The Home Medical Library Volume II Part 2

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 a.s.sistance 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 pa.s.sage. 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 pa.s.sage.

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 ca.n.a.l 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.

[Ill.u.s.tration: PLATE II

=Plate II=

=ANATOMY OF THE EAR=

The ill.u.s.tration on the opposite page shows the interior structure of the ear. The concha and =Meatus=, or ca.n.a.l, 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 Ca.n.a.ls=, 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 pa.s.sed 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.

CHAPTER II

=The Nose and Throat=

_Cold in the Head--Mouth-Breathing--Toothache--Sore Mouth--Treatment of Tonsilitis--Quinsy--Diphtheria._

=NOSEBLEED.=--Nosebleed is caused by blows or falls, or more frequently by picking and violently blowing the nose. The cartilage of the nasal septum, or part.i.tion which divides the two nostrils, very often becomes sore in spots, owing to irritation of dust-laden air, and these crust over and lead to itching. Then "picking the nose"

removes the crusts, and frequent nosebleed results. Nosebleed also is common in both full-blooded and anaemic persons; in the former because of the high pressure within the blood vessels, in the latter owing to the thin walls of the arteries and capillaries which readily rupture.

Nosebleed is again an accompaniment of certain general disorders, as heart disease and typhoid fever. The bleeding comes usually from one nostril only, and is a general oozing from the mucous membrane, or more commonly flows from one spot on the septum near the nostril, the cause of which we have just noted. The blood may spout forth in a stream, as after a blow, or trickle away drop by drop, but is rarely dangerous except in infants and aged persons with weak blood vessels.

In the case of the latter the occurrence of bleeding from the nose is thought to indicate brittle vessels and a tendency to apoplexy, which may be averted by the nosebleed. This is uncertain. If nosebleed comes on at night during sleep, the blood may flow into the stomach without the patient's knowledge, and on being vomited may suggest bleeding from the stomach.

=Treatment.=--The avoidance of excitement and of blowing the nose, hawking, and coughing will a.s.sist recovery. The patient should sit quietly with head erect, unless there is pallor and faintness, when he may lie down on the side with the head held forward so that the blood will flow out of the nose. There is no cause for alarm in most cases, because the more blood lost the more readily does the remainder clot and stop bleeding. As the blood generally comes from the lower part of the part.i.tion separating the nostrils, the finger should be introduced into the bleeding nostril and pressure made against this point, or the whole lower part of the nose may be simply compressed between the thumb and forefinger. If this does not suffice a lump of ice may be held against the side of the bleeding nostril, and another placed in the mouth. The injection into the nostril of ice water containing a little salt is sometimes very serviceable in stopping nosebleed.

Blowing the nose must be avoided for some time after the bleeding ceases.

If none of these methods arrest the bleeding the nostril must be plugged. A piece of clean cotton cloth, about five inches square, should be pushed gently but firmly into the nostril with a slender cylinder of wood about as large as a slate pencil and blunt on the end. This subst.i.tute for a probe is pressed against the center of the cloth, which folds about the stick like a closed umbrella, and the cotton is pressed into the nostril in a backward and slightly downward direction, for two or three inches, while the head is held erect. Then pledgets of cotton wool are packed into the bag formed by the cotton cloth after the stick is withdrawn. The mouth of the bag is left projecting slightly from the nostril, so that the whole can be withdrawn in twenty-four hours.

The bleeding nostril may be more readily plugged by simply pressing into it little pledgets of cotton with a slender stick, but it would be impossible for an unskilled person to get them out again, and a physician should withdraw them inside of forty-eight hours.

=FOREIGN BODIES IN THE NOSE.=--Children often put foreign bodies in their nose, as shoe b.u.t.tons, beans, and pebbles. They may not tell of it, and the most conspicuous symptoms are the appearance of a thick discharge from one nostril, having a bad odor, and some obstruction to breathing on the same side. If the foreign body can be seen, the nostril on the un.o.bstructed side should be closed and the child made to blow out of the other one. If blowing does not remove the body it is best to secure medical aid very speedily.

[Ill.u.s.tration: PLATE III

=Plate III=

=THE NASAL CAVITY=

In the ill.u.s.tration on the opposite page, the =Red Portion= indicates the =Septum= of the nose, the part.i.tion which separates the nostrils.

