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The Home Medical
Library
By
KENELM WINSLOW, B.A.S., M.D.
_Formerly Assistant Professor Comparative Therapeutics, Harvard
University; Late Surgeon to the Newton Hospital;
Fellow of the Massachusetts Medical Society, etc._
With the Cooperation of Many Medical
Advising Editors and Special Contributors
IN SIX VOLUMES
_First Aid :: Family Medicines :: Nose, Throat, Lungs,
Eye, and Ear :: Stomach and Bowels :: Tumors and
Skin Diseases :: Rheumatism :: Germ Diseases
Nervous Diseases :: Insanity :: Sexual Hygiene
Woman and Child :: Heart, Blood, and Digestion
Personal Hygiene :: Indoor Exercise
Diet and Conduct for Long Life :: Practical
Kitchen Science :: Nervousness
and Outdoor Life :: Nurse and Patient
Camping Comfort :: Sanitation
of the Household :: Pure
Water Supply :: Pure Food
Stable and Kennel_
NEW YORK
The Review of Reviews Company
1907
Medical Advising Editors
Managing Editor
ALBERT WARREN FERRIS, A.M., M.D.
_Former Assistant in Neurology, Columbia University; Former Chairman,
Section on Neurology and Psychiatry, New York Academy of Medicine;
Assistant in Medicine, University and Bellevue Hospital Medical
College; Medical Editor, New International Encyclopedia._
Nervous Diseases
CHARLES E. ATWOOD, M.D.
_Assistant in Neurology, Columbia University; Former Physician, Utica
State Hospital and Bloomingdale Hospital for Insane Patients; Former
Clinical Assistant to Sir William Gowers, National Hospital, London._
Pregnancy
RUSSELL BELLAMY, M.D.
_Assistant in Obstetrics and Gynecology, Cornell University Medical
College Dispensary; Captain and Assistant Surgeon (in charge),
Squadron A, New York Cavalry; Assistant in Surgery, New York
Polyclinic._
Germ Diseases
HERMANN MICHAEL BIGGS, M.D.
_General Medical Officer and Director of Bacteriological Laboratories,
New York City Department of Health; Professor of Clinical Medicine in
University and Bellevue Hospital Medical College; Visiting Physician
to Bellevue, St. Vincent's, Willard Parker, and Riverside Hospitals._
The Eye and Ear
J. HERBERT CLAIBORNE, M.D.
_Clinical Instructor in Ophthalmology, Cornell University Medical
College; Former Adjunct Professor of Ophthalmology, New York
Polyclinic; Former Instructor in Ophthalmology in Columbia University;
Surgeon, New Amsterdam Eye and Ear Hospital._
Sanitation
THOMAS DARLINGTON, M.D.
_Health Commissioner of New York City; Former President Medical Board,
New York Foundling Hospital; Consulting Physician, French Hospital;
Attending Physician, St. John's Riverside Hospital, Yonkers; Surgeon
to New Croton Aqueduct and other Public Works, to Copper Queen
Consolidated Mining Company of Arizona, and Arizona and Southeastern
Railroad Hospital; Author of Medical and Climatological Works._
Menstruation
AUSTIN FLINT, JR., M.D.
_Professor of Obstetrics and Clinical Gynecology, New York University
and Bellevue Hospital Medical College; Visiting Physician, Bellevue
Hospital; Consulting Obstetrician, New York Maternity Hospital;
Attending Physician, Hospital for Ruptured and Crippled, Manhattan
Maternity and Emergency Hospitals._
Heart and Blood
JOHN BESSNER HUBER, A.M., M.D.
_Assistant in Medicine, University and Bellevue Hospital Medical
College; Visiting Physician to St. Joseph's Home for Consumptives;
Author of "Consumption: Its Relation to Man and His Civilization; Its
Prevention and Cure."_
Skin Diseases
JAMES C. JOHNSTON, A.B., M.D.
_Instructor in Pathology and Chief of Clinic, Department of
Dermatology, Cornell University Medical College._
Diseases of Children
CHARLES GILMORE KERLEY, M.D.
_Professor of Pediatrics, New York Polyclinic Medical School and
Hospital; Attending Physician, New York Infant Asylum, Children's
Department of Sydenham Hospital, and Babies' Hospital, N. Y.;
Consulting Physician, Home for Crippled Children._
Bites and Stings
GEORGE GIBIER RAMBAUD, M.D.
_President, New York Pasteur Institute._
Headache
ALONZO D. ROCKWELL, A.M., M.D.
_Former Professor Electro-Therapeutics and Neurology at New York
Post-Graduate Medical School; Neurologist and Electro-Therapeutist to
the Flushing Hospital; Former Electro-Therapeutist to the Woman's
Hospital in the State of New York; Author of Works on Medical and
Surgical Uses of Electricity, Nervous Exhaustion (Neurasthenia), etc._
Poisons
E. ELLSWORTH SMITH, M.D.
_Pathologist, St. John's Hospital, Yonkers; Somerset Hospital,
Somerville, N. J.; Trinity Hospital, St. Bartholomew's Clinic, and the
New York West Side German Dispensary._
Catarrh
SAMUEL WOOD THURBER, M.D.
_Chief of Clinic and Instructor in Laryngology, Columbia University;
Laryngologist to the Orphan's Home and Hospital._
Care of Infants
HERBERT B. WILCOX, M.D.
_Assistant in Diseases of Children, Columbia University._
Special Contributors
Food Adulteration
S. JOSEPHINE BAKER, M.D.
_Medical Inspector, New York City Department of Health._
Pure Water Supply
WILLIAM PAUL GERHARD, C.E.
_Consulting Engineer for Sanitary Works; Member of American Public
Health Association; Member, American Society Mechanical Engineers;
Corresponding Member of American Institute of Architects, etc.; Author
of "House Drainage," etc._
Care of Food
JANET MCKENZIE HILL
_Editor, Boston Cooking School Magazine._
Nerves and Outdoor Life
S. WEIR MITCHELL, M.D., LL.D.
_LL.D. (Harvard, Edinburgh, Princeton); Former President, Philadelphia
College of Physicians; Member, National Academy of Sciences,
Association of American Physicians, etc.; Author of essays: "Injuries
to Nerves," "Doctor and Patient," "Fat and Blood," etc.; of scientific
works: "Researches Upon the Venom of the Rattlesnake," etc.; of
novels: "Hugh Wynne," "Characteristics," "Constance Trescott," "The
Adventures of Francois," etc._
Sanitation
GEORGE M. PRICE, M.D.
_Former Medical Sanitary Inspector, Department of Health, New York
City; Inspector, New York Sanitary Aid Society of the 10th Ward, 1885;
Manager, Model Tenement-houses of the New York Tenement-house Building
Co., 1888; Inspector, New York State Tenement-house Commission, 1895;
Author of "Tenement-house Inspection," "Handbook on Sanitation," etc._
Indoor Exercise
DUDLEY ALLEN SARGENT, M.D.
_Director of Hemenway Gymnasium, Harvard University; Former President,
American Physical Culture Society; Director, Normal School of Physical
Training, Cambridge, Mass.; President, American Association for
Promotion of Physical Education; Author of "Universal Test for
Strength," "Health, Strength and Power," etc._
Long Life
SIR HENRY THOMPSON, Bart., F.R.C.S., M.B. (Lond.)
