THE LIBRARY 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 SOUTHERN BRANCH 
 
 UNIVERSITY OF CALIFORNIA 
 LIBRARY 
 
 LOS ANGELES, CALIF, 
 
 yf-
 
 GENERAL ADVICE REGARDING THE 
 USE AND PRESERVATION OF THE 
 EYES, EARS, NOSE, AND THROAT 
 
 BY 
 
 HENRY O. REIK, M.D. 
 
 FORMERLY ASSOCIATE IN OPHTHALMOLOGY AND OTOLOGY IN 
 
 THE JOHNS HOPKINS UNIVERSITY AND SURGEON IN 
 
 THE BALTIMORE EYE, EAR AND THROAT 
 
 HOSPITAL, BALTIMORE, 
 
 MARYLAND 
 
 ILLUSTRATED 
 
 PHILADELPHIA 
 
 F. A. DAVIS COMPANY, PUBLISHERS 
 1912 
 
 62-
 
 COPYRIGHT, NOVEMBER, 1912 
 
 BY 
 F. A. DAVIS COMPANY 
 
 Copyright, Great Britain. All Rights Reserved 
 
 Philadelphia, Pa., U. S. A. : 
 
 Press of F. A. Davis Company 
 
 1914-16 Cherry Street
 
 "KE. 
 
 PREFACE. 
 
 FIFTEEN years of experience as a specialist in 
 diseases of the eye, ear, nose, and throat has 
 convinced the author that the majority of 
 persons suffering from serious affections of these 
 organs have arrived at that stage of their dis- 
 eases either through ignorance of the normal use 
 and functions of these parts of the body or as the 
 result of neglecting to properly care-for them. 
 The child is not expected to know that snoring 
 generally means obstructed respiration, that re- 
 curring attacks of pain in the ear mean an 
 abnormal growth in the nose or throat, nor that 
 inability to clearly see -the school blackboard, or 
 headaches following study, are indications of bad 
 eyes. In very, very many instances parents, 
 though more might well be expected of them, are 
 but little wiser. Disinclination to study, a tend- 
 ency to "hook school," or failure to maintain 
 a satisfactory class standard are much more fre- 
 quently due to poor vision or eye-strain than to 
 original sin; parents are too prone to attribute 
 a dislike of books to laziness or wickedness, and 
 to try various forms of punishment, when a 
 proper pair of glasses would really make that 
 
 (3)
 
 4 PREFACE. 
 
 child as fond of reading and study as are his 
 classmates. What percentage of fathers and 
 mothers realize even the immediate dangers of 
 enlarged tonsils or adenoid growths, not to men- 
 tion the more remote, but oftentimes serious, 
 sequelae of these abnormalities that are so 
 common in childhood? 
 
 Second only to the crime of not properly safe- 
 guarding the health of his children is the sin the 
 adult commits in neglecting to care for himself. 
 Men and women doing the finest kind of eye- 
 work in improperly or insufficiently lighted 
 rooms; absolute disregard for ventilation in 
 offices and work rooms, often even in the homes 
 of the wealthy; failure to regard colds in the 
 head or purulent discharges from the ear as of 
 any consequence until some dangerous complica- 
 tion arises, such as pneumonia or meningitis; 
 these are conditions commonly observed and at- 
 tributable partly to ignorance, partly to neglect. 
 
 It is probably safe to say that 50 per cent, of 
 the practice of specialists is made up of efforts 
 to correct conditions that should never have been 
 permitted to* exist. They are constantly crying 
 to the family physician and to the public that 
 prevention is not only cheaper but easier and 
 better than cure; that proper care of the eyes in 
 early life prevents the onset of cataracts and
 
 PREFACE. 5 
 
 other intraocular diseases in old age, that the 
 removal of bad tonsils and adenoid growths 
 permits the child to develop normally and insures 
 against certain affections of the ear and of the 
 respiratory tract, that proper attention to colds 
 in the head and early treatment of running ears 
 would wipe out 80 per cent, of the cases of brain 
 abscess and purulent meningitis. 
 
 Specialists are a body of medical experts who 
 have devoted time and study to some special 
 organs of the body and who, by so doing, have 
 acquired not only a certain amount of knowledge 
 of their functions and, the means of restoring 
 them to health when diseased, but, at the same 
 time, have learned how a healthy condition of 
 these organs might have been maintained. This 
 knowledge they pass along to that larger por- 
 tion of the medical profession, the general prac- 
 titioners of medicine, the family doctors. They, 
 in turn, are expected to ut.ilize that knowledge in 
 so far as possible and to instruct their patients 
 in the simpler measures. Attainment of the 
 latter portion of this desire is, however, not well 
 provided for; the family physician is not suffi- 
 ciently often consulted regarding preventive 
 methods and the specialist is usually reserved 
 for more or less serious conditions of disease. 
 Unfortunately medical men have not had suffi-
 
 6 PREFACE. 
 
 cient opportunity to use their knowledge for 
 instruction of the laity. Public lecture courses 
 and occasional magazine articles reach but a 
 small proportion of the public, and then deal with 
 but a few topics relating to some one organ. 
 
 It is with the idea of presenting in one small 
 volume, at a price low enough to bring it within 
 reach of all who desire information on the sub- 
 ject, such simple facts and suggestions relating 
 to the care of the eye, ear, nose, and throat as 
 will enable reasonably intelligent persons to keep 
 those special organs healthy and to recognize 
 evidences of abnormality therein, so that they 
 may promptly seek safe advice for cure, that the 
 author has undertaken the task of writing this 
 little book. 
 
 HENRY O. REIK, M.D. 
 
 506 CATHEDRAL ST., 
 BALTIMORE, MD.
 
 CONTENTS. 
 
 PAGE 
 
 I. THE EYE 11 
 
 Structure and Function 13 
 
 Organic Defects 18 
 
 Eye-strain 24 
 
 Removal of Eye-strain 31 
 
 The Eyes in Infancy 38 
 
 Care During Childhood 41 
 
 Crossed Eyes 44 
 
 Reading Light and Position 47 
 
 Wild Hairs 48 
 
 Foreign Bodies 48 
 
 Granular Lids 49 
 
 Styes 51 
 
 Pink-eye (Conjunctivitis) 51 
 
 Iritis and Glaucoma 52 
 
 Cataracts 53 
 
 Tobacco and Alcoholic Blindness 56 
 
 Subjective Sensations that Should Call Attention to 
 
 Possible Eye Disorders 57 
 
 How to Make Applications to the Eyes 60 
 
 II. THE EAR 65 
 
 Malformations 73 
 
 Foreign Bodies in the Ear 74 
 
 Accumulation of Earwax 76 
 
 Diseases of the Drum of the Ear 77 
 
 "Catarrh" of the Ear 80 
 
 Nerve Deafness and Deaf-mutism 82 
 
 III. THE NOSE AND THROAT 87 
 
 Nasal Structure 89 
 
 Rhinitis (Cold in the Head) 92 
 
 Chronic Rhinitis (Nasal Catarrh) 94 
 
 Affections of the Tonsils 104 
 
 Adenoids 112 
 
 (7)
 
 ILLUSTRATIONS. 
 
 FIG. FACE PAGE 
 
 1. Section of an eye showing various layers 
 
 and most important elements of which 
 
 it is composed. (Colored.) 12 
 
 2. Proper method of applying drops to the 
 
 eyes 62 
 
 3. Showing lateral aspects of nasal chambers 
 
 and neighboring structures. The tur- 
 binate bones are especially well de- 
 picted. (Colored.) 90 
 
 4. View of throat in which can be seen small 
 
 diseased tonsils and parts of an adenoid 
 hanging below the soft palate on either 
 side of the mouth 108 
 
 (9)
 
 L 
 THE EYE. 
 
