Chapter VII: Part 7

EALING, a municipal borough in the Ealing parliamentary division of Middlesex, England, suburban to London, 9 m. W. of St Paul's cathedral. Pop. (1891) 23,979; (1901) 33,031. The nucleus of the town, the ancient village, lies south of the highroad to Uxbridge, west of the open Ealing Common. The place is wholly residential. At St Mary's church, almost wholly rebuilt c. 1870, are buried John Oldmixon, the historian (d. 1742), and Horne Tooke (d. 1812). The church of All Saints (1905) commemorates Spencer Perceval, prime minister, who was assassinated in the House of Commons in 1812. It was erected under the will of his daughter Frederica, a resident of Ealing. Gunnersbury Park, south of Ealing Common, is a handsome Italian mansion. Among former owners of the property was Princess Amelia, daughter of George II., who lived here from 1761 till her death in 1786. The name of Gunnersbury is said to be traceable to the residence here of Gunilda, niece of King Canute. The manor of Ealing early belonged to the see of London, but it is not mentioned in Domesday and its history is obscure.

EAR (common Teut.; O.E. _eare_, Ger. _Ohr_, Du. _oor_, akin to Lat. _auris_, Gr. [Greek: ous]), in anatomy, the organ of hearing. The human ear is divided into three parts--external, middle and internal. The external ear consists of the pinna and the external auditory meatus. The pinna is composed of a yellow fibro-cartilaginous framework covered by skin, and has an external and an internal or cranial surface. Round the margin of the external surface in its upper three quarters is a rim called the helix (fig. 1, a), in which is often seen a little prominence known as Darwin's tubercle, representing the folded-over apex of a prick-eared ancestor. Concentric with the helix and nearer the meatus is the antihelix (c), which, above, divides into two limbs to enclose the triangular fossa of the antihelix. Between the helix and the antihelix is the fossa of the helix. In front of the antihelix is the deep fossa known as the concha (fig. 1, d), and from the anterior part of this the meatus passes inward into the skull. Overlapping the meatus from in front is a flap called the tragus, and below and behind this is another smaller flap, the antitragus. The lower part of the pinna is the lobule (e), which contains no cartilage. On the cranial surface of the pinna elevations correspond to the concha and to the fossae of the helix and antihelix. The pinna can be slightly moved by the anterior, superior and posterior auricular muscles, and in addition to these there are four small intrinsic muscles on the external surface, known as the helicis major and minor, the tragicus and the antitragicus, and two on the internal surface called the obliquus and transversus. The external auditory meatus (fig. 1, n) is a tube running at first forward and upward, then a little backward and then forward and slightly downward; of course all the time it is also running inward until the tympanic membrane is reached. The tube is about an inch long, its outer third being cartilaginous and its inner two-thirds bony. It is lined by skin in its whole length, the sweat glands of which are modified to secrete the wax or cerumen.

a, Helix. m, Tip of petrous process.
b, Antitragus. n, External auditory meatus.
c, Antihelix. o, Membrana tympani.
d, Concha. p, Tympanum.
e, Lobule. 1, points to malleus.
f, Mastoid process. 2, to incus.
g, Portio dura. 3, to stapes.
h, Styloid process. 4, to cochlea.
k, Internal carotid artery. 5, 6, 7, the three semicircular canals.
l, Eustachian tube. 8 and 9, facial and auditory nerves.]

The middle ear or tympanum (fig. 1, p) is a small cavity in the temporal bone, the shape of which may perhaps be realized by imagining a hock bottle subjected to lateral pressure in such a way that its circular section becomes triangular, the base of the triangle being above. The neck of the bottle, also laterally compressed, will represent the Eustachian tube (fig. 1, l), which runs forward, inward and downward, to open into the naso-pharynx, and so admits air into the tympanum. The bottom of the bottle will represent the posterior wall of the tympanum, from the upper part of which an opening leads backward into the mastoid antrum and so into the air-cells of the mastoid process. Lower down is a little pyramid which transmits the stapedius muscle, and at the base of this is a small opening known as the iter chordae posterius, for the chorda tympani to come through from the facial nerve. The roof is formed by a very thin plate of bone, called the tegmen tympani, which separates the cavity from the middle fossa of the skull. Below the roof the upper part of the tympanum is somewhat constricted off from the rest, and to this part the term "attic" is often applied. The floor is a mere groove formed by the meeting of the external and internal walls. The outer wall is largely occupied by the tympanic membrane (fig. 1, o), which entirely separates the middle ear from the external auditory meatus; it is circular, and so placed that it slopes from above, downward and inward, and from behind, forward and inward. Externally it is lined by skin, internally by mucous membrane, while between the two is a firm fibrous membrane, convex inward about its centre to form the umbo. Just in front of the membrane on the outer wall is the Glaserian fissure leading to the glenoid cavity, and close to this is the canal of Huguier for the chorda tympani nerve. The inner wall shows a promontory caused by the cochlea and grooved by the tympanic plexus of nerves; above and behind it is the fenestra ovalis, while below and behind the fenestra rotunda is seen, closed by a membrane. Curving round, above and behind the promontory and fenestrae, is a ridge caused by the aqueductus Fallopii or canal for the facial nerve. The whole tympanum is about half an inch from before backward, and half an inch high, and is spanned from side to side by three small bones, of which the malleus (fig. 1, 1) is the most external. This is attached by its handle to the umbo of the tympanic membrane, while its head lies in the attic and articulates posteriorly with the upper part of the next bone or incus (fig. 1, 2). The long process of the incus runs downward and ends in a little knob called the os orbiculare, which is jointed on to the stapes or stirrup bone (fig. 1, 3). The two branches of the stapes are anterior and posterior, while the footplate fits into the fenestra ovalis and is bound to it by a membrane. It will thus be seen that the stapes lies nearly at right angles to the long process of the incus. From the front of the malleus a slender process projects forward into the Glaserian fissure, while from the back of the incus the posterior process is directed backward and is attached to the posterior wall of the tympanum. These two processes form a fulcrum by which the lever action of the malleus and incus is brought about, so that when the handle of the malleus is pushed in by the membrane the head moves out; the top of the incus, attached to it, also moves out, and the os orbiculare moves in, and so the stapes is pressed into the fenestra ovalis. The stapedius and tensor tympanic muscles, the latter of which enters the tympanum in a canal just above the Eustachian tube to be attached to the malleus, modify the movements of the ossicles.

