“The subject (says Dr. Stiff) of sanguineous cyst of the ear in the insane is of importance in a medico-legal point of view. Some writers allege that these hæmatic cysts are the result of injuries, either self-inflicted or from the employment of violence on the part of attendants and nurses. The statement of Gudden, in support of the latter view, has been most extensively circulated. He maintains that these swellings are entirely owing to mal-treatment, and points out that ears closely resembling those of the insane are not unfrequently met with amongst sculptures depicting pugilistic athletæ. Singularly enough, in his efforts to bring this home to the attendants, he avers that he has never met with an instance in which the injury could be traced to the patient himself, or to other patients. How this can be reconciled with the fact that patients frequently fall on the ear in fits, and are struck on it by their own associates, I am at a loss to imagine. Again, in the lately published work of Dr. Kramer, ‘On the Aural Surgery of the Present Day,’ the observations of that author are calculated to encourage the theory of the physical origin of the disease. He says—‘The causes of these bloody tumours on the cartilage of the ear are unknown, though we must admit that they are especially likely to be produced by violence (blows on the ear), which, perhaps, explains their more frequent occurrence on the left ear.’ (New Sydenham Society's edition, page 41.) In the ‘British and Foreign Medico-Chirurgical Review’ for January, 1858, I published a short memoir on this peculiar disease, illustrated by engravings after photographs of the altered ears; and I therein advocated the contrary opinion, based upon observation and inquiry, that the lesion is not occasioned by physical injury, but that it is the result of a spontaneous hæmorrhage arising out of a pre-existing diseased condition of the vessels of the pinna of thee a r.