_Surgeon Extraordinary to His Majesty the King of the Belgians;
Consulting Surgeon to University College Hospital, London; Emeritus
Professor of Clinical Surgery to University College, London, etc._
Camp Comfort
STEWART EDWARD WHITE
_Author of "The Forest," "The Mountains," "The Silent Places," "The
Blazed Trail," etc._
[Illustration: HARVEY WASHINGTON WILEY, Ph.D., LL.D.
The researches of Dr. Wiley, Chief of the Bureau of Chemistry in the
United States Department of Agriculture, were important factors in
hastening the enactment of the present pure food law. He analyzed the
various food products and made public the deceptions practiced by
unscrupulous manufacturers. He aroused attention throughout the
country by pointing out the necessity of a campaign of education, in
order, as stated in Volume V, Part II, that the housekeeper might be
able to determine the purity of every article of food offered for
sale. As an example of his methods, he organized a "poison squad" of
government employees who restricted themselves to special diets,
consisting of food preparations containing drugs commonly used as
adulterants. In this way he actually demonstrated the effect of these
substances upon the human system.]
The Home Medical
Library
Volume II
THE EYE AND EAR
THE NOSE, THROAT AND LUNGS
SKIN DISEASES
TUMORS :: RHEUMATISM
HEADACHE :: SEXUAL HYGIENE
By KENELM WINSLOW, B.A.S., M.D. (Harv.)
_Formerly Assistant Professor Comparative Therapeutics, Harvard
University; Late Surgeon to the Newton Hospital; Fellow of the
Massachusetts Medical Society, etc._
INSANITY
By ALBERT WARREN FERRIS, A.M., M.D.
_Former Assistant in Neurology, Columbia University; former Chairman,
Section on Neurology and Psychiatry, New York Academy of Medicine;
Assistant in Medicine, University and Bellevue Hospital Medical
College; Medical Editor, "New International Encyclopedia"_
NEW YORK
The Review of Reviews Company
1907
Copyright, 1907, by
THE REVIEW OF REVIEWS COMPANY
THE TROW PRESS, NEW YORK
_Contents_
PART I
CHAPTER PAGE
I. THE EYE AND EAR 13
Foreign Bodies in the Eye--Black Eye--Twitching of
the Eyelids--Wounds and Burns--Congestion--
Conjunctivitis--"Pink Eye"--Strain--Astigmatism--
Deafness--Foreign Bodies in the Ear--Earache--Simple
Remedies.
II. THE NOSE AND THROAT 51
Nosebleed--Foreign Bodies in the Nose--Cold in the
Head--Toothache--Mouth-Breathing--Sore Mouth--
Pharyngitis--How to Treat Tonsilitis--Quinsy--
Diphtheria--Croup--Laryngitis.
III. THE LUNGS AND BRONCHIAL TUBES 87
Acute and Chronic Bronchitis--Coughs in Children--
Liniments and Poultices--Cough Mixtures--Treatment
of Pneumonia--Consumption--Asthma--Influenza, its
Symptoms and Cure.
IV. HEADACHES 113
Causes of Sick Headache--Symptoms and Treatment--
Headaches Caused by Indigestion--Organic Disease a
Frequent Source--Nervous and Neuralgic Headaches--
Effect of Poison--Heat-Stroke.
PART II
I. GROWTHS AND ENLARGEMENTS 123
Cancers--Fatty Tumors--Use of Patent Preparations
Dangerous--Symptoms and Cure of Rupture--The Best
Kind of Truss--Varicose Veins--Varicocele--External
and Internal Piles--Operations the Most Certain
Cure.
II. SKIN DISEASES AND RELATED DISORDERS 139
Itching, Chafing, and Chapping--Treatment of
Hives--Nettlerash--Pimples--Fever Blisters--Prickly
Heat--Cause of Ringworm--Freckles and Other Skin
Discolorations--Ivy Poison--Warts and Corns--
Boils--Carbuncles.
III. RHEUMATISM AND KINDRED DISEASES 169
Inflammatory Rheumatism--Symptoms and Treatment--
Muscular Rheumatism--Lumbago--Stiff Neck--Rheumatism
of the Chest--Chronic Rheumatism--Rheumatic Gout--
Scurvy in Adults and Infants--Gout, its Causes and
Remedies.
PART III
I. HEALTH AND PURITY 191
Duties of Parents--Sexual Abuse--Dangers to
Health--Physical Examination of Infants--Necessary
Knowledge of Sex Functions Natural--The Critical Age
of Puberty--Marriage Relations.
II. GENITO-URINARY DISEASES 199
Gonorrhea in Men and Women--Dangers of Infection--
Syphilis, its Causes, Symptoms, and Treatment--
Incontinence and Suppression of Urine--Bed-wetting--
Inflammation of the Bladder--Acute and Chronic
Bright's Disease.
PART IV
I. INSANITY 229
Mental Disorder Not Insanity--Illusions of the
Insane--Hallucinations and Delusions--Signs and
Causes of Insanity--Paranoia--How the Physician
Should Be Aided--The Best Preventive.
_Appendix._ PATENT MEDICINES 245
Advice Regarding the Use of Patent Medicines--Laws
Regulating the Sale of Drugs--Proprietary
Medicines--Good Remedies--Dangers of So-called
"Cures"--Headache Powders--The Great American Fraud.
Part I
THE EYE AND EAR, THE NOSE
AND THROAT, THE LUNGS
AND BRONCHIAL TUBES,
HEADACHES
BY
KENELM WINSLOW
CHAPTER I
=The Eye and Ear=
_Injuries to the Eye--Inflammatory Conditions--"Pink
Eye"--Nearsightedness and Farsightedness--Deafness--Remedies for
Earache._
=CINDERS AND OTHER FOREIGN BODIES IN THE EYE.=--Foreign bodies are
most frequently lodged on the under surface of the upper lid, although
the surface of the eyeball and the inner aspect of the lower lid
should also be carefully inspected. A drop of a two-per-cent solution
of cocaine will render painless the manipulations. The patient should
be directed to continue looking downward, and the lashes and edge of
the lid are grasped by the forefinger and thumb of the right hand,
while a very small pencil is gently pressed against the upper part of
the lid, and the lower part is lifted outward and upward against the
pencil so that it is turned inside out. The lid may be kept in this
position by a little pressure on the lashes, while the cinder, or
whatever foreign body it may be, is removed by gently sweeping it off
the mucous membrane with a fold of a soft, clean handkerchief.
Hot cinders and pieces of metal may become so deeply lodged in the
surface of the eye that it is necessary to dig them out with a needle
(which has been passed through a flame to kill the germs on it) after
cocaine solution has been dropped into the eye twice at a minute
interval. Such a procedure is, of course, appropriate for an oculist,
but when it is impossible to secure medical aid for days it can be
attempted without much fear, if done carefully, as more harm will
result if the offending body is left in place. It is surprising to see
what a hole in the surface of the eye will fill up in a few days. If
the foreign body has caused a good deal of irritation before its
removal, it is best to drop into the eye a solution of boric acid (ten
grains to the ounce of water) four times daily.