The mucous membrane lining the tympanum is continuous through the Eustachian tube with that of the naso-pharynx, and is reflected on to the ossicles, muscles and chorda tympani nerve. It is ciliated except where it covers the membrana tympani, ossicles and promontory; here it is stratified.

DC, Ductus cochlearis.
dr, Ductus reuniens.
S, Sacculus.
U, Utriculus.
dv, Ductus endolymphaticus.
SC, Semicircular canals.
(After Waldeyer.)]

The internal ear or labyrinth consists of a bony and a membranous part, the latter of which is contained in the former. The bony labyrinth is composed of the vestibule, the semicircular canals and the cochlea. The vestibule lies just internal to the posterior part of the tympanum, and there would be a communication between the two, through the fenestra ovalis, were it not that the footplate of the stapes blocks the way. The inner wall of the vestibule is separated from the bottom of the internal auditory meatus by a plate of bone pierced by many foramina for branches of the auditory nerve (fig. 1, 9), while at the lower part is the opening of the aqueductus vestibuli, by means of which a communication is established with the posterior cranial fossa. Posteriorly the three semicircular canals open into the vestibule; of these the external (fig. 1, 7) has two independent openings, but the superior and posterior (fig. 1, 5 and 6) join together at one end and so have a common opening, while at their other ends they open separately. The three canals have therefore five openings into the vestibule instead of six. One end of each canal is dilated to form its ampulla. The superior semicircular canal is vertical, and the two pillars of its arch are nearly external and internal; the external canal is horizontal, its two pillars being anterior and posterior, while the convexity of the arch of the posterior canal is backward and its two pillars are superior and inferior. Anteriorly the vestibule leads into the cochlea (fig. 1, 4), which is twisted two and a half times round a central pillar called the modiolus, the whole cochlea forming a rounded cone something like the shell of a snail though it is only about 5 mm. from base to apex. Projecting from the modiolus is a horizontal plate which runs round it from base to apex like a spiral staircase; this is known as the lamina spiralis, and it stretches nearly half-way across the canal of the cochlea. At the summit it ends in a little hook named the hamulus. The modiolus is pierced by canals which transmit branches of the auditory nerve to the lamina spiralis.

The membranous labyrinth lies in the bony labyrinth, but does not fill it; between the two is the fluid called perilymph, while inside the membranous labyrinth is the endolymph. In the bony vestibule lie two membranous bags, the saccule (fig. 2, S) in front, and the utricle (fig. 2, U) behind; each of these has a special patch or macula to which twigs of the auditory nerve are supplied, and in the mucous membrane of which specialized hair cells are found (fig. 3, p).

