing or interrupting the current at will. A rheostat added to the accumulator makes it possible to graduate the light at one's leisure and cause it to pass through all the shades comprised between cherry-red and incandescence. Finally, the orifice through which the observer looks is of such dimensions that it gives passage to all the instruments necessary for treating complaints of the middle and internal ear.
This mode of lighting and reflection may be adapted to a Brunton otoscope, utilized for examining other natural cavities, such as the nose, pharynx, etc. Elliptical reflectors do not appear to have been employed up to the present.