"=BLACK EYE.="--To relieve this condition it is first necessary to
reduce the swelling. This can be done by applying to the closed lids,
every three minutes, little squares of white cotton or linen, four
fold and about as large as a silver dollar, which have laid on a cake
of ice until thoroughly cold. This treatment is most effective when
pursued almost continuously for twenty-four hours. The cold compresses
should not be permitted to overlap the nose, or a violent cold in the
head may ensue. The swelling having subsided, the discoloration next
occupies our attention. This may be removed speedily by applying, more
or less constantly below the lower lid, little pieces of flannel
dipped in water as hot as can be borne. The cloths must be changed as
often as they cool. Repeat this treatment for a half hour every two
hours or so during the day.
=STYE.=--A stye is a boil on the eyelid; it begins at the root of a
hair as a hard swelling which may extend to the whole lid. The tip of
the swelling takes on a yellowish color, breaks down and discharges
"matter" or pus. There are pain and a feeling of tension in the lid,
and, very rarely, some fever. When one stye follows another it is well
to have the eyes examined by an oculist, as eye-strain is often an
inviting cause of the trouble, and this can be corrected by the use of
glasses. Otherwise the patient is probably "run down" from chronic
constipation and anaemia (poverty of the blood) and other causes, and
needs a change of air, tonics, and exercise out of doors. In a
depreciated condition, rubbing the lids causes introduction of disease
germs.
The immediate treatment, which may cut short the trouble, consists in
bathing the eyelid for fifteen minutes at a time, every hour, with a
hot solution of boric acid (half a teaspoonful to the cup of water).
Then at night the swelling should be painted with collodion, several
coats, being careful not to get it in the eye, as it would cause much
smarting. If the stye persists in progressing, bathing it in hot water
will cause it to discharge pus and terminate much sooner.
=TWITCHING OF THE EYELIDS.=--This condition may be due to eye-strain,
and can be relieved if the eyes are fitted to glasses by an oculist
(not an optician). It is frequently an accompaniment of inflammation
of the eyes, and when this is cured the twitching of the lids
disappears. When the eyes are otherwise normal the twitching is
frequently one of the signs of nerve fag and overwork.
=WOUNDS AND BURNS ABOUT THE EYES.=--Slight wounds of the inner surface
of the eyelids close readily without stitching if the boric-acid
solution (ten grains to the ounce of water) is dropped into the eye
four times daily. Burns of the inner surface of the lids follow the
entrance of hot water, hot ashes, lime, acids, and molten metals.
Burns produced by lime are treated by dropping a solution of vinegar
(one part of vinegar to four of water) into the eye, while those
caused by acids are relieved by similar treatment with limewater or
solution of baking soda (half a teaspoonful to the glass of water). If
these remedies are not at hand, the essential object is attained by
washing the eye with a strong current of water, as from a hose or
faucet. If there is much swelling of the lids, and inflammation after
the accident, drop boric-acid solution into the eye four times daily.
Treatment by cold compresses, as recommended for "black eye," will do
much also to quiet the irritation, and the patient should wear dark
glasses.
=SORE EYES; CONJUNCTIVITIS.=--The mucous membrane lining the inner
surface of the eyelids also covers the front of the eyeball, although
so transparent here that it is not apparent to the observer.
Inflammation of this membrane is more commonly limited to that portion
covering the inner surfaces of the lids, but may extend to the
eyeball when the eye becomes "bloodshot" and the condition more
serious. For the sake of convenience we may speak of a mild form of
sore eye, as _congestion of the eyelids_, and the more severe type, as
true _conjunctivitis_ (see p. 18).
=CONGESTION OF THE EYELIDS.=--This may be caused by smoke or dust in
the atmosphere, by other foreign bodies in the eye; frequently by
eye-strain, due to far- or near-sightedness, astigmatism, or muscular
weakness, which may be corrected by an oculist's (never an optician's)
prescription for glasses. Exposure to an excessive glare of light, as
in the case of firemen, or, on the other hand, reading constantly and
often in a poor light, will induce irritation of the lids. The germs
which cause "cold in the head" often find their way into the eyes
through the tear ducts, which connect the inner corner of the eyes
with the nose, and thus may set up similar trouble in the eyes.
=Symptoms.=--The eyes feel weary and "as if there were sand in them."
There may be also smarting, burning, or itching of the lids, and there
is disinclination for any prolonged use of the eyes. The lids, when
examined, are found to be much deeper red than usual, and slightly
swollen, but there is no discharge from the eye, and this fact serves
to distinguish this mild type of inflammation from the more severe
form.
=Treatment.=--The use of dark glasses and a few drops of zinc-sulphate
solution (one grain to the ounce of water) in the eye, three times
daily, will often cure the trouble. If this does not do so within a
few days then an oculist should be consulted, and it will frequently
be found that glasses are needed to secure freedom from irritation of
the eyes. In using "eye-drops" the head should be held back, and
several drops be squeezed from a medicine dropper into the inner
corner of the eye.
=CONJUNCTIVITIS; CATARRHAL INFLAMMATION OF THE EYES.=--In this
disorder there is discharge which sticks the lids together during the
night. The inner surface of the lids is much reddened, the blood
vessels in the lining membrane are much enlarged, and the lids are
slightly swollen. The redness may extend to the eyeball and give it a
bloodshot appearance. There is no interference with sight other than
momentary blurring caused by the discharge, and occasionally there is
very severe pain, as if a cinder had suddenly fallen in the eye. This
symptom may occur at night and awaken the patient, and may be the
reason for his first consulting a physician.
One eye is commonly attacked twenty-four to thirty-six hours before
the other, and even if it is thought that the cause is a cinder, in
case of one eye, it can hardly be possible to sustain this belief in
the case of the involvement of both eyes. There is a feeling of
discomfort about the eyes, and often a burning, and constant watering,
the tears containing flakes of white discharge.
When the discharge is a copious, creamy pus or "matter," associated
with great swelling of the lids and pain on exposure to light, the
cause is usually a germ of a special disease, and the eyesight will
very probably be lost unless a skillful physician be immediately
secured. Early treatment is, however, of great service, and, until a
physician can be obtained, the treatment recommended below should be
followed conscientiously; by this means the sight may be saved. This
dangerous variety of inflammation of the eyes is not rare in the
newborn, and infants having red eyes within a few days of birth should
immediately receive proper attention, or blindness for life will be
the issue. This is the usual source of that form of blindness with
which babies are commonly said to have been born.
All forms of severe inflammation of the lids are contagious,
especially the variety last considered, and can be conveyed, by means
of the discharge, through the agency of towels, handkerchiefs, soap,
wash basins, etc., and produce the same or sometimes different types
of inflammation in healthy eyes. Therefore, if the severe form of
conjunctivitis breaks out among any large number of people, as in
schools, prisons, asylums, and almshouses, isolation of the patients
should be enforced.
"=PINK EYE.="--This is a severe epidemic form of catarrh of the eye,
which is caused by a special germ known as the "Koch-Weeks bacillus."
The treatment of this is the same as that outlined below. The germ of
pneumonia and that of grippe also often cause conjunctivitis, and
"catching cold," chronic nasal catarrh, exposure to foul vapors and
gases, or tobacco smoke, and the other causes enumerated, as leading
to congestion of the lids, are also responsible for catarrhal
inflammation of the eye.
=Treatment.=--In the milder attacks of conjunctivitis the treatment
should be that recommended above for congestion of the lids. The
swelling and inflammation, in the severer types, are greatly relieved
by the application of the cold-water compresses, advised under the
section on "black eye," for an hour at a time, thrice daily.