Inflammation of the membrane lining the nasal cavity is the condition peculiar to catarrh or "cold in the head." Deformity of the septum may obstruct the entrance of air into the nose and create suction on the walls of the nasal cavity, causing an overfilling of the blood vessels, or "congestion," with subsequent thickening of the mucous membrane.

Polypi, small growths which form in the nose, or enlargement of the glands in the upper part of the throat (just beyond dotted line at inner edge of red portion) also block the air pa.s.sages and give rise to mouth-breathing and its attendant disorders.

Another cause of mouth-breathing is extreme swelling of the membrane which covers the turbinated bones of the nose.]

=COLD IN THE HEAD FROM OVERHEATING.=--Chilling of the surface of the body favors the occurrence of colds, in which lowered bodily vitality allows the growth of certain germs always present upon the mucous membrane lining the cavities of the nose. Dust and irritating vapors also predispose to colds. Overwarm clothing makes a person susceptible to colds, while the daily use of cold baths is an effective preventive. There is no sufficient reason for dressing more warmly in a heated house in winter than one would dress in summer. It is, moreover, unwise to cover the chest more heavily than the rest of the body. Some one has wisely said: "The best place for a chest protector is on the soles of the feet." The rule should always be to keep the feet dry and warm, and adapt the clothing to the surrounding temperature. Among the germs which cause colds in the head, that of pneumonia is the one commonly found in the discharge from the nose.

When pneumonia is epidemic it is therefore wise to take extra precautions to avoid colds, and care for them when they occur.

The presence of chronic trouble in the throat and nose, such as described under Mouth-Breathing, Adenoids, etc. (p. 60), is perhaps the most frequent cause of colds, because the natural resistance of the healthy mucous membrane to the attack of germs is diminished thereby, and the catarrhal secretions form a source of food for the germs to grow upon. It should also be kept in mind that cold in the head is the first sign of measles and of _grippe_. Colds are more common in the spring and fall.

=Symptoms.=--Colds begin with chilliness and sneezing, and, if severe, there may be also headache, fever, and pain in the back and limbs, as in _grippe_. The nose at first feels dry, but soon becomes more or less stopped with secretion. The catarrh may extend from the back of the nose through the Eustachian tube to the ear, causing earache, noises in the ear, and deafness (see p. 41). This unfortunate result may be averted by proper spraying of the nose, and avoidance of blowing the nose violently.

=Treatment.=--Treatment must be begun at the first suspicion of an attack to be of much service. The bowels should be opened with calomel or other cathartic; two-fifths of a grain for an adult, half a grain for a child. Rest in bed for a day or two, after taking a hot bath and a gla.s.s of hot lemonade containing a tablespoonful or two of whisky, is the most valuable treatment. The Turkish bath is also very efficacious in cutting short colds, but involves great risk of increasing the trouble unless the patient can return home in a closed carriage directly from the bath. Of the numerous remedies which are commonly used to arrest colds in the first stages are two which possess special virtue; namely, quinine and Dover's powder, given in single dose of ten grains of each for an adult. Both of these remedies may be taken, but while the Dover's powder is most effective it is often necessary for the patient to remain in bed twelve to eighteen hours after taking it on account of nausea and faintness which would be produced if the patient were up and moving about.

Rhinitis tablets should never be used. They are generally abused, and, indeed, some fatal cases are on record in which they caused death.

Drugs are of little value except in the beginning of a cold, when they are given with the hope of cutting short an attack.

The local applications of remedies to the inflamed region is of service. At the onset of the cold, Seiler's solution (conveniently made from tablets which are sold in the shops) or Dobell's solution should be sprayed from an atomizer, into the nostrils, every half hour, and, when the discharge becomes thick and copious, this is to be discarded for a spray consisting of alboline (four ounces) and camphor and menthol (each thirty grains), used in the same manner as long as the cold lasts. Containing bottles should be stood in hot water, in order that all sprays for the nostrils may be used warm.

It is well to give babies a teaspoonful of castor oil and a warm bath, and keep them in bed. If there is fever with the cold, five drops of sweet spirit of niter may be given in a teaspoonful of sweetened water every two hours. Liquid vaseline, or the alboline mixture advised for adults, may be dropped into the nostrils with a medicine dropper more conveniently than applied by spray.