. The pathological anatomy of the ear . this loss of substance depends very much onconstitutional conditions. The largest and most rapiddestructions occur in scrofula, tuberculosis, and espe-cially in scarlet fever. Spontaneous atrophy, or atrophy^ of the mem-brana tympani from any pressure upon it, withoutthe existence of suppurative inflammation, is a veryrare cause of perforation. When it does occur thewhole drum-membrane appears extremely delicateand transparent, and the walls of the perforation arevery thin. According to Beck^ there is a predisposi-tion to atrophic perforation of the drum
. The pathological anatomy of the ear . this loss of substance depends very much onconstitutional conditions. The largest and most rapiddestructions occur in scrofula, tuberculosis, and espe-cially in scarlet fever. Spontaneous atrophy, or atrophy^ of the mem-brana tympani from any pressure upon it, withoutthe existence of suppurative inflammation, is a veryrare cause of perforation. When it does occur thewhole drum-membrane appears extremely delicateand transparent, and the walls of the perforation arevery thin. According to Beck^ there is a predisposi-tion to atrophic perforation of the drum-membrane inold age. Fresh perforations show irregular, rough, raggededges, old ones smooth, thinned or thickened, or occa-sionally calcified edges, the thickening being causedby development of blood vessels and infiltration ofcells. The edges of the perforations may be partiallyor completely united with the mucous membrane of 1 Sfhwartze, 0., ii., S. 291. 2 Beck, Krankhciten des Gehoroi-gans, Heidelberg and Leipzig. 1827,S. THE DRUM-MEMBRANE. 79 the labyrinthine wall, either directly or by bands ofconnective tissue. Duplicate perforations of the drum-membrane wereformerly considered very rare (for instance by Polit-zer, Beleuchtungsbilder, S. 135),but from what I have seen during life,and also on dissection, double andtriple perforations, separated fromeach other by a bridge of membrane,are by no means uncommon. For along time I doubted the existence of g ^i. the cribriform condition of the mem- Double Perforation of the Drum-membrane. brana tympani such as was first de-scribed by Bonnofont, but from my own experienceI am convinced that, not only in tuberculosis pulmo-num and miliary tuberculosis, but also in scarlatinaAvith pharyngeal diphtheritis and pytemic conditions,the membrana tympani may be simultaneously per-forated at different points. These multiple perfora-tions are at first vQvy minute, but rapidly enlarge andfinally coalesce into a large opening (perha
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