 OF the five special senses, that of sight is un- 
 questionably the most important and the one most 
 highly prized by the great majority of human 
 beings. This is reasonably so, for what greater 
 calamity can befall one than complete loss of 
 vision? How sad for the individual, how pa- 
 thetic even for the observer, are the sightless days 
 of those who have previously delighted in oc- 
 cupations that depended upon their eyes; think 
 how terrible is blindness to one who has loved 
 books and who has derived his chief pleasure in 
 life from reading ! To be deprived of the enjoy- 
 ment of art, to be shut out from observation of 
 all the beauties of nature, to be forever denied 
 another glimpse of the faces of loved ones; can 
 anything more depressing, more disheartening, 
 be imagined? If one pauses to consider these 
 things the appreciation of good sight is immeas- 
 urably enhanced. 
 
 If then we fully realize the fact that perfect 
 vision is one of our most valuable possessions it 
 would seem well that everyone should have a 
 
 (11)
 
 12 ' THE EYE. 
 
 clear understanding of the structure of the eye 
 and its physiological action in the function of 
 seeing, some knowledge of the things that may 
 happen to impair sight, and the ways to pre- 
 vent or avoid such catastrophes. Before we can 
 understand the workings of any piece of machin- 
 ery or the things necessary to keep it in working 
 order we must know something about how and 
 of what it is made, must know the nature of the 
 materials entering into its construction and what 
 each part is designed to do. Just so, the primary 
 step in studying any organ of the body is con- 
 sideration of its formation and structure. 
 
 Comparison of the unknown with the familiar 
 object is an easy and successful method of teach- 
 ing; man reasons from that which he knows and 
 understands and in the endeavor to conceive a 
 new mechanism it helps materially if he can com- 
 pare it with something of which he already has a 
 fair conception. The human eye has been fre- 
 quently and aptly compared to the camera of the 
 photographer and, since kodakery has made this 
 instrument a familiar one to so large a part of 
 the populace, we may here employ the comparison 
 for the purpose of instruction. The sclerotic 
 may be said to form the box ; the cornea the point 
 of entrance for light, the amount of which is 
 regulated by the iris acting as a shutter; the
 
 CORNEA 
 
 IRIS 
 
 OPTIC NERVE 
 
 VITREOUS 
 
 Fig-. 1. Section of an eye showing various layers and most 
 important elements of which it is composed.
 
 STRUCTURE AND FUNCTION. 13 
 
 choroid furnishes the dark lining to nature's 
 camera; the lens refracts the rays of light and 
 forms an inverted image of objects on the sensi- 
 tized plate, which is here represented by the 
 retina; and the sensation produced by this nega- 
 tive, when transmitted to the brain, is converted 
 into a positive and we "see" the picture. Yet, 
 how inadequate is this comparison, how insignifi- 
 cant is the camera produced by man compared 
 to the living camera! Consider the astounding 
 adaptability of the human lens which can, and in 
 the normal eye without perceptible effort on our 
 .part, focus for either near or distant objects, and, 
 also, the remarkable rapidity with which one 
 scene follows another as the eye roves over a 
 landscape and yet every picture is received upon 
 the same plate. 
 
 STRUCTURE AND FUNCTION. 
 
 The eyeball is a nearly spherical body about 
 one inch in diameter. Externally it presents a 
 tough, fibrous coat about one millimeter in thick- 
 ness 1 , and so resistant that it not only preserves 
 the shape of the globe but affords excellent pro- 
 tection to the delicate contents. The front por- 
 tion of this external coat, the cornea (glassy part 
 of the eye), is transparent, while the remaining
 
 14 THE EYE. 
 
 four-fifths, the sclerotic (commonly spoken of 
 as "white of the eye"), is opaque; posteriorly the 
 sclera is perforated for admission of the optic 
 nerve, a direct offshoot of special fibers from 
 the brain. Just within the sclera, and resting 
 upon it, is a second coat or membrane, called the 
 choroid, which carries most of the blood-vessels 
 of the eye and contains a considerable amount of 
 pigment, so that it constitutes a dark lining for 
 this optical apparatus. As this coat spreads for- 
 ward toward the cornea its character changes 
 somewhat, muscle tissue being developed within 
 it to form the ciliary muscle that governs the 
 focusing action of the lens and finally it drops 
 behind the cornea in the form of a delicate, in- 
 complete curtain the iris. Both the choroid and 
 the iris are covered on their innermost surfaces 
 by a layer of flat, pigmented cells, and it is the 
 varying amount of pigment in these cells, par- 
 ticularly of the iris, which determines the "color" 
 of the eye. If a large amount of pigment is 
 present we say the iris is black, or the individual 
 has a black eye, while if less in amount we see 
 brown, gray or blue eyes, and so on through 
 varying shades of color down to the pink eye of 
 the albino, in which there is practically no pig- 
 ment ; the pink color here being due to reflection 
 from the deep blood-vessels through the un-
 
 STRUCTURE AND FUNCTION. 15 
 
 colored iris. Dark-complexioned people will 
 usually have dark eyes and blondes light ones, 
 but there is no scientific foundation for the popu- 
 lar notion that dark eyes are stronger than light 
 ones. It is rather a question of evolution, and 
 nature has provided those who live in tropical 
 countries with a goodly supply of pigment, the 
 better to protect them from glaring sunlight, 
 whereas the more temperate and cooler countries 
 furnish a larger proportion of fair eyes. 
 
 The iris does not form a complete curtain, 
 but has a round, central opening through which 
 all light must enter the eve, and which varies 
 in size in accordance with the amount of light 
 entering; when we are in a darkened room the 
 pupillary opening is largest, but if we pass out 
 into the bright light the sphincter muscle tissue 
 of the iris is stimulated to contract and the pupil 
 is reduced in size. 
 
 The lens, situated just behind the pupil, is 
 soft, transparent, elastic, and contained in a cap- 
 sule suspended by a circular ligament which is 
 attached to the ciliary muscle. In the normal eye 
 the lens should, in a state of rest, bring to a 
 focus on the retina parallel rays of light, that is, 
 rays of light coming from an object twenty feet 
 or more away. Should we desire to look at some 
 nearer object, we contract the ciliary muscle, the
 
 16 THE EYE. 
 
 lens capsule is relaxed, and the lens substance, 
 through its elasticity, assumes a greater con- 
 vexity, and thereby becomes stronger, so that it 
 is enabled to focus upon the retina the divergent 
 rays that emanate from an object near by. A 
 simple experiment to illustrate this action, which 
 is called the accommodation of the eye, may be 
 tried in this way. Look at some object across 
 the room and while doing so pass a pencil in 
 front of the eye ; you will observe the latter only 
 indistinctly. Now, fixing your attention upon 
 the pencil, you will see it distinctly, but the dis- 
 tant object, while still in view, has now become 
 hazy ; it is out of focus. The rapidity with which 
 the lens successively focuses different objects at 
 varying distances is one of the marvels of nature. 
 As soon as the optic nerve penetrates the 
 sclera and choroid it spreads out over the latter 
 in a thin sheet, the retina, which is one of the 
 most wonderful tissues of the body. It con- 
 tains those highly specialized elements which 
 enable it not only to receive the image of an ob- 
 ject, but to transmit the impression of that image, 
 through the fibers of the optic nerve, to the brain, 
 where its registry constitutes what we call sight. 
 How this is accomplished is, and probably must 
 always remain, a mystery. Professor Tyndall 
 says: "When we endeavor to pass from the
 
 STRUCTURE AND FUNCTION. 17 
 
 phenomena of physics to those of thought, we 
 meet a problem which transcends any conceivable 
 expression of the powers we now possess. We 
 may think of the subject again and again it 
 eludes all intellectual presentation we stand, at 
 length, face to face with the incomprehensible." 
 