Confinement in a dark room, or the use of dark glasses, and drops of
zinc sulphate (one grain in an ounce of water) three times a day, with
hourly dropping of boric acid (ten grains to the ounce of water)
constitute the ordinary treatment.
In inflammations with copious discharge of creamy pus, and great
swelling of the lids, the eyes should be washed out with the
boric-acid solution every half hour, and a solution of silver nitrate
(two grains to the ounce of water) dropped into the eye, once daily,
followed immediately by a weak solution of common salt in water to
neutralize the nitrate of silver, after its action has been secured.
The constant use of ice cloths, already mentioned, forms a necessary
adjunct to treatment. The sound eye must be protected from the chance
of contagion, arising from a possible infection from the pus
discharging from its mate. This may be secured by bandaging the well
eye, or, better, by covering it with a watch crystal kept in place by
surgeon's plaster.
In treating sore eyes with discharge, in babies, the infant should be
held in the lap with its head backward and inclined toward the side of
the sore eye, so that in washing the eye no discharge will flow into
the sound eye. The boric acid may then be dropped from a medicine
dropper, or applied upon a little wad of absorbent cotton, to the
inner corner of the eye, while the eyelids are held apart.
Hemorrhages occurring under the conjunctiva (or membrane lining the
inner surface of the lids and covering the front surface of the
eyeball) may be caused by blows or other injury to the eye, by violent
coughing, by straining, etc. Dark-red spots may appear in the white of
the eyeball, slightly raised above the surface, which are little blood
clots under the conjunctival membrane. No special trouble results and
there is nothing to be done except to wait till the blood is absorbed,
which will happen in time. If the eyes water, solution of zinc
sulphate (one grain to the ounce of water) may be dropped into the
eye, twice daily. Hot applications are beneficial here to promote
absorption of the clot.
=EYE-STRAIN.=--Eye-strain is commonly due to either astigmatism,
nearsightedness, farsightedness, or weakness of the eye muscles. The
farsighted eye is one in which parallel rays entering the eye, as from
a distance, come to a focus behind the retina. The retina is the
sensitive area for receiving light impressions in the back of the
eyeball. Sight is really a brain function; one sees with the brain,
since the optic nerve endings in the back of the eye merely carry
light impressions to the brain where they are properly interpreted.
In order that vision be clear and perfect, it is essential that the
rays of light entering the eye be bent so that they strike the retina
as a single point. In the farsighted or hyperopic eye, the eyeball is
usually too short for the rays to be properly focused on the sensitive
nerve area in the back of the eye.
This defect in vision is, however, overcome by the act of
"accommodation." There is a beautiful transparent, double-convex body,
about one-third of an inch thick, which looks very much like an
ordinary glass lens, and is situated in the eye just back of the
pupil. This is what is known as the crystalline lens, and the rays of
light are bent in passing through it so as to be properly focused on
the retina.
The foregoing statements have been made as though objects were always
at a distance from the eye, so that the rays of light coming from them
were almost parallel. Yet when one is looking at an object within a
few inches of the eye the rays diverge or spread out, and these the
normal eye (if rigid) could not focus on the retina--much less the
farsighted eye. But the eye is adaptable to change of focus through
the action of a certain muscle, situated within the eyeball about the
lens, which controls to a considerable extent the shape of the lens.
When the muscle contracts it allows the lens to bulge forward by
virtue of its elasticity, and, therefore, become more convex. This is
what happens when one looks at near objects, the increased convexity
of the lens bending the rays of light so that they will focus as a
point on the retina. (See Plate I, p. 30.)
Now in the farsighted eye this muscular control or "accommodative
action" must be continually exercised even in looking at distant
objects, and it is this constant attempt of nature to cure an optical
defect of the eye which frequently leads to nervous exhaustion or
eye-strain. The nerve centers, which animate and control the nerves
supplying the eye muscles to which we have just alluded, are in close
proximity to other most important nerve centers in the brain, so
irritation of the eye centers will produce sympathetic irritation of
these other centers, leading to manifold and complex symptoms which we
will describe under this head. But these symptoms do not necessarily
develop in everyone having farsightedness or astigmatism, since both
are often present at birth.
The power of accommodation is sufficient to overcome the optical
defect of the eye, providing that the general health is good and the
eye is not used much for near work. If, on the other hand, excessive
use of the eyes in reading, writing, figuring, sewing, or other fine
work is required, and especially if the health becomes impaired, it
happens that the constant drain on the eye center in the brain will
result in a group of symptoms which we will consider later. Failure of
accommodation comes on at about forty, and gradually increases until
all accommodation is lost at the age of seventy-five.
For this reason it is necessary for persons over forty-five years of
age, having normal or farsighted eyes, to wear convex glasses in
reading or doing near work, and these should be changed for stronger
ones every year or two. These convex glasses save the eyes in their
attempt to make the lens more convex when looking at near objects in
farsightedness, and also prove serviceable in the same manner when
accommodation begins to fail in the case of what is called "old
sight." The neglect to provide proper glasses for reading any time
after the age of forty-five, and the failure to replace them by
stronger lenses when required, distinctly favor the occurrence of
cataract in later life.
In the act of accommodation, in addition to the muscular action by
which the lens is made more convex, there is the tendency for the
action of another group of muscles outside the eyeball, which turn the
eyes inward when they are directed toward a near object. Here then is
another source of trouble resulting from farsightedness, i. e., the
not infrequent occurrence of inward "squint" occasioned by the
constant use of the muscles pulling the eyes inward during
accommodation for near objects. Again, inflammation of the eyelids,
and sometimes of deeper parts of the eyeball, follows untreated
hyperopia. Early distaste for reading is often acquired by farsighted
persons, owing to the strain on the accommodative apparatus. The
convex lens is that used to correct farsightedness.
=NEARSIGHTED EYE.=--In the nearsighted eye the eyeball is too long for
parallel rays entering the eye to be focused upon the retina; they are
bent, instead, to a point in front of the retina, and then diverge
making the vision blurred. (Plate I, p. 30.) The act of accommodation
in making the lens more convex will not aid this condition, but only
make it worse, so that it is not attempted.
Eye-strain in this optical defect is brought on by constant use of the
eye muscles (attached to the outside of the eyeball) in directing both
eyes inward so that they will both center on near objects; the only
ones which can be seen. Outward squint frequently results, because the
muscular efforts required to direct both eyes equally inward to see
near objects are so great that the use of both eyes together is given
up, and the poorer eye is not used and squints outward, while the
better eye is turned inward in the endeavor to see. Nearsighted
persons are apt to stoop, owing to the habitual necessity for coming
close to the object looked at. Their facial expression is also likely
to be rather vacant, since they do not distinctly see, and do not
respond to the facial movements of others.
Nearsightedness, or myopia, is not a congenital defect, but is usually
acquired owing to excessive near work which requires that the eye
muscles constantly direct both eyes inward to see near objects. In so
acting the muscles compress the sides of the eyeballs and tend to
increase their length, interfere with their nutrition, and aggravate
the condition when it is once begun. (See Diagram.) Concave lenses are
used to correct myopia, and they must be worn all the time.