Attached to the maculae are crystals of carbonate of lime called otoconia. The membranous semicircular canals are very much smaller in section than the bony; in the ampulla of each is a ridge, the crista acustica, which is covered by a mucous membrane containing sensory hair cells like those in the maculae. All the canals open into the utricle. From the lower part of the saccule a small canal called the ductus endolymphaticus (fig. 2, dv) runs into the aqueductus vestibuli; it is soon joined by a small duct from the utricle, and ends, close to the dura mater of the posterior fossa of the cranium, as the saccus endolymphaticus, which may have minute perforations through which the endolymph can pass. Anteriorly the saccule communicates with the membranous cochlea or scala media by a short ductus reuniens (fig. 2, dr). A section through each turn of the cochlea shows the bony lamina spiralis, already noticed, which is continued right across the canal by the basilar membrane (fig. 4, bm), thus cutting the canal into an upper and lower half and connected with the outer wall by the strong spiral ligament (fig. 4, sl). Near the free end of the lamina spiralis another membrane called the membrane of Reissner (fig. 4, mR) is attached, and runs outward and upward to the outer wall, taking a triangular slice out of the upper half of the section. There are now three canals seen in section, the upper of which is the scala vestibuli (fig. 4, SV), the middle and outer the scala media, ductus cochlearis or true membranous cochlea (fig. 4, DC), while the lower is the scala tympani (fig. 4, ST). The scala vestibuli and scala tympani communicate at the apex of the cochlea by an opening known as the helicotrema, so that the perilymph can here pass from one canal to the other. At the base of the cochlea the perilymph in the scala vestibuli is continuous with that in the vestibule, but that in the scala tympani bathes the inner surface of the membrane stretched across the fenestra rotunda, and also communicates with the subarachnoid space through the aqueductus cochleae, which opens into the posterior cranial fossa. The scala media containing endolymph communicates, as has been shown, with the saccule through the canalis reuniens, while, at the apex of the cochlea, it ends in a blind extremity of considerable morphological interest called the lagena.

m, Modiolus. bm, Basilar membrane.
0, Outer wall of cochlea. cs, Crista spiralis.
SV, Scala vestibuli. sl, Spiral ligament.
ST, Scala tympani. sg, Spiral ganglion of auditory nerve.
DC, Ductus cochlearis. oc, Organ of Corti.
mR, Membrane of Reissner.]

The scala media contains the essential organ of hearing or organ of Corti (fig. 4, oc), which lies upon the inner part of the basilar membrane; it consists of a tunnel bounded on each side of the inner and outer rods of Corti; on each side of these are the inner and outer hair cells, between the latter of which are found the supporting cells of Deiters. Most externally are the large cells of Hensen. A delicate membrane called the lamina reticularis covers the top of all these, and is pierced by the hairs of the hair cells, while above this is the loose membrana tectoria attached to the periosteum of the lamina spiralis, near its tip, internally, and possibly to some of Deiter's cells externally. The cochlear branch of the auditory nerve enters the lamina spiralis, where a spiral ganglion (fig. 4, sg) is developed on it; after this it is distributed to the inner and outer hair cells.

(From R. Howden--Cunningham's _Text-Book of Anatomy_.)]

For further details see _Text-Book of Anatomy_, edited by D.J.
Cunningham (Edinburgh, 1906); Quain's _Elements of Anatomy_ (London,
1893); Gray's _Anatomy_ (London, 1905); _A Treatise on Anatomy_,
edited by H. Morris (London, 1902); _A Text-Book of Human Anatomy_, by
A. Macalister (London, 1889).

_Embryology._--The pinna is formed from six tubercles which appear round the dorsal end of the hyomandibular cleft or, more strictly speaking, pouch. Those for the tragus and anterior part of the helix belong to the first or mandibular arch, while those for the antitragus, antihelix and lobule come from the second or hyoid arch. The tubercle for the helix is dorsal to the end of the cleft where the two arches join. The external auditory meatus, tympanum and Eustachian tube are remains of the hyomandibular cleft, the membrana tympani being a remnant of the cleft membrane and therefore lined by ectoderm outside and entoderm inside. The origin of the ossicles is very doubtful. H. Gadow's view, which is one of the latest, is that all three are derived from the hyomandibular plate which connects the dorsal ends of the hyoid and mandibular bars (_Anatomischer Anzeiger_, Bd. xix., 1901, p. 396). Other papers which should be consulted are those of E. Gaupp, _Anatom. Hefte, Ergebnisse_, Bd. 8, 1898, p. 991, and J.A. Hammar, _Archiv f. mikr. Anat._ lix., 1902. These papers will give a clue to the immense literature of the subject. The internal ear first appears as a pit from the cephalic ectoderm, the mouth of which in Man and other mammals closes up, so that a pear-shaped cavity is left. The stalk of the pear which is nearest the point of invagination is called the recessus labyrinthi, and this, after losing its connexion with the surface of the embryo, grows backward toward the posterior cranial fossa and becomes the ductus endolymphaticus. The lower part of the vesicle grows forward and becomes the cochlea, while from the upper part three hollow circular plates grow out, the central parts of which disappear, leaving the margin as the semicircular canals. Subsequently constrictions appear in the vesicle marking off the saccule and utricle. From the surrounding mesoderm the petrous bone is formed by a process of chondrification and ossification.

See W. His, Junr., _Archiv f. Anat. und Phys._, 1889, supplement, p.
1; also Streeter, _Am. Journ. of Anat._ vi., 1907.