 The retina is not equally sensitive in all its 
 parts to visual impressions. A small area, called 
 the macula lutea, or yellow spot, is the most 
 sensitive portion, and in order to secure a clear 
 and accurate view of any object we direct the 
 eyes toward it in such relative positions as will 
 allow the images to fall upon the yellow spot of 
 each eye. The movements of the eye are con- 
 trolled by a set of six muscles, four of which are 
 so arranged that they can direct the eye upward, 
 downward, inward or outward, and the remain- 
 ing two, working in conjunction with these, give 
 it a rotary motion. When the eyes are viewing 
 distant objects the visual axes of the two are 
 practically parallel and the muscles are at rest. 
 As vision is fixed on closer things the visual axes 
 begin to converge, and the closer the object 
 comes to the eyes, the greater must become the 
 convergence of the two eyes. You will remem- 
 ber, also, that the closer the object approaches 
 the eyes the greater must be the accommodative 
 
 action of the lens. The harmonious action of 
 
 2
 
 18 THE EYE. 
 
 these two sets of eye muscles is such that con- 
 vergence is definitely associated with the act of 
 accommodation without conscious effort, and 
 thus binocular vision, the simultaneous use of 
 both eyes, is maintained. If conjoint action of 
 the muscles is interfered with and images are 
 formed on unrelated portions of the eyes, two 
 separate images, or double vision, results. 
 Should the dissociation be sufficiently marked to 
 cause one eye to turn in or out much more 
 strongly than the other, we say that eye "squints" 
 or has a "cast." 
 
 I * 
 
 ORGANIC DEFECTS. 
 
 Refraction of light is the bending which its 
 rays undergo in passing through media of differ- 
 ent density, and, according to physical laws, rays 
 of light passing from the air through a medium 
 of s such character and shape as the human lens 
 are converged to a point on the other side, 
 which point is called the focus of the lens. An 
 eye that refracts parallel rays in this way accu- 
 rately upon the retina is said to be emmetropic. 
 Should the eyeball be flatter than normal, that 
 is, have a shorter anteroposterior axis, the retina 
 will be situated in front of the focal point of the 
 lens and, hence, will not receive a distinct image ; 

 
 ORGANIC DEFECTS. 19 
 
 just as in the use of your camera, if your plate 
 and lens are too close together if you have 
 focused too short you will get a blurred nega- 
 tive. Such an eye is said to be hypermetropic 
 (sometimes called over sighted or far-sighted). 
 The term "far-sighted" is misleading, has caused 
 much confusion in the public mind, and should 
 be expunged from our vocabulary. The hyper- 
 metrope is not far-sighted, that is, he does not 
 see farther than the normal-eyed person. He 
 does often see as far as the person with normal 
 eyes, but he does even that well by a trick. It 
 has been explained that the normal eye is in a 
 state of rest when looking at a distant object. 
 That is to say, if looking at some object in the 
 distance the eye sees it without making any effort 
 whatsoever ; the eye is as quiescent as the photog- 
 rapher's box that has been set for a distant view. 
 Now, if the hypermetrope attempts to see that 
 same object from the same distance he can do so 
 only by correcting his natural defect ; this he does 
 by calling upon his ciliary muscle to focus the 
 lens sufficiently to bring the image forward to 
 the plane of his retina. This means that even for 
 distant vision, when the eye should be in a state 
 of rest, almost constant muscular effort is re- 
 quired and power that should be saved as a 
 reserve force for close work is being drawn upon.
 
 20 THE EYE. 
 
 The person with normal eyes looks at distant 
 things without effort and uses his focusing 
 ability only for looking at closer objects, the 
 greatest amount of power being required in such 
 acts as reading, writing, sewing, etc. He comes 
 to such close work with rested and active muscles. 
 The hypermetrope, on the other hand, being 
 forced to use muscular power in his distant 
 vision, comes to his close work with muscles that 
 are tired and is, besides, required to call forth 
 an extra amount of energy ; this accounts for the 
 discomfort experienced by these people when 
 doing school work or following occupations re- 
 quiring close application of the eyes. The act of 
 focusing for distant objects is to them an un- 
 conscious thing, of course, the ciliary muscle 
 being what is called an involuntary muscle, one 
 that responds perfunctorily when the eye is 
 directed at something and not because of special 
 effort put forth, and, so, they are not aware that 
 in claiming "far-sight" they are taking advantage 
 of the normal-eyed competitor ; it was referred to 
 as a trick, but, it is unconsciously performed. 
 
 Myopia, commonly called "near-sightedness" 
 or "short-sightedness," is an exactly opposite 
 condition, that is, the eyeball is elongated has 
 an unusually long anteroposterior axis and the 
 image is naturally formed in front of the retina.
 
 ORGANIC DEFECTS. 21 
 
 Here again a blurred image would result; com- 
 paring the condition once more to photography, 
 it matters not whether you have focused a bit 
 beyond or a bit short of the plate, the result will 
 be a blur. The hypermetrope has the power to 
 alter his defect by focusing, but the myope has 
 not; the ciliary muscle is fully relaxed in the 
 normal eye and the lens set for distant vision, 
 and, as it cannot be further relaxed, the myope 
 cannot reduce the strength of his lens to meet 
 the abnormal condition. He must therefore ap- 
 proach closer to the object or hold it closer to his 
 eyes, if he would see it. You have observed the 
 very myopic person holding small things very 
 close to his face or putting the face down to the 
 desk until it almost touched the book; and you 
 know they are shut off from distant vision so that 
 they cannot recognize friends across the street, or 
 sometimes even at much closer range. 
 
 Hypermetropia and myopia are the principal 
 defects of the eye due to variations in size, but 
 there is a third and perhaps a more important 
 one, that is the result of abnormal shape. Astig- 
 matism is a condition of faulty refraction that 
 results from defective curvature of the corneal 
 or lens surfaces. If, for instance, the cornea is 
 not a true section of a sphere, but has a greater 
 degree of curvature in one meridian than in
 
 22 THE EYE. 
 
 another, light will be refracted by it unequally in 
 these different meridians and, again, a blurred 
 image formed. An eye may be perfect as to the 
 length of its anteroposterior axis, but have an 
 irregularity of curvature of the corneal surface; 
 this condition is called simple astigmatism, and 
 may be either hypermetropic or myopic, accord- 
 ing as the defect tends to cause a focusing of part 
 of the image beyond or in front of the retina. 
 Astigmatism, however, occurs not only as such 
 alone, but may occur in combination with hyper- 
 metropia or myopia; a condition known as 
 compound hypermetropic or compound myopic 
 astigmatism. That is, an eye may be not only 
 shortened or elongated, but have an irregular 
 corneal surface as well. 
 
 Astigmatism is existent to some degree in 
 almost all eyes. It sounds rather startling to say 
 that there are few, if any, perfect eyes. Consider 
 for a moment, though, that nature has succeeded 
 in making very few perfect spherical bodies ; the 
 world itself is believed to be flattened at the poles. 
 Careful scientific measurement will show the 
 presence of refractive errors in nearly all eyes, 
 though the error may not be of sufficient degree 
 to cause any inconvenience, or the person having 
 the unsuspected defect may live in that blissful 
 state by virtue of the fact that he has the strength
 
 ORGANIC DEFECTS. 23 
 
 to bear the tax upon his muscles without suffer- 
 ing discomfort. The amount of discomfort pro- 
 duced, however, by unsuspected astigmatic errors 
 almost surpasses belief. Thousands of people are 
 suffering from the far-reaching effects of refract- 
 ive errors without for a moment suspecting that 
 the eyes are in any way connected with their 
 troubles ; but of that we shall speak later on. 
 
