This instrument is a decided improvement over the instrument first sent out, and is capable of producing a most profound effect upon the drum-head and ossicula; indeed, upon the entire auditory apparatus. I am able to confirm Dr. Garey’s statement of the effect of high and low vibrations us regards treatment.
I have also been very much interested in the use of stringed or reed instruments for diagnosis, and find that we can detect any abnormal sensitiveness of the auditory nerve to high or low tones. Some patients are extremely sensitive to all tones, high or low; others to high tones and not to low tones; others, conversely. Again, in some instances, there is a peculiar sensitiveness to single tones or to discords produced by sounding the note and half-note at the same time.
Under the action of the central attachment of the vibrometer this sensitiveness is modified, the sensitiveness to high tones disappearing and being replaced by a low tone or, conversely, under treatment, a low tone disappears and a high tone is established, temporarily, at least. Again, in cases of recent origin, treatment will substitute an undefined rushing sound for a definite musical tone, either high or low, and later, the treatment will abolish this, the patient being relieved of this intensely annoying symptom. In some cases, with this relief, there is an improvement in the audition; in other cases, no improvement follows.
I confess to the domination of the material over my mind in my earlier experience with massage, and I think the inclination of operators will be to use a far greater degree of power than is necessary. I therefore notice with great satisfaction Professor Garey’s remark that “the object should be to produce a to-and-fro motion to the membrana tympani, and, if possible, by a force which is harmless and at the same time effective.” I would hardly say “to-and-fro motion of the drum-head,” because I think that the expression is liable to perpetuate the motion which is fixed in the minds of most physiologists, that the drum-head moves as a whole, with a to-and-fro motion.”
That is true under the influence of the Politzer, Siegle’s otoscope and similar instruments; but it certainly does not so move in the ordinary function of audition, but stands as the iris does in the eye, as an adjustor, a regulator of sound-force; in some sense as the iris does in its relation with the lens, to adjust, regulate and direct the essential force, and the vibration of the drum-head is at every node; every portion receives impressions that are converted into molecular disturbances of varying lengths, according as they are produced upon the stiff and unyielding portions of the drum-head at the periphery, along the manubrium, or in the more attenuated and easily-yielding portions which the between these two areas.
Not only so, but these impulses are communicated to the contained air of the tympanum, and make their impression upon the acoustic nerve through the round window synchronously with the impression made through the ossicula.
This whole subject widens before my mind in such a way that one might wish himself twenty years and at liberty to devote himself to a term of research in acoustics, such as is offered only in the technical schools of the continent of Europe.
WM. R. KING, M.D.: In discussing Dr. Garey’s paper I shall begin by saying that his methods have been closely followed by me since the beginning of his experiments, owing to the fact that I have been greatly interested in the treatment of deafness and tinnitus by means of sound waves or by aural massage since 1887, and have experimented and treated many cases by this method since then, though with crude and unsatisfactory instruments. Since using the vibrometer-which, after much study and experimentation, is now presented to the profession in practical shape-I have undoubtedly increased my percentage of good results.
I don’t believe I am over-sanguine or carried away by interest in this method, and believe I can rightly appreciate that this does not offer us a panacea or cure-all for auditory ailments, and hope I may always be ready to see the failures and to strive to find methods or remedies to reach some of them.
In speaking of the application of the instrument, I wish to call attention to the central attachment or post foe vibrations. Dr. Garey has not given it as much attention in the paper as it deserves. It is very useful as a general means of aural massage, rougher in nature and more general in application than the strings which help to make up the instrument. I often use it before applying the “similar found” to a given case, as a species of gymnastics, to stimulate secretion and motion in the conducting apparatus of the ear, viz., membrana tympani and ossicles. In most cases-in fact, in all-where tinnitus is present, I follow this up immediately by the nearest approach to the similar pitch obtainable.
I agree thoroughly with Dr. Garey, that the best results are achieved in cases accompanying hypertrophic catarrh, and that the least benefit is apparent in cases of atrophic nature.
Regarding the method of treatment in the absence of tinnitus, my experience the does not coincide with that of the author of the paper entirely; I do not feel that as yet we have any safe rule to guide us. My method has been to try the numerous sounds and variations the of until I find the one that seems to give the best immediate results, or that the patient himself will speak of as very penetrating and powerful )though not necessarily loud and heavy).
It seems almost impossible at present to simulate all the qualities of tone as they occur in the ears of those suffering with tinnitus; in fact, it would appear to be unnecessary. However, it seems advantageous and quite necessary to secure the closest simulation of pitch, thus in many cases soon obliterating annoying tinnitus and improving hearing powers.
The arrangement permitting of the picking of two strings simultaneously adds decidedly the usefulness of the instrument, as it increases the range of pitch as well as varying the quality of tones procurable, thereby decidedly enlarging our field of application.
The force used for creating the message or gymnastics of the membrana tympani and the ossicles-viz, vibratory force or sound- carefully and scientifically applied, is nature’s remedy, because it is adapted by nature, and is the only force which can rightly or safely be applied to these delicate portions of this complex organ of hearing.
A startling commentary on this subject is the array of cases benefited who have been relegated to the shelf by ancient and modern otology; cases declared unhelpable have been vastly improved. Pray, make no mistake; I did not say all cases.
It may be interesting to hear the latest regarding the instrument which was first invented for the application of this method of aural massage Mr. E.J. Godman, the inventor and patentee, is constantly on the lookout, and always striving for improvements to his machine. He has made many that you all know of. Permit me to report a few so recent they have not yet left the factory.
First.-The machine has been taken from its case, and is now mounted on a solid stand or table of oak, being set below the level, or so that the face of the instrument is just level with the face of the table. This is all supported by rigid, solid metal legs, which absolutely prevent foreign vibrations.
Second.-The motor has been removed from its little shelf and relegated below the table. I t can be placed upon a box on the floor, a shelf against the wall, or, better yet, a shelf solidly attached to the metal supports of the table. A belt goes up through an aperture to a wheel on a shaft, the other extremity of which carries a wheel with a rubber tire (a friction wheel), which in its revolution, being in contact with a larger flat- surfaced wheel on the main shaft of the instrument, turns this in harmony with itself.
This arrangement does away with the necessity of shifting the motor each time you wish to shift the carriage from one string to another- a consummation to be devoutly thankful for. The removal of the motor from the instrument as at present attached will recommend itself to all who have used the vibrometer, a great amount of undesirable jar being thus avoided.
Third.-Ratchet keys capable of very fine adjustment of tension of strings are now provided for the instrument.
Fourth.-A rheostadt or resistance-coil is now to be placed beneath the table between the storage battery and the switch, by this means enabling us to control the speed and number of revolutions to a nicety.
Other, though comparatively minor, improvements are being made, and others are contemplated, as, for instance, the substitution of a roughly corrugated rubber band for the picker on the wheel, thereby getting rid of the metallic sound of the picker on the wire strings.
I have experimented with a number of appliance for the production of the sounds and pitches that I have required, but I always fall back on the vibrometer, especially as at present constructed, for satisfactory work and results.