_Comparative Anatomy._--The ectodermal inpushing of the internal ear has probably a common origin with the organs of the lateral line of fish. In the lower forms the ductus endolymphaticus retains its communication with the exterior on the dorsum of the head, and in some Elasmobranchs the opening is wide enough to allow the passage of particles of sand into the saccule. It is probable that this duct is the same which, taking a different direction and losing its communication with the skin, abuts on the posterior cranial fossa of higher forms (see Rudolf Krause, "Die Entwickelung des Aq. vestibuli seu d. Endelymphaticus," _Anat. Anzeiger_, Bd. xix., 1901, p. 49). In certain Teleostean fishes the swim bladder forms a secondary communication with the internal ear by means of special ossicles (see G. Ridewood, _Journ. Anat. & Phys._ vol. xxvi.). Among the Cyclostomata the external semicircular canals are wanting; Petromyzon has the superior and posterior only, while in Myxine these two appear to be fused so that only one is seen. In higher types the three canals are constant. Concretions of carbonate of lime are present in the internal ears of almost all vertebrates; when these are very small they are called otoconia, but when, as in most of the teleostean fishes, they form huge concretions, they are spoken of as otoliths. One shark, Squatina, has sand instead of otoconia (C. Stewart, _Journ. Linn. Society_, xxix. 409). The utricle, saccule, semicircular canals, ductus endolymphaticus and a short lagena are the only parts of the ear present in fish.

The Amphibia have an important sensory area at the base of the lagena known as the macula acustica basilaris, which is probably the first rudiment of a true cochlea. The ductus endolymphaticus has lost its communication with the skin, but it is frequently prolonged into the skull and along the spinal canal, from which it protrudes, through the intervertebral foramina, bulging into the coelom. This is the case in the common frog (A. Coggi, _Anat. Anz._ 5. Jahrg., 1890, p. 177). In this class the tympanum and Eustachian tube are first developed; the membrana tympani lies flush with the skin of the side of the head, and the sound-waves are transmitted from it to the internal ear by a single bony rod--the columella.

In the Reptilia the internal ear passes through a great range of development. In the Chelonia and Ophidia the cochlea is as rudimentary as in the Amphibia, but in the higher forms (Crocodilia) there is a lengthened and slightly twisted cochlea, at the end of which the lagena forms a minute terminal appendage. At the same time indications of the scalae tympani and vestibuli appear. As in the Amphibia the ductus endolymphaticus sometimes extends into the cranial cavity and on into other parts of the body. Snakes have no tympanic membrane. In the birds the cochlea resembles that of the crocodiles, but the posterior semicircular canal is above the superior where they join one another. In certain lizards and birds (owls) a small fold of skin represents the first appearance of an external ear. In the monotremes the internal ear is reptilian in its arrangement, but above them the mammals always have a spirally twisted cochlea, the number of turns varying from one and a half in the Cetacea to nearly five in the rodent _Coelogenys_. The lagena is reduced to a mere vestige. The organ of Corti is peculiar to mammals, and the single columella of the middle ear is replaced by the three ossicles already described in Man (see Alban Doran, "Morphology of the Mammalian Ossicula auditus," _Proc. Linn. Soc._, 1876-1877, xiii. 185; also _Trans. Linn. Soc._ 2nd Ser. Zool. i. 371). In some mammals, especially Carnivora, the middle ear is enlarged to form the tympanic bulla, but the mastoid cells are peculiar to Man.

For further details see G. Retzius, _Das Gehoerorgan der Wirbelthiere_
(Stockholm, 1881-1884); Catalogue of the Museum of the R. College of
Surgeons--Physiological Series, vol. iii. (London, 1906); R.
Wiedersheim's _Vergleichende Anatomie der Wirbeltiere_ (Jena, 1902).
(F. G. P.)

DISEASES OF THE EAR

Modern scientific aural surgery and medicine (commonly known as Otology) dates from the time of Sir William Wilde of Dublin (1843), whose work marked a great advance in the application of anatomical, physiological and therapeutical knowledge to the study of this organ. Less noticeable contributions to the subject had not long before been made by Saunders (1827), Kramer (1833), Pilcher (1841) and Yearsley (1841). The next important event in the history of otology was the publication of J. Toynbee's book in 1860 containing his valuable anatomical and pathological observations. Von Troeltsch of Wuerzburg, following on the lines of Wilde and Toynbee, produced two well-known works in 1861 and 1862, laying the foundation of the study in Germany. In that country and in Austria he was followed by Hermann Schwartze, Politzer, Gruber, Weber-Liel, Ruedinger, Moos and numerous others. France produced Itard, de la Charriere, Meniere, Loewenberg and Bonnafont; and Belgium, Charles Delstanche, father and son. In Great Britain the work was carried on by James Hinton (1874), Peter Allen (1871), Patterson Cassells and Sir William Dalby. In America we may count among the early otologists Edward H. Clarke (1858), D.B. St John Roosa, H. Knapp, Clarence J. Blake, Albert H. Buck and Charles Burnett. Other workers all over the world are too numerous to mention.

_Various Diseases and Injuries._--Diseases of the ear may affect any of the three divisions, the external, middle or internal ear. The commoner affections of the _auricle_ are eczema, various tumours (simple and malignant), and serous and sebaceous cysts. Haematoma auris (othaematoma), or effusion of blood into the auricle, is often due to injury, but may occur spontaneously, especially in insane persons. The chief diseases of the _external auditory canal_ are as follows:--impacted cerumen (or wax), circumscribed (or furuncular) inflammation, diffuse inflammation, strictures due to inflammatory affections, bony growths, fungi (otomycosis), malignant disease, caries and necrosis, and foreign bodies.