 There is still another optical defect to be con- 
 sidered, one which comes to all eyes alike if they 
 reach the period of old age. Presbyopia, com- 
 monly called "old sight," is simply a natural 
 diminution of power to focus or accommodate 
 the eye for different distances. Ordinarily this 
 loss of power begins at about the fortieth year of 
 life and, as age creeps on, the lens gradually 
 undergoes a change, loses its elasticity, and the 
 power to assume greater convexity fails. The 
 most obvious feature of this change is the gradual 
 receding of the near-point of vision as shown 
 by the necessity for holding the book or paper 
 farther from the eyes when reading. Persons 
 between forty and fifty, who are loath to put on 
 glasses, often insist that they can read as well as 
 ever, while, at the same time, you observe that 
 they are holding the paper at arms' length to 
 enable them to do so; a fact which proves of 
 itself that they are failing in visual power. A
 
 24 THE EYE. 
 
 patient recently rather cleverly described this 
 mental attitude in his own case by saying "Well 
 doctor, I guess I shall have to come to the 
 glasses. I can still see as well as ever; my eyes 
 are good, but my arms are too short." 
 
 EYE-STRAIN 
 
 In the preceding paragraphs we have con- 
 sidered only the structure and function of the 
 eye, referring mainly to normal organs, and have 
 alluded to abnormalities of formation only in 
 sufficient degree to establish a basis for under- 
 standing such irregular formations and per- 
 formances as constitute or serve to produce 
 diseased conditions. 
 
 In all the possible errors of refraction that 
 we have pointed out, however, it has been shown 
 that there is imperfect focusing of objects on the 
 retina, and in order to secure that perfect focus- 
 ing which is essential to distinct vision the deli- 
 cate muscles of the eye are kept in more or less 
 constant action. Remember that tb muscles of 
 the iris and of the ciliary body cannot be seen in 
 the ordinary dissection of the eye, but become 
 visible only under a microscope. When we con- 
 sider the small size of these muscles it is sur- 
 prising that they are able to work so continuously
 
 EYE-STRAIN. 25 
 
 and to perform such enormous tasks with such 
 comparative ease. In very many instances of 
 slightly defective eyes they carry the burden 
 without complaint; in some cases, where the 
 error is gross and the burden too heavy, they 
 rebel and the victim seeks assistance promptly ; in 
 very many more instances, possibly in the 
 majority of all cases, they struggle on, making a 
 desperate effort to carry the load, become 
 l^mined, and cause a variety of distressing symp- 
 toms, not limited to the region of the eye alone, 
 but wic ^spread throughout the system. You are 
 familiar ^Khe size and power of the biceps 
 muscle of the arm and with the large, strong leg 
 muscles^and,^^wise, know the effect of long 
 exertion of theseknuscles ; how when a man has 
 walked all day or swung an axe for hours not 
 only do those strong muscles of the leg and arm 
 become tired and sore, but he feels the effect all 
 over his body; perhaps he has headache, cannot 
 digest his food, does not sleep well, and even 
 such organs as the heart and kidneys show the 
 result of overexertion. Compare with those 
 muscles the delicate, macroscopically invisible, 
 internal eye muscles and you will not be sur- 
 prised at how far-reaching may be the effect of 
 straining them by prolonged, incessant labor. 
 Thousands of us think little of working our eyes,
 
 26 THE EYE. 
 
 probably defective ones at that, sixteen hours or 
 more per day, year after year, yet wonder why 
 they feel tired at times, or find it hard to under- 
 stand how such a local strain can account for 
 general ill health or a derangement of some other 
 organ of the body. Did we work any other 
 muscle or set of muscles in the body one-half so 
 hard or so constantly as we do the ciliary muscles 
 of the eyes, we would be physical wrecks in short 
 order. It is the direct and reflex effects of eye- 
 strain that we shall now take up for brief con- 
 sideration. 
 
 Usually the first symptom which calls atten- 
 tion to a refractive error is the occurrence of 
 discomfort whenever the eyes are employed in 
 close work. This irritation may manifest itself 
 in various ways: there may be simply a tired 
 feeling about the eyes ; a sense of drowsiness or 
 heaviness of the eyelids ; a tendency to fall asleep 
 after a very brief period of reading; twitching 
 of the lid muscles, sometimes amounting to a 
 regular spasm that forces closure of the lids for 
 some seconds, until recovery takes place and the 
 eye can be opened for the resumption of work; 
 a vague sense of heaviness or discomfort over the 
 brow; and, a pronounced headache. These may 
 be classified as local evidences of eye-strain and 
 indicate rather the acute symptoms or those ob-
 
 EYE-STRAIN. 27 
 
 served in the beginning of the trouble. Among 
 the characteristic local features of the more pro- 
 longed or chronic^cases of eye-strain are to be 
 enumerated: congested eyes ("bloodshot"), 
 giving one the appearance of being an alcoholic; 
 red and encrusted lids ; styes, which are infections 
 made possible through local weakness of the tis- 
 sues; narrowly contracted lid apertures or 
 wrinkles under the lids or over the brows, from 
 the constant muscular effort made to overcome 
 visual defects; and, pain in the eyes or forehead. 
 When we come to enumerate the reflex symp- 
 toms of eye-strain, symptoms that are referred 
 to other parts of the body than the eyes, we enter 
 upon a very broad subject. There is nothing in 
 the whole realm of medicine, however, a knowl- 
 edge of which is of greater importance and value 
 to the intelligent layman than this fact, that a 
 defect in the eyes can be the cause of disturbances 
 and derangements of portions of the body ap- 
 parently remote from the eyes. Sometimes these 
 reflex symptoms occur in conjunction with one 
 or more of the local eye symptoms mentioned 
 above. Quite frequently they appear without 
 any localizing eye symptoms, and then the patient 
 may suffer for a long time before his attention 
 is attracted to the eyes as a possible cause of 
 trouble. To add to the difficulties of solving this
 
 28 THE EYE. 
 
 puzzle, a definite ocular defect does not always 
 cause the same symptoms in a number of dif- 
 ferent persons. Thus, a certain degree of hyper- 
 metropic astigmatism, let us say, produces in the 
 first man inflamed lids or red eyes ; in the second, 
 headaches; for a third, some form of nervous 
 manifestation, such as twitching of the lid 
 muscles, choreic movements of the face, or even 
 epileptic convulsions. It is these facts that make 
 it necessary to consider carefully the remote 
 evidences of eye-strain and how they can be 
 detected. 
 
 Headache is perhaps the most common of 
 these reflex symptoms and the one most widely 
 recognized now as of ocular origin ; probably the 
 vast majority of repeated or recurring head- 
 aches are attributable to defective eyes. Often- 
 times the connection is recognized from the fact 
 that the headache appears in association with or 
 immediately after use of the eyes for close work, 
 as in reading, writing, sewing, drawing, fancy 
 work, visits to art galleries, or sightseeing. 
 Car-sickness is a kindred type of eye-headache, 
 the effect upon the eyes of watching the various 
 objects rapidly passed being*much the same as 
 that of reading or other close work. Occasionally 
 the headache does not appear as an immediate 
 consequence of the tax upon the eyes, but comes
 
 EYE-STRAIN. 29 
 
 on some hours afterward; as witnessed in some 
 persons who awake with a headache in the morn- 
 ing after employment of the eyes at night. The 
 character of the headaches induced by overstrain 
 of the eyes varies greatly, and ranges from slight 
 pain in or over the eyes to the most severe type 
 of "sick-headache"; in the latter group of cases 
 the eyes may have withstood the strain for con- 
 siderable periods of time and then there comes 
 an explosion, as it were, the headache being ac- 
 companied by nausea, vomiting, serious depres- 
 sion, the whole attack lasting for several days 
 and completely incapacitating the sufferer. A 
 not inconsiderable percentage of drug fiends have 
 acquired their bad habits from the use of reme- 
 dies for the relief of headaches, and the number 
 of hard-worked men and women (especially book- 
 keepers, clerks, sewing girls, milliners, and others 
 engaged in service requiring close application of 
 the eyes) that are daily consuming large quan- 
 tities, often dangerous quantities, of headache 
 powders and tablets is as alarming as it is sur- 
 prising; in nine cases out of ten they do not need 
 drugs, but proper attention to their eyes. 
 