=ASTIGMATISM.=--This is a condition caused by inequality of the outer
surface of the front of the eyeball, and rarely by a similar defect in
the surfaces of the lens. The curvature of the eyeball in the
astigmatic eye is greater in one meridian than in the opposite. In
other words, the front of the eyeball is not regularly spherical, but
bulges out along a certain line or meridian, while the curvature is
flattened or normal in the other meridian. For instance, if two
imaginary lines were drawn, one vertically, and the other horizontally
across the front of the eyeball intersecting in the center of the
pupil, they would represent the principal meridians, the vertical and
the horizontal. As a rule the meridian of greatest curvature is
approximately vertical, and that of least curvature is at right angles
to it, or horizontal.
Rays of light in passing through the different meridians of the
astigmatic eye are differently bent, so that in one of the principal
meridians rays may focus perfectly on the retina, while in the other
the rays may focus on a point behind the retinal field. In this case
the eye is made farsighted or hyperopic in one meridian, and is
normal in the other. Or again, the rays may be focused in front of the
retina in one meridian, and directly on the retina in the other; this
would be an example of nearsighted or myopic astigmatism.
Farsightedness and nearsightedness are then both caused by
astigmatism, although in this case not by the length of the eyeball,
but by inequality in the curvature of the front part (cornea) of the
eyeball. For example, in simple astigmatism one of the principal
meridians is hyperopic (turning the rays so that they focus behind the
retina) or myopic (bending the rays so that they focus in front of the
retina), while the other meridian is normal. In mixed astigmatism, one
of the principal meridians is myopic, the other hyperopic; in compound
astigmatism the principal meridians are both myopic, or both
hyperopic, but differ in degree; while in irregular astigmatism, rays
of light passing through different parts of the outer surface of the
eyeball are turned in so many various directions that they can never
be brought to a perfect focus by glasses.
It is not by any means possible for a layman to be able always to
inform himself that he is astigmatic, unless the defect is
considerable. If a card, on which are heavy black lines of equal size
and radiating from a common center like the spokes of a wheel, be
placed on a wall in good light, it will appear to the astigmatic eye
as if certain lines (which are in the faulty meridian of the eyeball)
are much blurred, while the lines at right angles to these are clear
and distinct. Each eye should be tested separately, the other being
closed. The chart should be viewed from a distance as great as any
part of it can be seen distinctly. All the lines on the test card
should look equally black and clear to the normal eye.
Astigmatism is corrected by a cylindrical lens, which is in fact a
segment of a solid cylinder of glass. The axis of the cylindrical lens
should be at right angles to the defective meridian of the eye, in
order to correct the astigmatism. Eye-strain is caused by astigmatism
in the same manner that it is brought about in the simple farsighted
eye, i. e., by constant strain on the ciliary muscle, which regulates
the convexity of the crystalline lens. For it is possible for the
inequalities of the front surface of the eyeball or of the lens to be
offset or counterbalanced by change in the convexity of the lens
produced by the action of this muscle, and it is conceivable that the
axis of the lens may be tilted one way or another by the same agency,
and for the same purpose. But, as we have already pointed out, this
continual muscular action entails great strain on the nerve centers
which animate the muscle, and if constant near work is requisite, or
the health is impaired, the nervous exhaustion becomes apparent. The
lesser degrees of astigmatism often give more trouble than the
greater.
[Illustration: PLATE I
=Plate I=
=ANATOMY OF THE EYE=
The upper illustration shows the six muscles attached to the eye. The
=Superior Rectus Muscle= pulls and directs the eye upward; the
=Inferior Rectus=, downward; the =External= and =Internal Rectus
Muscles= pull the eye to the right and left; the =Oblique Muscles=
move the eye slantwise in any direction.
Lack of balance of these muscles, and especially inability to focus
both eyes on a near object without effort, constitute "eye-strain."
The lower cut illustrates the relation of the crystalline lens to
sight. =Lens Nearsight Focus= shows the lens bulging forward and very
convex; =Lens Farsight Focus= shows it flat and less convex.
This adjustment of the shape of the crystalline lens is called
"accommodation"; it is effected by a small muscle in the eyeball.
In the normal eye, the rays of light from an object pass through the
lens, adjusted for the proper distance, and focus on the retina.
In the nearsighted eye, these rays focus at a point in front of the
retina; while in the farsighted eye these rays focus behind the
retina; the nearsighted eye being elongated, and the farsighted eye
being shortened.]
=WEAKNESS OF THE EYE MUSCLES.=--There are six muscles attached to the
outside of the eyeball which pull it in various directions, and so
enable each eye to be directed upon a common point, otherwise objects
will appear double. Weakness of these muscles or insufficiency,
especially of those required to direct the eyes inward for near work,
may lead to symptoms of eye-strain. When reading, for example, the
muscles which pull the eye inward soon grow tired and relax, allowing
the opposing muscles to pull the eye outward so that the eyes are no
longer directed toward a common point, and two images may be perceived
or, more frequently, they become fused together producing a general
blurring on the page. Then by a new effort of will the internal
muscles pull the eyes into line again, only to have the performance
repeated, all of which entails a great strain upon the nervous system,
and may lead to permanent squint, as has been pointed out. In addition
to these symptoms caused by weakness of the eye muscles--seeing
double, blurred vision, and want of endurance for close work--there
are others which are common to eye-strain in general, as headache,
nausea, etc., described in the following paragraph.
=Symptoms of Eye-strain.=--Headache is the most frequent symptom. It
may be about the eyes, but there is no special characteristic which
will positively enable one to know an eye headache from that arising
from other sources, although eye-strain is probably the most common
cause of headache. The headache resulting from eye-strain may then be
in the forehead, temples, top or the back of the head, or limited
to one side. It frequently takes the form of "sick headache" (p. 113).
It is perhaps more apt to appear after any unusual use of the eyes in
reading, writing, sewing, riding, shopping, or sight-seeing, and going
to theaters and picture galleries, but this is not by any means
invariably the case, as eye headache may appear without apparent
cause.
Nausea and vomiting, with or without headache, nervousness,
sleeplessness, and dizziness often accompany eye-strain. Sometimes
there is weakness of the eyes, i. e., lack of endurance for eye work,
twitching of the eyelids, weeping, styes, and inflammation of the
lids. In view of the extreme frequency of eye-disorders which lead to
eye-strain, it behooves people, in the words of an eminent medical
writer, to recognize that "the subtle influence of eye-strain upon
character is of enormous importance" inasmuch as "the disposition may
be warped, injured, and wrecked," especially in the young. Some of the
more serious nervous diseases, as nervous exhaustion, convulsions,
hysteria, and St. Vitus's dance may be caused by the reflex irritation
of the central nervous system following eye-strain.
=Treatment of Eye-strain.=--The essential treatment of eye-strain
consists in the wearing of proper glasses. It should be a rule,
without any exception, to consult only a regular and competent
oculist, and never an optician, for the selection of glasses. It is as
egregious a piece of folly to employ an optician to choose the
glasses as it would be to seek an apothecary's advice in a general
illness. Considerably more damage would probably accrue from following
the optician's prescription than that of the apothecary, because
nature would soon offset the effects of an inappropriate drug; but the
damage to the eyes from wearing improper glasses would be lasting.
Properly to determine the optical error in astigmatic and farsighted
eyes it is essential to place drops in the eye, which dilate the pupil
and paralyze the muscles that control the convexity of the crystalline
lens, and to use instruments and methods of examination, which can
only be properly undertaken and interpreted by one with the general
and special medical training possessed by an oculist.