Diseases of the _middle ear_ fall into two categories, suppurative and non-suppurative (i.e. with and without the formation of pus). Suppurative inflammation of the middle ear is either acute or chronic, and is in either case accompanied by perforation of the drum head and discharge from the ear. The chief importance of these affections, in addition to the symptoms of pain, deafness, discharge, &c., is the serious complications which may ensue from their neglect, viz. aural polypi, caries and necrosis of the bone, affections of the mastoid process, including the mastoid antrum, paralysis of the facial nerve, and the still more serious intracranial and vascular infective diseases, such as abscess in the brain (cerebrum or cerebellum), meningitis, with subdural and extradural abscesses, septic thrombosis of the sigmoid and other venous sinuses, and pyaemia. It is owing to the possibility of these complications that life insurance companies usually, and rightly, inquire as to the presence of ear discharge before accepting a life. Patterson Cassells of Glasgow urged this special point as long ago as 1877. Acute suppurative disease of the middle ear is often due to the exanthemata, scarlatina, measles and smallpox, and to bathing and diving. It may also be caused by influenza, diphtheria and pulmonary phthisis.

Non-suppurative disease of the middle ear may be acute or chronic. In the acute form the inflammation is less violent than in the acute suppurative inflammation, and is rarely accompanied by perforation. Chronic non-suppurative inflammation may be divided into the moist form, in which the symptoms are improved by inflation of the tympanum through the Eustachian tube, and the dry form (including sclerosis), which is more intractable and in which this procedure has little or no beneficial effect. Diseases of the _internal ear_ may be primary or secondary to an affection of the tympanum or to intracranial disease.

Injuries to any part of the ear may occur, among the commoner being injuries to the auricle, rupture of the drum head (from explosions, blows on the ear or the introduction of sharp bodies into the ear canal), and injuries from fractured skull. Congenital 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 Gelle. (2) Examination of the canal and drum-head with speculum and reflector, introduced by Kramer, Wilde and von Troeltsch. (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 fuer 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 fuer Ohrenheilkunde_ was started by
Politzer and Schwartze, and, in 1867, the _Monatsschrift fuer
Ohrenheilkunde_ (a monthly publication) was founded by Voltolini,
Gruber, Weber-Liel and Ruedinger. 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 fuer
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 of dignity and a circlet of gold was added. Under James I. the patent of creation was declared to be sufficient without any ceremony. An earl's robe of estate has three bars of ermine, but possibly it had originally four.

Something should be said of anomalous earldoms with Norman or Scottish styles. The Norman styles originated either under the Norman kings or at the time of the conquest of Normandy by the house of Lancaster. To the former period belonged that of Aumale, which successive fresh creations, under the Latinized form "Albemarle" have perpetuated to the present day (see ALBEMARLE, EARLS AND DUKES OF). The so-called earls of Eu and of Mortain, in that period, were really holders of Norman _comtes_. Henry V. and his son created five or six, it is said, but really seven at least, Norman countships or earldoms, of which Harcourt (1418), Perche (1419), Dreux (1427) and Mortain (? 1430) were bestowed on English nobles, Eu (1419), and Tankerville (1419) on English commoners, and Longueville (1419) on a foreigner, Gaston de Foix. Of these the earldom of "Eu" was assumed by the earls of Essex till the death of Robert, the parliament's general (1646), while the title of Tankerville still survives under a modern creation (1714). An anomalous royal licence of 1661 permitted the earl of Bath to use the title of earl of Corbeil by alleged hereditary right. Of Scottish earldoms recognized in the English parliament the most remarkable case is that of the Lords Umfraville, who were summoned for three generations (1297-1380), as earls of Angus; Henry, Lord Beaumont, also was summoned as earl of Buchan from 1334 to 1339.

The earldom of Chester is granted to the princes of Wales on their creation, and the Scottish earldom of Carrick is held by the eldest son of the sovereign under act of parliament.

The premier earldom is that of Arundel (q.v.), but as this is at present united with the dukedom of Norfolk, the oldest earldom not merged in a higher title is that of Shrewsbury (1442), the next in seniority being Derby (1485), and Huntingdon (1529). These three have been known as "the catskin earls," a term of uncertain origin. The ancient earldom of Wiltshire (1397) was unsuccessfully claimed in 1869 by Mr Scrope of Danby, and that of Norfolk (1312), in 1906, by Lord Mowbray and Stourton.