 Next to headaches, one of the most commonly 
 observed reflex effects of eye-strain is disturbed 
 digestion. It has long been recognized that any 
 nervous shock to the system may arrest the
 
 30 THE EYE. 
 
 process of digestion and produce nausea, and it 
 is easy to understand that persistent and pro- 
 longed nervous agitation can so derange the 
 digestive function that a fixed impairment there- 
 of results. Many long-standing cases of dyspep- 
 sia, indigestion, or other stomach disorders, that 
 have resisted years of treatment by lavage and 
 medicines, have been promptly cured upon the 
 patient having, for some other reason, had his 
 eyes cared for. When digestive disturbances 
 occur to people who are using their eyes a great 
 deal, and there is present no recognisable organic 
 lesion of the stomach, suspicion should be turned 
 upon the eyes and an examination for some visual 
 defect made. 
 
 A long list of reflex disorders of ocular origin 
 that might now be given would consume an un- 
 necessary amount of space and perhaps prove 
 more tedious than helpful to the reader. Suffice 
 it to say that a large number of cases of nervous 
 trouble, hysteria, neurasthenia, nervous prostra- 
 tion, chorea, and epilepsy are brought about or 
 provoked by the strained use of defective eyes. 
 The writer desires to avoid misunderstanding on 
 this question. No one would claim that all cases 
 of these diseases are due to eye-strain nor that 
 they can aways be cured or even relieved by treat- 
 ment of the eyes ; it is only meant to explain that
 
 REMOVAL OF EYE-STRAIN. 31 
 
 eye-strain certainly is a causative agent in the 
 production of these serious conditions in a con- 
 siderable number of instances. In the most 
 serious condition mentioned, for instance, epi- 
 lepsy, it has been repeatedly shown that eye-strain 
 may be the factor that provokes the epileptic 
 seizure, and that the wearing of glasses to cor- 
 rect the visual defect prevents further attacks. 
 In this disease, as in most of the reflex conditions 
 referred to, there is an underlying weakness of 
 the nervous system, or of some specific organ, 
 that manifests itself whenever the eye-strain 
 reaches a point of severity sufficient to overcome 
 the patient's normal resistant power. In such 
 cases cure or relief follows removal of the 
 exciting cause; the excitable nervous system, or 
 weak stomach or other organ, cannot be disposed 
 of, but can be protected. 
 
 REMOVAL OF EYE-STRAIN. 
 
 From what has been said above concerning 
 the causes of these refractive errors, it is evident 
 that no amount of treatment will remove them, 
 since we cannot change the shape of the eye to 
 any desired form. We can, however, by means 
 of proper glasses, bring about a condition of 
 emmetropia. Where hypermetropia exists, a
 
 32 THE EYE. 
 
 glass with convex surfaces is used to converge 
 the light more strongly and relieve the lens and 
 ciliary muscle of that necessity. In myopia, a 
 concave glass is required to cause a divergence 
 of the rays, and thus extend the focus of the 
 lens backward through the abnormally long eye 
 to the retina. For astigmatic conditions, glasses 
 are ground so as to have a different power of 
 refraction for different meridians. 
 
 Do not suppose for a moment, however, that 
 the adjustment of correcting glasses is purely a 
 mathematical problem. The human eye is not a 
 mathematical optical instrument and cannot be 
 treated as such. In almost every case one must 
 consider a number of other points of great im- 
 portance, points which deal with the anatomy and 
 physiology of the eye, the general health and 
 muscular tone of the patient, and these can be 
 properly appreciated only by one who possesses a 
 thorough knowledge of medicine. The selection 
 and prescribing of the correct glasses is just as 
 much the practice of the art of medicine as is 
 the choosing and prescribing of the proper me- 
 dicinal remedy for any diseased condition. Con- 
 sequently, the only competent individual to 
 examine the eye is the physician who has given 
 special attention to the science of ophthalmology. 
 The newspapers, street-cars, and other adver-
 
 REMOVAL OF EYE-STRAIN. 33 
 
 tising media are filled with the alluring signs of 
 the optical quack, the most attractive feature of 
 whose advertisement is "Examination made free 
 of charge." The thoughtful will see at once that 
 the optician can no more afford to "give some- 
 thing for nothing" than can any other business 
 man, and those who fall into his trap will likely 
 discover that the advertisement is a falsehood. 
 The optician is in no sense qualified to make the 
 proper examination for glasses. He has his 
 legitimate field of labor, but it should be under- 
 stood by all that there exists the same difference 
 between the oculist and the optician as between i 
 the physician and the druggist; the latter may 
 occasionally give relief by administering a dose 
 of medicine, but one would hardly argue from 
 this that he is competent to prescribe, or safe to 
 consult, for any ailment whatever. Some one of 
 my readers may be wearing with comfort glasses 
 selected by one of these men, or even chosen from 
 the tray of a peddler or street vendor, but such 
 person has taken grave risks with the most 
 valuable organ of his body, and a large percent- 
 age of the people who pursue such a course suffer 
 therefore in one way or another. 
 
 It is the business of the physician to diagnose 
 disease, ascertain the cause thereof, and to pre- 
 scribe the correcting remedy; while to the phar-
 
 34 THE EYE. 
 
 macist, on the other hand, is entrusted the duty 
 of preparing drugs, compounding the prescrip- 
 tions, and supplying 'the patient with the ordered 
 remedies. In like manner, the oculist studies the 
 character of ocular defect, the alterations in 
 physiological action produced thereby, considers 
 the anatomical, physiological, and pathological 
 elements in the case, and then calculates the char- 
 acter of glass that can best promise good vision 
 and comfort; the optician, like the druggist, has 
 a kindred but a different profession that of 
 constructing from a simple piece of glass a lens 
 which shall have the desired refractive power, 
 and so adjusting it in frames that the patient can 
 wear it in front of the eyes in such position that 
 its varying refractive portions shall properly 
 cover the defective parts of the eye a profession 
 based upon a thorough knowledge of optics and 
 marked mechanical skill. Neither of these men 
 can change positions; the physician, unless also 
 educated in pharmacy, is not capable of filling his 
 own prescriptions ; the pharmacist knows little or 
 nothing of the art of prescribing for diseases; 
 the oculist is not taught to grind lenses nor fit 
 frames; the optician is utterly incapable of ap- 
 preciating the various medical elements at stake 
 in the ocular conditions that require correcting 
 glasses, and is therefore unfit to examine eyes
 
 REMOVAL OF EYE-STRAIN. 35 
 
 for such purpose or to prescribe glasses. It is a 
 very serious mistake to suppose that these eye 
 examinations are simple matters, and that any 
 glass that one can see through is good enough 
 to use ; as we have attempted to show, it is usually 
 not a question of what one can see, but whether 
 they can see normally without tax upon the eye 
 or system, and glasses are given most frequently 
 not to make people see better so much as to make 
 them see well with comfort and safety. The 
 jeweler, the pharmacist, the department-store 
 keeper, and the spectacle vendor are not, then, 
 the proper persons to examine eyes or furnish 
 glasses. The examination should be made by an 
 expert oculist and his prescription for glasses be 
 filled by a skilled optician. 
 