The statement has been emphasized that farsighted and astigmatic
persons, up to the age of forty-five or fifty, can sometimes overcome
the optical defects in their eyes by exercise of the ciliary muscle
which alters the shape of the lens, and, therefore, it would be
impossible for an examiner to discover the fault without putting drops
in the eye, which temporarily paralyze the ciliary muscles for from
thirty-six to forty-eight hours, but otherwise do no harm. After the
age of fifty it may be unnecessary to use drops, as the muscular power
to alter the convexity of the lens is greatly diminished. Opticians
are incompetent to employ these drops, as they may do great damage in
certain conditions of the eye which can only be detected by a medical
man specially trained for such work. Opticians are thus sure to be
caught on one of the horns of a dilemma; either they do not use drops
to paralyze the ciliary muscle, or, if they do employ the drops, they
may do irreparable damage to the eye. Any abnormality connected with
the vision, especially in children, should be a warning to consult an
oculist. Squint, "cross-eye" (_Strabismus_), as has been stated, may
often result from near- or far-sightedness, and it may be possible in
young children to cure the squint by the use of glasses or even drops
in the eye, whereas in later life it may be necessary to cut some of
the muscles of the eyeball to correct the condition. It is a wise rule
to subject every child to an oculist's examination before entering
upon school life.
=DEAFNESS.=--Sudden deafness without apparent reason is more apt to
result from an accumulation of wax than from any other cause. It is a
very common ear disorder. The opening into the ear is about an inch
long, or a little more, and is separated from that part of the ear
within, which is known as the middle ear, by the eardrum membrane. The
drum membrane is a thin, skinlike membrane stretched tightly across
the bottom of the external opening in the ear or auditory canal, and
shuts it off completely from the middle ear within, and in this way
protects the middle ear from the entrance of germs, dust, and water,
but only secondarily aids hearing. The obstruction caused by wax
usually exists in about the middle of the auditory canal or opening in
the ear, and only causes deafness when it completely blocks this
passage.
The deafness is sudden because, owing to the accidental entrance of
water, the wax quickly swells and chokes the canal; or, in attempts to
relieve irritation in the ear, the finger or some other object is
thrust into the opening in the ear (auditory canal) and presses the
wax down on the ear drum. The obstruction in the ear is usually a
mixture of waxy secretion from the canal, and little scales of dead
skin which become matted together in unwise efforts at cleansing the
ear by introducing a twisted towel or some other object into the ear
passage and there turning it about; or it may occur owing to disease
of the ear altering the character of the natural secretion. In the
normal state, the purpose of the wax is, apparently, to repel insects
and to glue together the little flakes of cast-off skin in the
auditory canal, and these, catching on the hairs lining the canal, are
thrown out of the ears upon the shoulders by the motion of the jaws in
eating.
Nothing should be introduced into the ear with the idea of cleansing
it, as the skin growing more rapidly from within tends naturally to
push the dead portions out as required, and so the canal is
self-cleansing.
=Symptoms.=--Sudden deafness in one ear usually calls the attention of
the patient to an accumulation of wax. There is apt to be more or less
wax in the other ear as well. Noises in the deaf ear and a feeling of
pressure are also common. Among rarer symptoms are nausea and
dizziness. But the only way to be sure that deafness is due to choking
of the ear passage with wax is to see it. This is usually accomplished
by a physician in the following way: he throws a good light from a
mirror into a small tube introduced into the ear passage. This is, of
course, impossible for laymen to do, but if the ear is drawn upward,
backward, and outward, so as to straighten the canal, it may be
possible for anyone to see a mass of yellowish-brown or blackish
material filling the passage. And in any event, if the wax cannot be
seen, one is justified in treating the case as if it were present, if
sudden deafness has occurred and competent medical aid is
unobtainable, since no harm will be done if wax is absent, and, if it
is present, the escape of wax will usually give immediate relief from
the deafness and other symptoms.
=Treatment.=--The wax is to be removed with a syringe and water as hot
as can be comfortably borne. A hard-rubber syringe having a piston,
and holding from two teaspoonfuls to two tablespoonfuls, is to be
employed--the larger ones are better. The clothing should be protected
from water by towels placed over the shoulder, and a basin is held
under the ear to catch the water flowing out of the canal. The tip of
the syringe is introduced just within the entrance of the ear, which
is to be pulled backward and upward, and the stream of water directed
with some force against the upper and back wall of the passage rather
than directly down upon the wax. The water which is first returned is
discolored, and then, on repeated syringing, little flakes of dry
skin, with perhaps some wax adhering, may be seen floating on the top
of the water which flows from the ear, and finally, after a longer or
shorter period, a plug of wax becomes dislodged, and the whole trouble
is over.
This is the rule, but sometimes the process is very long and tedious,
only a little coming away at a time, and, rarely, dizziness and
faintness will require the patient to lie down for a while. The water
should always be removed from the ear after syringing by twisting a
small wisp of absorbent cotton about the end of a small stick, as a
toothpick, which has been dipped into water to make the cotton adhere.
The tip of the toothpick, thus being thoroughly protected by dry
cotton applied so tightly that there is no danger of it slipping off,
while the ear is pulled backward and upward to straighten the canal,
is gently pushed into the bottom of the canal and removed, and the
process repeated with fresh cotton until it no longer returns moist.
Finally a pledget of dry cotton should be loosely packed into the ear
passage, and worn by the patient for twelve or twenty-four hours.
=PERSISTENT AND CHRONIC DEAFNESS.=--A consideration of deafness
requires some understanding of the structure and relations of the ear
with other parts of the body, notably the throat. It has been pointed
out that the external ear--comprising the fleshy portion of the ear,
or auricle, and the opening, or canal, about an inch long--is
separated from that portion of the ear within (or middle ear) by the
drum membrane. The middle ear, while protected from the outer air by
the drum, is really a part of the upper air passages, and participates
in disorders affecting them. It is the important part of the ear as it
is the seat of most ear troubles, and disease of the middle ear not
only endangers the hearing, but threatens life through proximity to
the brain.
In the middle ear we have an air space connected with the throat by
the Eustachian tube, a tube about an inch long running downward and
forward to join the upper air passage at the junction of the back of
the nose and upper part of the throat. If one should run the finger
along the roof of the mouth and then hook it up behind and above the
soft palate one could feel the openings of these tubes (one for each
ear) on either side of the top of the throat or back of the nose,
according to the view we take of it.
Then the middle ear is also connected with a cavity in the bone back
of the ear (mastoid cavity or cells), and the outer and lower wall is
formed by the drum membrane. Vibrations started by sound waves which
strike the ear are connected by means of a chain of three little bones
from the drum through the middle ear to the nervous apparatus in the
internal ear. The head of one of these little bones may be seen by an
expert, looking into the ear, pressing against the inside of the drum
membrane. Stiffening or immovability of the joints between these
little bones, from catarrh of the middle ear, is most important in
producing permanent deafness. The middle ear space is lined with
mucous membrane continuous with that of the throat through the
Eustachian tube. This serves to drain mucus from the middle ear, and
also to equalize the air pressure on the eardrum so that the pressure
within the middle ear shall be the same as that without.