The premier earldom of Scotland as recognized by the Union Roll (1707), is that of Crawford, held by the Lindsays since its creation in 1398; but it is not one of the ancient "seven earldoms." The Decreet of Ranking (1606) appears to have recognized the earldom of Sutherland as the most ancient in virtue of a charter of 1347, but the House of Lords' decision of 1771 recognized it as having descended from at least the year 1275, and it may be as old as 1228. It is at present united with the dukedom of Sutherland. The original "seven earldoms" (of which it was one) represented seven provinces, each of which was under a "_mormaer_." This Celtic title was rendered "_jarl_" by the Norsemen, and under Alexander I. (c. 1115) began to be replaced by earl (_comes_), owing to Anglo-Norman influence, which also tended to make these earldoms less official and more feudal.

In Ireland the duke of Leinster is, as earl of Kildare, premier earl as well as premier duke.

An earl is "Right Honourable," and is styled "My Lord." His eldest son bears his father's "second title," and therefore, that second title being in most cases a viscounty, he generally is styled "Viscount"; where, as with Devon and Huntingdon, there is no second title, one may be assumed for convenience; under all circumstances, however, the eldest son of an earl takes precedence immediately after the viscounts. The younger sons of earls are "Honourable," but all their daughters are "Ladies." In formal documents and instruments, the sovereign, when addressing or making mention of any peer of the degree of an earl, usually designates him "trusty and well-beloved cousin,"--a form of appellation first adopted by Henry IV., who either by descent or alliance was actually related to every earl and duke in the realm. The wife of an earl is a countess; she is "Right Honourable," and is styled "My Lady." For the earl's coronet see CROWN AND CORONET.

See Lord's _Reports on the Dignity of a Peer_; Pike's _Constitutional_
_History of the House of Lords_; Selden's _Titles of Honour_; G.E.
C(okayne)'s _Complete Peerage_; Round's _Geoffrey de Mandeville_.
(J. H. R.)

EARLE, JOHN (c. 1601-1665), English divine, was born at York about 1601. He matriculated at Christ Church, Oxford, but migrated to Merton, where he obtained a fellowship. In 1631 he was proctor and also chaplain to Philip, earl of Pembroke, then chancellor of the university, who presented him to the rectory of Bishopston in Wiltshire. His fame spread, and in 1641 he was appointed chaplain and tutor to Prince Charles. In 1643 he was elected one of the Assembly of Divines at Westminster, but his sympathies with the king and with the Anglican Church were so strong that he declined to sit. Early in 1643 he was chosen chancellor of the cathedral of Salisbury, but of this preferment he was soon deprived as a "malignant." After Cromwell's great victory at Worcester, Earle went abroad, and was named clerk of the closet and chaplain to Charles II. He spent a year at Antwerp in the house of Isaac Walton's friend, George Morley, who afterwards became bishop of Winchester. He next joined the duke of York (James II.) at Paris, returning to England at the Restoration. He was at once appointed dean of Westminster, and in 1661 was one of the commissioners for revising the liturgy. He was on friendly terms with Richard Baxter. In November 1662 he was consecrated bishop of Worcester, and was translated, ten months later, to the see of Salisbury, where he conciliated the nonconformists. He was strongly opposed to the Conventicle and Five Mile Acts. During the great plague Earle attended the king and queen at Oxford, and there he died on the 17th of November 1665.

Earle's chief title to remembrance is his witty and humorous work entitled _Microcosmographie, or a Peece of the World discovered, in Essayes and Characters_, which throws light on the manners of the time. First published anonymously in 1628, it became very popular, and ran through ten editions in the lifetime of the author. The style is quaint and epigrammatic; and the reader is frequently reminded of Thomas Fuller by such passages as this: "A university dunner is a gentlemen follower cheaply purchased, for his own money has hyr'd him." Several reprints of the book have been issued since the author's death; and in 1671 a French translation by J. Dymock appeared with the title of _Le Vice ridicule_. Earle was employed by Charles II. to make the Latin translation of the _Eikon Basilike_, published in 1649. A similar translation of R. Hooker's _Ecclesiastical Polity_ was accidentally destroyed.

"Dr Earle," says Lord Clarendon in his _Life_, "was a man of great piety and devotion, a most eloquent and powerful preacher, and of a conversation so pleasant and delightful, so very innocent, and so very facetious, that no man's company was more desired and loved. No man was more negligent in his dress and habit and mien, no man more wary and cultivated in his behaviour and discourse. He was very dear to the Lord Falkland, with whom he spent as much time as he could make his own."

See especially Philip Bliss's edition of the _Microcosmographie_
(London, 1811), and E. Arber's Reprint (London, 1868).

EARLE, RALPH (1751-1801), American historical and portrait painter, was born at Leicester, Massachusetts, on the 11th of May 1751. Like so many of the colonial craftsmen, Earle was self-taught, and for many years was an itinerant painter. He went with the Governor's Guard to Lexington and made battle sketches, from which in 1775 he painted four scenes, engraved by Amos Doolittle, which are probably the first historical paintings by an American. After the War of Independence, Earle went to London, entered the studio of Benjamin West, and painted the king and many notables. After his return to America in 1786 he made portraits of Timothy Dwight, Governor Caleb Strong, Roger Sherman, and other prominent men. He also painted a large picture of Niagara Falls. He died at Bolton, Connecticut, on the 16th of August 1801.