 In this connection one more word of caution 
 may not be out of place. Some of the depart- 
 ment stores and jewelers advertise that their 
 spectacle departments are presided over by a 
 physician or a trained man who poses under some 
 high-sounding title, such as "Optometrist" or 
 "Graduate Refractionist." In the vast majority of 
 instances these are fraudulent pretenses. As to 
 the alleged physicians in these places; they are 
 sometimes men who have failed to pass their 
 medical examinations, or failed to win success or 
 professional standing in their medical work, or,
 
 36 THE EYE. 
 
 worse, have simply assumed the title ; of one thing 
 you can be quite sure, no self-respecting physician 
 of any ability will enter into such an alliance to 
 defraud the public. As regards the gentlemen of 
 special titles referred to, the title is the most 
 imposing and important portion of their equip- 
 ment ; usually they are very deficient in knowledge 
 of either medicine or optics. It must be acknowl- 
 edged that not all oculists and opticians are as 
 highly skilled and reliable as they might be. 
 Some eye specialists are excellent surgeons in the 
 treatment of that organ, and have only moderate 
 ability as ref ractionists ; if you were to undergo 
 any surgical operation you would choose the most 
 skilled and expert surgeon at your command; in 
 the same way it is equally to be recommended 
 that when needing an examination for glasses 
 you should choose the eye specialist who is most 
 skilled in this particular part of his branch of 
 medicine. In selecting an optician a similar rule 
 should apply ; go to that one who is reputed to do 
 the most careful work in making and adjusting 
 spectacles. 
 
 Some people object strenuously to the wearing 
 of spectacles, especially by children, and express 
 the fear that "if they once begin to wear them 
 they are afraid they can never leave them off 
 again." To fight against the assistance which art
 
 REMOVAL OF EYE-STRAIN. 37 
 
 may supply in this direction is as absurd as to 
 refuse to eat when hungry or to sit down when 
 tired. Why should they not be worn through 
 life, if by their aid discomfort is removed and 
 sight preserved; while through their lack vision 
 is indistinct, eye-pains or headaches prevail, and 
 the tendency is toward the destruction of the eye 
 and the general impairment of health ? It would 
 be just as sensible for the lame man to refuse the 
 aid of crutches because he can never hope to 
 walk again without them. The use of glasses in 
 early life, of the proper kind and at the proper 
 time, has saved many a person not only from im- 
 mediate discomforts, but from calamities far 
 worse than the ill looks or slight inconvenience 
 of having to wear spectacles. We once believed 
 that nearly every one would have cataracts if 
 they lived long enough. It is known now that 
 cataracts and many other serious affections of 
 the eyes in elderly people are the result of neglect 
 in early life, and that by the use of glasses at the 
 proper time to prevent eye-strain, with its conse- 
 quent injury to the nervous and vascular struc- 
 tures of the eye, such diseases can be avoided. 
 Indeed, as the result of the past twenty years or 
 so of careful and accurate refraction work, cata- 
 racts are much less common today than they were 
 a generation ago.
 
 38 THE EYE. 
 
 THE EYES IN INFANCY. 
 
 The need for special care of the eyes begins 
 at a very early period of life. It is the duty of 
 both the doctor and the nurse to watch the baby's 
 eyes carefully during the first week of life, as one 
 of the worst diseases to which the eye is liable is 
 prone to make its appearance about the second or 
 third day, rarely later, and unless very prompt 
 medical attention is secured it may result in blind- 
 ness. This affection is called ophthalmia neona- 
 torum (meaning eye-inflammation of the new- 
 born), and it is a purulent disease of great 
 virulency. The lids become red and intensely 
 swollen, and pus flows out very freely, often 
 seeming to reappear as fast as it is wiped away. 
 If. neglected the cornea soon ulcerates, and in 
 such cases, even if the inflammation is then 
 checked, an opacity appears where healing takes 
 place, and vision is forever interfered with ; in the 
 less favorable cases, where the disease succeeds 
 in forcing a perforation of the cornea, the interior 
 of the eye is infected and the whole structure 
 destroyed, leaving only a shrunken, sightless 
 globe. In our public institutions for the blind a 
 larger percentage can trace their affliction to this 
 disease than to any other single source. And yet, 
 it is a preventable disease. The infection really
 
 THE EYES IN INFANCY. 39 
 
 occurs at the time of birth by contamination with 
 infective vaginal secretions. If immediately after 
 birth the eyes are carefully cleansed and a few 
 drops of a i per cent, nitrate of silver solution, or 
 of a 5 per cent, solution of argyrol or protargol, 
 be placed upon the eyeball, the disease will not 
 develop, in the majority of instances, even when 
 the child has been delivered through a canal be- 
 lieved to have been infected. Inasmuch as such 
 drops, properly used, can do no harm, it should 
 be the universal routine practice of physicians 
 and midwives to treat the baby's eyes in this way. 
 The fact that this custom has not been more 
 widely adopted depends in some degree upon the 
 attitude of the public toward purely preventive 
 medicine; many parents are averse to having 
 drops applied to the baby's eyes unless there is 
 visible evidence of existing disease. Of course 
 this position is due really to lack of understand- 
 ing, and when they come to fully realize that 
 there is no danger in so simple ,a precautionary 
 measure against a possible infection, and further 
 recognize the fact that the disease to be guarded 
 against is so terrible a one that if it once gets a 
 start it is almost certain to produce a serious 
 condition if not complete blindness, the prejudice 
 against this preventive measure at least must 
 disappear.
 
 40 THE EYE. 
 
 To those poor mothers who are entrusted to 
 midwives, women who are not educated in the 
 employment of preventive medicines, we can only 
 say that the very moment you observe any evi- 
 dence of eye trouble in the infant you must im- 
 mediately demand the services of a physician; in 
 the larger cities, where this disease is far more 
 prevalent than in country districts, it is always 
 possible to secure the attendance of an expert 
 from one of the many eye hospitals. The affec- 
 tion is amenable to treatment if this be instituted 
 promptly, but delay is extremely dangerous, even 
 a few hours often sufficing to impair the vision 
 seriously. Do not waste time in following the 
 suggestions of old women nurses who place un- 
 bounded faith in the use of "mother's milk," "tea- 
 leaves," "chamomile tea," etc. Such remedies 
 are absolutely valueless in this or any other af- 
 fection of the eyes, and not infrequently do much 
 harm. Those who have the care of the baby, in 
 giving the necessary attention to a case of this 
 kind, must be very careful thoroughly to cleanse 
 the hands after having touched the patient or any 
 article that might have become contaminated by 
 the secretion, for a minute particle of this secre- 
 tion introduced into the eye of an adult may cause 
 rapid loss of that eye; the same disease is ap- 
 parently much more virulent in the adult eye
 
 CARE DURING CHILDHOOD. 41 
 
 than in the baby's, and the eye may be destroyed 
 in the short space of a few hours in spite of 
 prompt and vigorous treatment. The attendants 
 should, then, most carefully cleanse their hands 
 after every treatment or washing of the baby's 
 eyes, and special care should be exercised to pre- 
 vent others from using the same towels or hand- 
 kerchiefs employed in the sick-room for any 
 purpose. 
 
 CARE DURING CHILDHOOD. 
 
 During infancy the child should be guarded 
 against glaring lights in the house, or direct sun- 
 light out of doors, and the growing youth should 
 be encouraged to take part in outdoor amuse- 
 ments rather than devote too much time to books 
 and small toys. The inflammatory affections of 
 the eye are usually quickly recognized and sub- 
 mitted to treatment. Errors of refraction, how- 
 ever, are not so apt to be detected promptly 
 during childhood, and it would seem to be a part 
 of wisdom to have every child's eyes examined at 
 the beginning of school life, and, where defects 
 are found, to have other examinations from time 
 to time thereafter. If this were universally done 
 it would aid greatly in the advancement of those 
 children who start out in life with congenitally 
 defective eyes, would secure for them proper care
 
 42 THE EYE. 
 
 of the eyes, and prevent the serious effects of eye- 
 strain, and would lessen the chances of conveying 
 these defects to future generations. We fre- 
 quently meet with children who have been 
 severely punished both at home and at school 
 because of a pronounced dislike of study or an 
 apparent dullness in school work, with inability 
 to keep up with their classes, when investigation 
 shows that the children are in no way to blame, 
 but are laboring under a handicap in the form of 
 defective vision. 
 