When there is catarrh or inflammation of the throat or nose it is apt
to extend up the Eustachian tubes and involve the middle ear. In this
way the tubes become choked and obstructed with the oversecretion or
by swelling. The air in the middle ear then becomes absorbed in part,
and a species of vacuum is produced with increased pressure from
without on the eardrum. The drum membrane will be pressed in, and
through the little bones pressure will be made against the sensitive
nervous apparatus, irritating it and giving rise to deafness,
dizziness, and the sensation of noises in the ear. Noises from without
will also be intensified in passing through the middle ear when it is
converted into a closed cavity through the blocking of the Eustachian
tube.
A very important feature following obstruction of the Eustachian
tubes, and rarefaction of the air in the middle ear, is that
congestion of the blood vessels ensues and increased secretion,
because the usual pressure of the air on the blood vessels within the
middle ear is taken away.
This then is the cause of most permanent deafness, to which is given
the name catarrhal deafness, because every fresh cold in the head, or
sore throat, tends to start up trouble in the ear such as we have just
described. Repeated attacks leave vestiges behind until permanent
deafness remains. In normal conditions every act of swallowing opens
the apertures of the Eustachian tubes in the throat, and allows of
equalization of the air pressure within and without the eardrum, but
if the nose is stopped up by a cold in the head, or enlargement of the
tonsil at the back of the nose (as from adenoids, see p. 61), the
process is reversed and air is exhausted from the Eustachian tubes
with each swallowing motion.
The moral to be drawn from all the foregoing is to treat colds
properly when they are present, keeping the nose and throat clean and
clear of mucus, and to have any abnormal obstruction in the nose or
throat and source of chronic catarrh removed, as enlarged tonsils,
adenoids, and nasal outgrowths.
=FOREIGN BODIES IN THE EAR.=--Foreign bodies, as buttons, pebbles,
beans, cherry stones, coffee, etc., are frequently placed in the ear
by children, and insects sometimes find their way into the ear passage
and create tremendous distress by their struggles. Smooth,
nonirritating bodies, as buttons, pebbles, etc., do no particular harm
for a long time, and may remain unnoticed for years. But the most
serious damage not infrequently results from unskillful attempts at
their removal by persons (even physicians unused to instrumental work
on the ear) who are driven to immediate and violent action on the
false supposition that instant interference is called for. Insects, it
is true, should be killed without delay by dropping into the ear sweet
oil, castor, linseed, or machine oil or glycerin, or even water, if
the others are not at hand, and then the insect should be removed in
half an hour by syringing as recommended for wax (p. 35).
To remove solid bodies, turn the ear containing the body, downward,
pull it outward and backward, and rub the skin just in front of the
opening into the ear with the other hand, and the object may fall out.
Failing in this, syringing with warm water, as for removal of wax,
while the patient is sitting, may prove successful. The essentials of
treatment then consist, first, in keeping cool; then in killing
insects by dropping oil or water into the ear, and, if syringing
proves ineffective, in using no instrumental methods in an attempt to
remove the foreign body, but in awaiting such time as skilled medical
services can be obtained. If beans or seeds are not washed out by
syringing, the water may cause them to swell and produce pain. To
obviate this, drop glycerin in the ear which absorbs water, and will
thus shrivel the seed.
=EARACHE.=--Earache is due usually not to neuralgia of the ear, but to
a true inflammation of the middle ear, which either subsides or
results in the accumulation of inflammatory products until the drum is
ruptured and discharge occurs from the external canal. The trouble
commonly originates from an extension of catarrhal disease of the nose
or throat; the germs which are responsible for these disorders finding
their way into the Eustachian tubes, and thus into the middle ear. Any
source of chronic catarrh of the nose or throat, as enlarged and
diseased tonsils, adenoids in children, or nasal obstruction, favor
the growth of germs and the occurrence of frequent attacks of acute
catarrh or "colds." The grippe has been the most fruitful cause of
middle-ear inflammation and earache in recent years. Any act which
forces up fluid or secretions from the back of the nose into the
Eustachian tubes (see section on Deafness) and thus into the middle
ear, is apt to set up inflammation there, either through the
introduction of germs, or owing to the mechanical injury sustained.
Thus the use of the nasal douche, the act of sniffing water into the
nose, or blowing the nose violently when there is secretion or fluid
in the back of the nose, or the employment of the post-nasal syringe
are one and all attended with this danger. Swimming on the back,
diving, or surf bathing also endangers the ear, as cold water is
forcibly driven not only into the external auditory canal, but, what
is more frequently a source of damage, into the Eustachian tubes
through the medium of the nose or throat. In this case the plugging
of the nose with cotton would be of more value than the external
canal, as is commonly practiced. If water has entered the Eustachian
tube, blowing the nose and choking merely aggravate the trouble. The
wiser plan is to do nothing but trust that the water will drain out,
and if pain ensues treat it as recommended below for earache.
Water in the ears is sometimes removed by jumping about on one foot
with the troublesome ear held downward, and if it is in the external
canal it may be wiped out gently with cotton on the end of a match, as
recommended in the article on treating wax in the ear (see p. 35). In
the treatment of catarrh in the nose or throat only a spray from an
atomizer should be used, as Dobell's or Seiler's solutions followed by
menthol and camphor, twenty grains of each to the ounce of alboline or
liquid vaseline.[1]
Exposure to cold and the common eruptive diseases of children, as
scarlet fever, measles, and also diphtheria, are common causes of
middle-ear inflammation. In the latter disorders the protection
afforded by a nightcap which comes down over the ears, and worn
constantly during the illness, is frequently sufficient to ward off
ear complications.
Although earache or middle-ear inflammation is common, its dangers are
not fully appreciated, since the various complications are likely to
arise, and the result is not rarely serious. Extension of the
inflammation to the bone behind the ear may necessitate chiseling
away a part of the skull to liberate pus or dead bone in this
locality, and the occurrence of abscess of the brain will necessitate
operation.
The use of leeches in the beginning of the attack is of great value,
and though unpleasant are not difficult or painful in their
application. One should be applied just in front of the opening into
the ear (which should be previously closed with cotton to prevent the
entrance of the leech), and the other behind the ear in the crease
where it joins the side of the head and at a point a little below the
level of the external opening into the ear. A drop of milk on these
spots will often start the leeches immediately at work, or a drop of
blood obtained with a pin prick. When the leeches are gorged with
blood and cease to suck, they should be removed and bleeding
encouraged for half an hour with applications of absorbent cotton
dipped in hot water. Then clean, dry absorbent cotton is applied, and
pressure made on the wounds if bleeding does not soon stop or is
excessive.
The after treatment of the bites consists in cleanliness and the use
of vaseline. The patient must stay in bed, and the hot-water bag be
constantly kept on the ear till all pain ceases. If the drum
perforates, a discharge will usually appear from the external ear.
Then the canal must be cleansed, once or more daily, by injecting very
gently into the ear a solution of boric acid (as much of boric acid
as the water will dissolve), following this by wiping the water out of
the canal with sterilized cotton, as directed for the treatment of wax
in the ear (p. 35).