EARL MARSHAL, in England, a functionary who ranks as the eighth of the great officers of state. He is the head of the college of arms, and has the appointment of the kings-of-arms, heralds and pursuivants at his discretion. He attends the sovereign in opening and closing the session of parliament, walking opposite to the lord great chamberlain on his or her right hand. It is his duty to make arrangements for the order of all state processions and ceremonials, especially for coronations and royal marriages and funerals. Like the lord high constable he rode into Westminster Hall with the champion after a coronation, till the coronation banquet was abandoned, taking his place on the left hand, and with the lord great chamberlain he assists at the introduction of all newly-created peers into the House of Lords.

The marshal appears in the feudal armies to have been in command of the cavalry under the constable, and to have in some measure superseded him as master of the horse in the royal palace. He exercised joint and co-ordinate jurisdiction with the constable in the court of chivalry, and afterwards became the sole judge of that tribunal till its obsolescence. The marshalship of England was formerly believed to have been inherited from the Clares by the Marshal family, who had only been marshals of the household. It was held, however, by the latter family, as the office of chief (_magister_) marshal, as early as the days of Henry I. Through them, under Henry III., it passed to the Bigods, as their eldest co-heirs. In 1306 it fell to the crown on the death of the last Bigod, earl of Norfolk, who had made Edward I. his heir, and in 1316 it was granted by Edward II. to his own younger brother, Thomas "of Brotherton," earl of Norfolk. As yet the style of the office was only "marshal" although the last Bigod holder, being an earl, was sometimes loosely spoken of as the earl marshal. The office, having reverted to the crown, was granted out anew by Richard II., in 1385, to Thomas Mowbray, earl of Nottingham, the representative of Thomas "of Brotherton." In 1386 the style of "earl marshal" was formally granted to him in addition. After several attainders and partial restorations in the reigns of the Tudors and the Stuarts, the earl marshalship was granted anew to the Howards by Charles II. in 1672 and entailed on their male line, with many specific remainders and limitations, under which settlement it has regularly descended to the present duke of Norfolk. Its holders, however, could not execute the office until the Roman Catholic emancipation, and had to appoint deputies. The duke is styled earl marshal "and hereditary marshal of England," but the double style would seem to be an error, though the Mowbrays, with their double creation (1385, 1386) might have claimed it. His Grace appends the letters "E.M." to his signature, and bears behind his shield two batons crossed in saltire, the marshal's rod (_virga_) having been the badge of the office from Norman times. There appear to have been hereditary marshals of Ireland, but their history is not well ascertained. The Keiths were Great Marischals of Scotland from at least the days of Robert Bruce, and were created earls marischal in or about 1458, but lost both earldom and office by the attainder of George, the 10th earl, in 1716. (See also MARSHAL; STATE, GREAT OFFICERS OF.)

See "The Marshalship of England," in J.H. Round, _Commune of London
and Other Studies_ (London, 1899); G.E. C(okayne)'s _Complete
Peerage_. (J. H. R.)

EARLOM, RICHARD (1742-1822), English mezzotint engraver, was born and died in London. His natural faculty for art appears to have been first called into exercise by admiration for the lord mayor's state coach, just decorated by Cipriani. He tried to copy the paintings, and was sent to study under Cipriani. He displayed great skill as a draughtsman, and at the same time acquired without assistance the art of engraving in mezzotint. In 1765 he was employed by Alderman Boydell, then one of the most liberal promoters of the fine arts, to make a series of drawings from the pictures at Houghton Hall; and these he afterwards engraved in mezzotint. His most perfect works as engraver are perhaps the fruit and flower pieces after the Dutch artists Van Os and Van Huysum. Amongst his historical and figure subjects are--"Agrippina," after West; "Love in Bondage," after Guido Reni; the "Royal Academy," the "Embassy of Hyderbeck to meet Lord Cornwallis," and a "Tiger Hunt," the last three after Zoffany; and "Lord Heathfield," after Sir Joshua Reynolds. Earlom also executed a series of 200 facsimiles of the drawings and sketches of Claude Lorraine, which was published in 3 vols. folio, under the title of _Liber veritatis_ (1777-1819).

EARLSTON (formerly ERCILDOUNE, of which it is a corruption), a parish and market town of Berwickshire, Scotland. Pop. (1901) 1049. It is situated on Leader Water in Lauderdale, 721/2 m. S.E. of Edinburgh by the North British railway branch line from Reston Junction to St Boswells, and about 4 m. N.E. of Melrose. When the place was a hamlet of rude huts it was called Arcioldun or "Prospect Fort," with reference to Black Hill (1003 ft.), on the top of which may yet be traced the concentric rings of the British fort by which it was crowned. It is said to be possible to make out the remains of the cave-dwellings of the Ottadeni, the aborigines of the district. In the 12th and 13th centuries the Lindsays and the earls of March and Dunbar were the chief baronial families. The particular link with the remote past, however, is the ivy-clad ruin of the ancient tower, "The Rhymer's Castle," the traditional residence of Thomas Learmont, commonly called Thomas of Ercildoune, or Thomas the Rhymer, poet and prophet, and friend of the Fairies, who was born here about 1225. Rhymer's Tower was crumbling to pieces, and its stones were being used in the erection of dykes, cottages and houses, when the Edinburgh Border Counties Association acquired the relic and surrounding lands in 1895, and took steps to prevent further spoliation and decay. The leading manufactures are ginghams, tweeds and shirtings, and the town is also an important agricultural centre, stock sales taking place at regular intervals and cattle and horse fairs being held every year. Some 3 m. away is the estate of Bemersyde, said to have been in the possession of the Haigs for nearly 1000 years. The prospect from Bemersyde Hill was Sir Walter Scott's favourite view. The castle at Bemersyde was erected in 1535 to secure the peace of the Border.

