The Home Medical Library Volume II Part 1

The Home Medical Library.

Volume II.

by Various.

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 pa.s.sed 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 gla.s.ses. 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 gla.s.ses 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 f.a.g and overwork.

=WOUNDS AND BURNS ABOUT THE EYES.=--Slight wounds of the inner surface of the eyelids close readily without st.i.tching 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 gla.s.s 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 gla.s.ses.

=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 gla.s.ses. 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 gla.s.ses 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 gla.s.ses 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," a.s.sociated 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 gla.s.ses, 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) const.i.tute 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 gla.s.s 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 pa.s.sing 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 gla.s.ses in reading or doing near work, and these should be changed for stronger ones every year or two. These convex gla.s.ses 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 gla.s.ses 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.