 Dr. S. D. Risley, of Philadelphia, who has 
 devoted much time to a consideration of the in- 
 fluence of school work upon the eyes, and who 
 has published a most comprehensive paper on 
 School Hygiene, says: "It is highly important 
 that every child seeking to enter the schools 
 should be subjected to a systematic examination 
 as to the state of their vision, and, where this is 
 found defective, parents should be notified and 
 advised of the probable harm which will result 
 from the school work if professional advice is not 
 secured. The skillful correction of the errors of 
 refraction in our children's eyes, by glasses, would 
 go far to arrest the acquisition of near-sight and 
 its attending pathological conditions, and in most 
 cases would prevent also the discomfort which 
 precedes and accompanies the increase of refrac-
 
 CARE DURING CHILDHOOD. 43 
 
 tion. The following suggestions should be borne 
 in mind as important: (a) Sufficient light, prop- 
 erly admitted to the schoolroom, should be re- 
 garded as a fundamental requirement in school- 
 house architecture. The light should be admitted 
 from the left side of the pupils, and the ratio of 
 window surface to floor surface should never fall 
 below one to five, and this should be exceeded 
 in many localities, on the north side of buildings 
 and on the ground floors, (b) The desks and 
 seats should be of such a pattern as will permit 
 independent adjustment as to height and size, to 
 meet the requirements of individual pupils and to 
 insure upright sitting, (c) Instruction should 
 be imparted as far as possible by means of black- 
 boards, wall maps, charts, and orally, instead of 
 by work at a near point, as with pencil and paper 
 or slate. Where the work must be done at a 
 near point, a pen and black ink should be used 
 instead of a lead-pencil or slate and pencil, (d] 
 The work required to be done at home should be 
 in a large measure abandoned, or at least largely 
 reduced. (e) A more elastic curriculum of 
 study is desirable for pupils with weak eyes or 
 feeble health, which will permit the lengthening 
 of the school life and at the same time admit of 
 steady promotion. (/) Great care should be 
 exercised in the selection of properly printed
 
 44 THE EYE. 
 
 textbooks. Only good paper, and type no smaller 
 than eight-point, or preferably ten-point, are ad- 
 missible in schoolbooks, and these should be bold- 
 faced and well spaced, on a double-column page. 
 For the former a distance of two millimeters be- 
 tween the lines, and for the latter a distance of 
 two and one-half millimeters, should be required. 
 (g) In writing, the central position of the paper 
 should be maintained, but in properly lighted 
 rooms with suitably arranged seating the kind of 
 script, vertical or slanting, will depend upon the 
 vertical or the inclined position of the paper, and 
 may safely be left to natural selection." 
 
 Some of these suggestions are equally adapt- 
 able to the home life or office work of the adult. 
 
 CROSSED EYES. 
 
 A "squint" or "cast" of the eye is said to 
 exist when one of the external eye muscles acts 
 in excess of its opponent so that when one eye 
 is directed straight ahead the other turns in or 
 out, up or down. The most common form is that 
 known as "cross-eyed," and generally makes its 
 appearance between the third and fifth years of 
 age. In very many instances the mother believes 
 that the child became so afflicted through fright, 
 through imitation of some other child or
 
 CROSSED EYES. 45 
 
 servant, or as the result of an accident while 
 under the supervision of a careless attendant. 
 Generally there is no true basis for this reason- 
 ing. It is at about this age that the child begins 
 to use its eyes for close work, to study pictures 
 attentively, or to play with small objects. If the 
 child has a high degree of hypermetropia it is 
 compelled to employ considerable muscle power 
 to focus near objects and to converge the two 
 eyes so that both shall participate in the act of 
 seeing binocular vision. Now this is an ex- 
 treme tax upon the delicate muscles of the young 
 child, and something has to give way. Close 
 work could be abandoned, but the child, not being 
 able to reason out the cause of its discomfort, 
 does not arrive at that conclusion. Nature then 
 attempts to afford partial relief by giving up the 
 effort to use both eyes simultaneously, doing 
 away with the converging act. As the two eyes 
 are seldom exactly alike in these children, nature 
 selects the better one for seeing purposes and 
 turns the more defective one in toward the nose, 
 thus throwing it out of commission. Should the 
 eyes be very nearly alike it may require some 
 time to determine which eye shall be selected, and 
 in such cases we may observe the child squinting 
 sometimes with one, sometimes with the other, 
 eye (alternating squint), until nature makes her
 
 46 THE EYE. 
 
 selection and the squint of one eye becomes fixed. 
 So, crossed eyes are not usually the result of in- 
 jury or neglect nor evidence of the acquirement 
 of bad habits; they result from nature's effort 
 to relieve the child of a burden imposed upon it 
 by a serious error of refraction. 
 
 This also explains why in its early stage a 
 crossed eye may sometimes be made to assume 
 its proper position through the aid of proper 
 glasses to correct the refractive error. Such 
 children should be placed at once under the care 
 of a competent oculist. If the condition is 
 neglected until the eye has become more or less 
 fixed in its faulty position, glasses alone will not 
 be sufficient to correct the deformity; then an 
 operation will be required to bring the eye back 
 into position, and glasses will still have to be 
 worn to maintain it so. However, practically all 
 cases of crossed eyes, even of many years' stand- 
 ing, can be rectified, and when one considers 
 what a difference in personal appearance it 
 makes, the disagreeable effect of such an eye 
 upon those who must come in contact with the 
 afflicted person, and the simplicity of the opera- 
 tion, it looks like a sin against the community to 
 allow such persons to retain their deformity.
 
 READING LIGHT AND POSITION. 47 
 
 READING LIGHT AND POSITION. 
 
 We are too often careless in the matter of 
 securing good light to work and read by. The 
 most desirable source of light is from above, be- 
 hind and to the left of the body, and it should 
 thoroughly illumine the work without shining 
 directly or casting reflections in the eyes. As an 
 artificial light the incandescent electric is the 
 best; but as it is not available to the majority of 
 people, dependence must still be placed in gas or 
 coal-oil. The use of incandescent mantles has 
 much improved the gaslight, making it whiter, 
 more like daylight, and also much steadier. In 
 country districts where coal-oil is the only illumi- 
 nant, the so-called student-lamps will furnish a 
 very satisfactory light for reading and fine work. 
 The points of most importance in this connection 
 are that the light shall be sufficiently bright to 
 thoroughly illumine the work without dazzling 
 reflections, and from such a direction as to avoid 
 shadows on the field of vision. If a position can- 
 not be taken which will prevent the light striking 
 directly upon the eye, a shade may be worn on 
 the forehead. Reading while in a recumbent 
 position is generally inadvisable, since the strain 
 upon the eye muscles is somewhat increased and 
 it is difficult to secure as good light upon the
 
 48 THE EYE. 
 
 book. The latter is the chief objection, and if 
 pains be taken to place the couch in such position, 
 in relation to the windows or the artificial source 
 of lighting, as to secure a proper illumination of 
 the reading matter, there is no serious objection 
 to reading while lying down. 
 
 WILD HAIRS. 
 
 Wild hairs are eyelashes which have, as the 
 result of inflammation of the lids, become turned 
 in so that they scratch the eyeball. Sometimes 
 they may produce great discomfort and injury, 
 but they are nothing like so common as is 
 generally supposed, and very many people pull 
 out their lashes under the mistaken belief that 
 they have wild hairs, when they are suffering 
 from irritation due to some entirely different 
 cause. A good set of lashes should not be inter- 
 fered with, as they are important agents in pro- 
 tecting the eye from foreign bodies. 
 