The syringing is permissible only once daily, unless the discharge is
copious, but the canal may be wiped out in this manner several times a
day with dry cotton. It is well to keep the opening into the ear
greased with vaseline, and a plug of clean absorbent cotton loosely
packed into the canal to keep out the cold. Excessive or too forcible
syringing may bring about that complication most to be feared,
although it may appear through no fault in care, i. e., an implication
of the cavity in the bone back of the ear (mastoid disease). Germs
find their way through the connecting passage by which this cavity is
in touch with the middle ear, or may be forced in by violent
syringing. When this happens, earache, or pain just back of the ear,
commonly returns during the first or second week after the first
attack, and tenderness may be observed on pressing on the bone just
back of the ear close to the canal. Fever, and local redness and
swelling of the parts over the bone in this region may also occur.
Confinement to bed, and constant application of a rubber bag
containing cracked ice, to the painful parts must be enforced. If the
tenderness on pressure over the bone and pain do not subside within
twenty-four to forty-eight hours, surgical assistance must be obtained
at any cost, or a fatal result may ensue. The opening in the drum
membrane, caused by escape of discharge in the course of middle-ear
inflammation, usually closes, but even if it does not deafness is not
a necessary sequence.
The eardrum is not absolutely essential to hearing, but it is of great
importance to exclude sources of irritation, dust, water, and germs
which are likely to set up middle-ear trouble. More ordinary
after-effects are chronic discharge from the ear following acute
inflammation and perforation of the eardrum, which may mean at any
time a sudden return of pain with the occurrence of the more dangerous
conditions just recited, together with deafness. Bearing all this in
mind it is advisable never to neglect a severe or persistent earache,
but to call in expert attention. When this is not obtainable the
treatment outlined below should be carefully followed.
=Symptoms.=--Pain is severe and often excruciating in adults. It may
be felt over the temple, side and back of the head and neck, and even
in the lower teeth, as well as in the ear itself. The pain is
increased by blowing the nose, sneezing, coughing, and stooping. There
is considerable tenderness usually on pressing on the skin in front of
the ear passage. In infants there may be little evidence of pain in
the ear. They are apt to be very fretful, refuse food, cry out in
sleep, often lie with the affected ear resting on the hand, and show
tenderness on pressure immediately in front or behind the ear
passage.
Dullness, fever, chills, and convulsions are not uncommon in children,
but, on the other hand, after some slight illness it is not infrequent
for discharge from the ear to be the first sign which calls the
attention of parent or medical attendant to the source of the trouble.
For this reason the careful physician always examines the ear in
doubtful cases of children's diseases. Unless the inflammation
subsides with treatment, either a thin, watery fluid (serum) is formed
in the middle ear, or pus, when we have an "abscess of the ear." The
drum if left to itself breaks down in three to five days, or much
sooner in children who possess a thinner membrane. A discharge then
appears in the canal of the external ear, and the pain is relieved. It
may occasionally happen that the Eustachian tube drains away the
discharge, or that the discharge from the drum is so slight that it is
not perceived, and recovery ensues. Discharge from the ear continues
for a few weeks, and then the hole in the drum closes and the trouble
ceases. This is the history in favorable cases, but unfortunately, as
we have indicated, the opposite state of affairs results not
infrequently, especially in neglected patients.
=Treatment.=--The patient with severe earache should go to bed and
take a cathartic to move the bowels. He should lie all the time with
the painful ear on a rubber bag containing water as hot as can be
comfortably borne. Every two hours a jet of hot water, which has been
boiled and cooled just sufficiently to permit of its use, is allowed
to flow gently from a fountain syringe into the ear for ten minutes,
and then the ear is dried with cotton, as described under the
treatment of wax in the ear (p. 35). No other "drops" of any kind are
admissible for use in the ear, and even this treatment is of less
importance than the dry heat from the hot-water bag, and may be
omitted altogether if the appliances and skill to dry the ear are
lacking. Ten drops of laudanum[2] for an adult, or a teaspoonful of
paregoric for a child six years old, may be given by the mouth to
relieve the pain. The temperature of the room should be even and the
food soft.
If the pain continues it is wiser to have an aurist lance the drum, to
avoid complications, than to wait for the drum membrane to break open
spontaneously in his absence. Loss or damage of the eardrums may call
for "artificial eardrums." They do not act at all like the drumhead of
the musical instrument by their vibrations, but only are of service in
putting on the stretch the little bones in the middle ear which convey
sound. Some of those advertised do harm by setting up a mechanical
irritation in the ear after a time, and a better result is often
obtained with a ball of cotton or a paper disc introduced into the ear
by an aurist.
[Illustration: PLATE II
=Plate II=
=ANATOMY OF THE EAR=
The illustration on the opposite page shows the interior structure of
the ear. The concha and =Meatus=, or canal, comprise the external ear,
which is separated from the middle ear by the =Drum Membrane=. Wax is
secreted by glands located in the lining of the meatus, and should be
detached by the motion of the jaws during talking and eating. If it
adheres to the drum membrane it causes partial deafness.
The internal ear, or labyrinth, a cavity in the bone, back of the
middle ear, consists of three parts: the =Cochlea=, the =Semicircular
Canals=, and a middle portion, the =Vestibule=. The middle ear is
connected with the throat by the =Eustachian Tube=.
Sound vibrations, which strike the drum membrane, are conveyed by
means of a chain of three small bones through the middle ear to the
nervous apparatus of the internal ear. The Eustachian tube and middle
ear are lined throughout with mucous membrane, and any severe
inflammation of the throat may extend to and involve the tube and the
middle ear, causing deafness.]
=MODERATE OR SLIGHT EARACHE.=--A slight or moderate earache, which
may, however, be very persistent, not sufficient to incapacitate the
patient or prevent sleep, is often caused by some obstruction in the
Eustachian tube, either by swelling or mucous discharge. This
condition gives rise to the train of effects noted in the section on
deafness. The air in the middle ear is absorbed to some extent, and
therefore the pressure within the ear is less than that outside the
drum, so that the latter is pressed inward with the result that pain,
and perhaps noises and deafness ensue, and, if the condition is not
relieved, inflammation of the middle ear as described above.
=Treatment.=--Treatment is directed toward cleaning the back of the
nose and reducing swelling at the openings of the Eustachian tubes in
this locality, and inflating the tubes with air. A spray of Seiler's
solution[3] is thrown from an atomizer through the nostrils, with the
head tipped backward, until it is felt in the back of the throat, and
after the water has drained away the process is repeated a number of
times. This treatment is pursued twice daily, and one hour after the
fluid in the nose is well cleared away the Eustachian tubes may be
inflated by the patient. To accomplish this the lips are closed
tightly, and the nostrils also, by holding the nose; then an effort is
made to blow the cheeks out till air is forced into the tubes and is
felt entering both ears. This act is attended with danger of carrying
up fluid into the tubes and greatly aggravating the condition, unless
the water from the spray has had time to drain away.
Blowing the nose, as has been pointed out, is unwise, but the water
may be removed to some extent by "clearing the throat." The reduction
of swelling at the entrance of the Eustachian tube in the back of the
nose can be properly treated only by an expert, as some astringent
(glycerite of tannin) must be applied on cotton wound on a curved
applicator, and the instrument passed above and behind the roof of the
mouth into the region back of the nose.
Rubbing the parts just in front of the external opening into the ear
with the tip of one finger for a period of a few minutes several times
a day will also favor recovery in this trouble.
FOOTNOTES:
[1] See p. 49.
[2] Caution. Ask the doctor first.
[3] Tablets for the preparation of Seiler's solution are to be found
at most druggists.