malformations of the ear are most frequently met with in the auricle and external canal.
Methods of Examination.—The methods of examining the ear are roughly threefold:—(1) Testing the hearing with watch, voice and tuning-fork. The latter is especially used to distinguish between disease of the middle ear (conducting apparatus) and that of the internal ear (perceptive apparatus). Our knowledge of the subject has been brought to its present state by the labours of many observers, notably Weber, Rinne, Schwabach, Lucae and Gellé. (2) Examination of the canal and drum-head with speculum and reflector, introduced by Kramer, Wilde and von Tröltsch. (3) Examination of the drum-cavity through the Eustachian tube by the various methods of inflation.
Symptoms.—The chief symptoms of ear diseases are deafness, noises in the ear (tinnitus aurium), giddiness, pain and discharge. Deafness (or other disturbance of hearing) and noises may occur from disease in almost any part of the ear. Purulent discharge usually comes from the middle ear. Giddiness is more commonly associated with affections of the internal ear.
Treatment.—Ear diseases are treated on ordinary surgical and medical lines, due regard being had to the anatomical and physiological peculiarities of this organ of sense, and especially to its close relationship, on the one hand to the nose and naso-pharynx, and on the other hand to the cranium and its contents. The chief advance in aural surgery in recent years has been in the surgery of the mastoid process and antrum. The pioneers of this work were H. Schwartze of Halle, and Stacke of Erfurt, who have been followed by a host of workers in all parts of the world. This development led to increased attention being paid to the intracranial complications of suppurative ear disease, in the treatment of which great strides have been made in the last few years.
Effects of Diseases of the Nose on the Ear.—The influence of diseases of the nose and naso-pharynx on ear diseases was brought out by Loewenberg of Paris, Voltolini of Breslau, and especially by Wilhelm Meyer of Copenhagen, the discoverer of adenoid vegetations of the naso-pharynx (“adenoids”), who recognized the great importance of this disease and gave an inimitable account of it in the Trans. of the Royal Medical and Chirurgical Society of London, 1870, and the Archiv für Ohrenheilkunde, 1873. Adenoid vegetations, which consist of an abnormal enlargement of Luschka’s tonsil in the vault of the pharynx, frequently give rise to ear disease in children, and, if not attended to, lay the foundation of nasal and ear troubles in after life. They are often associated with enlargement of the faucial tonsils.
Journals.—In 1864 the Archiv für Ohrenheilkunde was started by Politzer and Schwartze, and, in 1867, the Monatsschrift für Ohrenheilkunde (a monthly publication) was founded by Voltolini, Gruber, Weber-Liel and Rüdinger. Appearing first as the Archives of Ophthalmology and Otology, simultaneously in English and German, in 1869, the Archives of Otology became a separate publication under the editorship of Knapp, Moos and Roosa in 1879. Amongst other journals now existing are Annales des maladies de l’oreille et du larynx (Paris), Journal of Laryngology (London), Centralblatt für Ohrenheilkunde (Leipzig), &c.
Societies.—The earliest society formed was the American Otological Society (1868), which held annual meetings and published yearly transactions. Flourishing societies for the study of otology (sometimes combined with laryngology) exist in almost all civilized countries, and they usually publish transactions consisting of original papers and cases. The Otological Society of the United Kingdom was founded in 1900.
International Congresses.—International Otological congresses have been held at intervals of about four years at New York, Milan, Basel, Brussels, Florence, London and Bordeaux (1904). The proceedings of the congresses appear as substantial volumes.
Hospitals.—The earliest record of a public institution for the treatment of ear diseases is a Dispensary for Diseases of the Eye and Ear in London, started by Saunders and Cooper, which existed in 1804; the aural part, however, was soon closed, so that the actual oldest institution appears to be the Royal Ear Hospital, London, which was founded by Curtis in 1816. Four years later there was started the New York Eye and Ear Infirmary. At the present time in every large town of Europe and America ear diseases are treated either in separate departments of general hospitals or in institutions especially devoted to the purpose.
For a history of otology from the earliest times refer to A Practical Treatise on the Diseases of the Ear, by D. B. St John Roosa, M.D., LL.D. (6th edition, New York, 1885), and for a general account of the present state of otological science to A Text-Book of the Diseases of the Ear for Students and Practitioners, by Professor Dr Adam Politzer, transl. by Milton J. Ballin, Ph.B., M.D., and Clarence J. Heller, M.D. (4th edition, London, 1902). (E. C. B.*)
EARL, a title and rank of nobility (corresponding to Lat. comes; Fr. comte), now the third in order of the British peerage, and accordingly intervening between marquess and viscount. Earl, however, is the oldest title and rank of English nobles, and was the highest until the year 1337, when the Black Prince was created duke of Cornwall by Edward III.
The nature of a modern earldom is readily understood, since it is a rank and dignity of nobility which, while it confers no official power or authority, is inalienable, indivisible, and descends in regular succession to all the heirs under the limitation in the grant until, on their failure, it becomes extinct.
The title is of Scandinavian origin, and first appears in England under Canute as jarl, which was englished as eorl. Like the ealdorman, whose place he took, the eorl was a great royal officer, who might be set over several counties, but who presided separately in the county court of each with the bishop of the diocese. Although there were counts in Normandy before the Norman Conquest, they differed in character from the English earls, and the earl’s position appears to have been but slightly modified by the Conquest. He was still generally entitled to the “third penny” of the county, but his office tended, under Norman influence, to become an hereditary dignity and his sphere was restricted by the Conqueror to a single county. The right to the “third penny” is a question of some obscurity, but its possession seems to have been deemed the distinctive mark of an earl, while the girding with “the sword of the county” formed the essential feature in his creation or investiture, as it continued to do for centuries later. The fact that every earl was the earl of a particular county has been much obscured by the loose usage of early times, when the style adopted was sometimes that of the noble’s surname (e.g. the Earls Ferrers), sometimes that of his chief seat (e.g. the Earls of Arundel), and sometimes that of the county. Palatine earldoms, or palatinates, were those which possessed regalia, i.e. special privileges delegated by the crown. The two great examples, which dated from Norman times, were Chester and Durham, where the earl and the bishop respectively had their own courts and jurisdiction, and were almost petty sovereigns.
The earliest known charter creating an earl is that by which Stephen bestowed on Geoffrey de Mandeville, in or about 1140, the earldom of Essex as an hereditary dignity. Several other creations by Stephen and the empress Maud followed in quick succession. From at least the time of the Conquest the earl had a double character; he was one of the “barons,” or tenants in chief, in virtue of the fief he held of the crown, as well as an earl in virtue of his “belting” (with the sword) and his “third penny” of the county. His fief would descend to the heirs of his body; and the earliest charters creating earldoms were granted with the same “limitation.” The dignity might thus descend to a woman, and, in that case, like the territorial fief, it would be held by her husband, who might be summoned to parliament in right of it. The earldom of Warwick thus passed through several families till it was finally obtained, in 1449, by the Kingmaker, who had married the heiress of the former earls. But in the case of “co-heiresses” (more daughters than one), the king determined which, if any, should inherit the dignity.
The 14th century saw some changes introduced. The earldom of March, created in 1328, was the first that was not named from a county or its capital town. Under Edward III. also an idea appears to have arisen that earldoms were connected with the tenure of lands, and in 1337 several fresh ones were created and large grants of lands made for their support. The first earldom granted with limitation to the heirs male of the grantee’s body was that of Nottingham in 1383. Another innovation was the grant of the first earldom for life only in 1377. The girding with the sword was the only observance at a creation till the first year of Edward VI., when the imposition of the cap