EARLY, JUBAL ANDERSON (1816-1894), American soldier and lawyer, was born in Franklin county, Virginia, on the 3rd of November 1816, and graduated at the U.S. Military Academy in 1837. He served in the Seminole War of 1837-38, after which he resigned in order to practise law in Franklin county, Va. He also engaged in state politics, and served in the Mexican War as a major of Virginia volunteers. He was strongly opposed to secession, but thought it his duty to conform to the action of his state. As a colonel in the Confederate army, he rendered conspicuous service at the first battle of Bull Run (q.v.). Promoted brigadier-general, and subsequently major-general, Early served throughout the Virginian campaigns of 1862-63, and defended the lines of Fredericksburg during the battle of Chancellorsville. At Gettysburg he commanded his division of Ewell's corps. In the campaign of 1864 Early, who had now reached the rank of lieutenant-general, commanded the Confederate forces in the Shenandoah Valley. The action of Lynchburg left him free to move northwards, his opponent being compelled to march away from the Valley. Early promptly utilized his advantage, crossed the Potomac, and defeated, on the Monocacy, all the troops which could be gathered to meet him. He appeared before the lines of Washington, put part of Maryland and Pennsylvania under contribution, and only retired to the Valley when threatened by heavy forces hurriedly sent up to Washington. He then fought a successful action at Winchester, reappeared on the Potomac, and sent his cavalry on a raid into Pennsylvania. A greatly superior army was now formed under General Sheridan to oppose Early. In spite of his skill and energy the Confederate leader was defeated in the battles of Winchester and Fisher's Hill. Finally, on the 19th of October, after inflicting at first a severe blow upon the Federal army in its camps on Cedar Creek, he was decisively beaten by Sheridan. (See SHENANDOAH VALLEY CAMPAIGNS.) Waynesboro (March 1865) was his last fight, after which he was relieved from his command. General Early was regarded by many as the ablest soldier, after Lee and Jackson, in the Army of Northern Virginia, and one of the ablest in the whole Confederate army. That he failed to make headway against an army far superior in numbers, and led by a general of the calibre of Sheridan, cannot be held to prove the falsity of this judgment. After the peace he went to Canada, but in 1867 returned to resume the practice of law. For a time he managed in conjunction with General Beauregard the Louisiana lottery. He died at Lynchburg, Va., on the 2nd of March 1894. General Early was for a time president of the Southern Historical Society, and wrote, besides various essays and historical papers, _A Memoir of the Last Year of the War, &c._ (1867).

EARLY ENGLISH PERIOD, in architecture, the term given by Rickman to the first pointed or Gothic style in England, nominally 1189-1307, which succeeded the Romanesque or Norman period towards the end of the 12th century, and developed into the Decorated period in the commencement of the 14th century. It is chiefly characterized by the almost universal employment of the pointed arch, not only in arches of wide span such as those of the nave arcade, but for doorways and windows. The actual introduction of the pointed arch took place at a much earlier date, as in the nave arcade of the Cistercian Abbey of Buildwas (1140), though the clerestory window above has semicircular arches. It is customary, therefore, to make allowance for a transitional epoch from the middle of the 12th century. Although the pointed arches used are sometimes equilateral and sometimes drop-arches, the lancet-arch is the most characteristic. The period is best recognized in England by the great depth given to the hollows of the mouldings, alternating with fillets and rolls, by the decoration of the hollows with the dog-tooth ornament, by the circular abacus of the capitals, and the employment of slender detached shafts of Purbeck marble which are attached to piers by circular moulded shaft-rings (Fr. _anneau_).

The arches are sometimes cusped; circles with trefoils, quatrefoils, &c., are introduced into the tracery, and large rose windows in the transept or nave, as at Lincoln (1220). The conventional foliage decorating the capitals is of great beauty and variety, and extends to spandrils, bosses, &c. In the spandrils of the arches of the nave, transept or choir arcades, diaper work is occasionally found, as in the transept of Westminster Abbey. The latter is one of the chief examples of the period, to which must be added the cathedral of Salisbury (except the tower); the Galilee at Ely; nave and transept of Wells (1225-1240); nave of Lincoln; west front of Peterborough; and the minster at Beverley. (R. P. S.)