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[History of the tuning fork. III: On the way to quantitative pure-tone measurement. Pictures from the history of otorhinolaryngology, represented by instruments from the collection of the Ingolstadt German Medical History Museum].

BACKGROUND
Weber's and Rinne's tuning-fork tests were for a long time considered unreliable, as they often seemed to yield inconsistent results. The sources of error were manifold and lay in the fields of physics, physiology, pathophysiology, and psychology. When the problems came to be understood, more sophisticated instruments and techniques were developed.


TECHNICAL IMPROVEMENTS IN TUNING FORKS
The prongs of the tuning fork were fitted with clamps to deaden overtones when it was put into vibration (Politzer 1870). By shifting the clamps along the prongs the tone of the tuning fork could be varied in a range up to one octave (Könlg 1878). A knob of hom or metal was fixed to the end of the shaft to ensure a good coupling to the skull when testing bone conduction (Lucae 1886). A small hammer fixed to the shaft and driven by a spring would activate the tuning fork with reproducible strength (Lucae 1899). A wedge-shaped figure drawn on the lateral surface of the clamps would allow one to optically control the amplitude of vibration (Gradenigo 1899).


METHODS FOR QUANTIFICATION OF MEASURING HEARING ACUITY
The time during which a patient hears the tuning fork after it has been struck as compared to that of a normal hearing subject was measured as parameter of hearing acutiy (v. Conta 1864). A number of tuning forks at intervals of one octave each were assembled in sets to cover the whole frequency range of hearing. The most sophisticated example of these sets was the Bezold-Edelmann continuous tone series (1894). It comprised ten tuning forks with sliding clamps, two pipes of the organ type, and a Galton whistle. With this instrumentation it was possible to test the whole range of hearing.


GRAPHIC PRESENTATION OF QUANTITATIVE RESULTS OF HEARING TESTING
The results of testing the hearing via air conduction and bone conduction measured in duration and calculated as percentage of normal hearing were presented in charts (Hartmann 1885, Gradenigo 1893) which can be considered precursors of modern audiograms. The evolution of these instruments and methods is described in detail and illustrated by exhibits from the museum.