 FOREIGN BODIES. 
 
 Travelers on the railroad and laborers en- 
 gaged in such occupations as stone-cutting, tool- 
 grinding, etc., are constantly in danger of catch- 
 ing foreign bodies in the eye, and such injuries
 
 GRANULAR LIDS. 49 
 
 may vary in effect from a simple temporary 
 inconvenience to complete loss of the eye. The 
 best means to prevent such accidents is to wear 
 some simple protection spectacles or goggles. 
 Unless the substance imbeds itself in the cornea, 
 its most common hiding place is just under the 
 edge of the upper lid, whence it can easily be 
 removed by everting the lid and wiping it off. 
 The natural tendency of foreign bodies, not im- 
 bedded, is to be washed along toward the inner 
 corner of the eyelids, where they give no trouble. 
 A very common practice is to introduce "eye 
 stones" or flaxseed under the lids to chase out 
 the cinder or bit of dirt; the smooth seed, being 
 naturally carried along to the inner corner, is 
 expected to push the foreign body before it. This 
 is not a good practice, however, and has occa- 
 sionally produced considerable trouble. Unless 
 the foreign body can be readily removed, the 
 prompt assistance of an expert should be secured. 
 
 GRANULAR LIDS. 
 
 The condition to which this term is properly 
 applied is the disease technically called "tra- 
 choma," but the vast majority of people who 
 think they have granular lids are merely suffering 
 from a slight irritation or inflammation of the
 
 50 THE EYE. 
 
 lid margins, the result of eye-strain. True tra- 
 choma is a very serious disease, a specific infec- 
 tion of the tissue lining the inner surfaces of the 
 lids and the fold between the lids and the eye- 
 ball. When the lid is everted the surface is 
 discovered to be rough and granular in appear- 
 ance (whence is derived the common name), and 
 this roughened surface soon causes an irritation, 
 or even an ulceration, of the delicate cornea, 
 with consequent impairment of vision. For- 
 tunately, the disease is not very common in this 
 country, being practically limited to the lower 
 classes of foreign immigrants, mainly the Rus- 
 sian or Polish Jews, and appears but very rarely 
 among Americans of cleanly habits; nurses and 
 physicians sometimes become infected, through 
 no fault of their own, while treating patients 
 who have the disease, but, otherwise, true granu- 
 lar lids are rarely observed except among the 
 unclean, poverty-stricken portion of our tene- 
 ment dwellers. 
 
 The encrusted, inflamed, and roughened lid 
 margins frequently seen and sometimes mis- 
 takenly spoken of as granulated lids are gener- 
 ally not a serious condition, but an annoying one 
 that produces a very unpleasant sensation and 
 an unsightly appearance. Examination of such 
 eyes usually shows an error of refraction, and
 
 PINK-EYE. 51 
 
 the wearing of correcting glasses cures the lid 
 trouble. 
 
 STYES. 
 
 Styes are localized abscesses of the lid 
 margin. They are caused by germs gaining 
 entrance to the little openings of the small gland- 
 ducts around the hairs or lashes and causing a 
 purulent inflammation. A local swelling with 
 redness and pain results, pus is formed, and in 
 time the stye bursts and discharges its contents. 
 They have a tendency to occur in crops, one 
 following another, because such infective germs 
 are more or less constantly present on the skin, 
 and the fact that the first one appeared means 
 that the local resistance to infection is below 
 normal. As has been stated elsewhere (on page 
 27), this reduction of local resistance is gener- 
 ally the result of eye-strain. Removal of the 
 cause prevents a succession of styes, and opening 
 the existing one, followed by application of heat, 
 preferably in the form of bathing with hot water, 
 to promote absorption and healing, is the quick- 
 est way to cure the affection. 
 
 PINK-EYE (CONJUNCTIVITIS). 
 
 An inflammation of the mucous-membrane 
 covering of the eye that occurs often in epidemic
 
 52 THE EYE. 
 
 form. It is an infection and is easily spread in 
 schools or public places where people congregate. 
 The technical name for it is conjunctivitis, and 
 it responds very promptly to proper treatment, 
 but it is not safe to rely upon hoine treatment 
 of any eye inflammation. Its most prominent 
 symptom is redness of the eye, but, as that is a 
 symptom that is common to all eye inflamma- 
 tions, and accompanies such serious eye diseases 
 as iritis and glaucoma, it is readily understood 
 that the layman should not depend upon his own 
 judgment in making the diagnosis. 
 
 IRITIS AND GLAUCOMA. 
 
 Iritis, as the name implies, is an inflammation 
 of the iris, the colored part of the eye, and in 
 addition to the intense redness of the eye ob- 
 servable it is marked by considerable pain. It 
 occurs frequently in association with rheumatism 
 or other blood disease, and unless promptly 
 treated may cause loss of sight. 
 
 Glaucoma, while not so commonly seen, is 
 yet not a rare disease. It consists essentially of 
 a gradual hardening of the eyeball and loss of 
 sight through the consequent pressure upon the 
 nerve of vision. It may occur in either an acute 
 or chronic form, and the former type is accom-
 
 CATARACTS. 53 
 
 panied by most excruciating pain. In the acute 
 form, prompt treatment, usually an operation, 
 offers the only hope of saving the sight. It 
 should be needless to say that a competent physi- 
 cian should be consulted immediately for any 
 inflammation of the eyes. 
 
 CATARACTS. 
 
 Cataract is the term used to describe an 
 opaque lens. There are a number of different 
 forms, as, for instance, the congenital cataract, a 
 child being born with opaque lenses or opaque 
 spots in the lens; traumatic cataracts, where the 
 opacity results from an injury but the word is 
 most commonly applied to that condition known 
 as senile cataract, an opacification of the lens 
 occurring spontaneously in elderly persons. It 
 was formerly assumed that all persons would 
 develop cataracts provided they lived to suffi- 
 ciently old age, but it is now believed that this 
 was a mistake, and that cataracts probably occur 
 principally to persons who have not taken good 
 care of their eyes throughout early adult life. 
 Abuse of the eyes by overwork or failing to 
 correct ocular defects in time, by proper glasses, 
 causes eye-strain, and the accompanying or con- 
 sequent interference with the nutrition of the
 
 54 THE EYE. 
 
 lens results in a gradual loss of its transparency. 
 The victim first notices some difficulty in seeing 
 small or fine objects and a gradual loss of ability 
 to read or to follow occupations requiring clear 
 vision. The development of a cataract may be 
 rapid or slow, and sometimes several years 
 intervene between the first impairment of vision 
 and complete loss of sight or even sufficient 
 loss to enforce abstention from all close work. 
 Generally both eyes are involved, but one be- 
 comes cloudy much sooner or more rapidly than 
 the other. It is fortunate that this is so, for it 
 often enables the patient to have the worst eye 
 operated upon and its vision restored before the 
 second eye requires treatment. The period at 
 which treatment is instituted has been called the 
 time when the cataract is "ripe," and may be 
 described most simply as the time when the 
 patient can no longer see well enough to count 
 fingers at arm's length or to read ordinary print. 
 The only treatment worthy of consideration 
 is surgical; the various advertisements of reme- 
 dies to "remove cataract without the use of the 
 knife," to "cure cataract by absorption," etc., are 
 utterly unreliable. The opaque lens must be 
 removed, since it is acting as an obstruction to 
 the passage of visual rays to the retina, and this 
 can only be done by making an incision in the
 
 CATARACTS. 55 
 
 cornea and taking the lens out. The operation 
 is, naturally, a delicate one, requiring marked 
 skill on the part of the operator, but to the 
 patient it is a comparatively trivial experience. 
 The discovery of cocaine has rendered the opera- 
 tion a painless one; it is not necessary, except 
 in very rare cases, to take a general anesthetic. 
 The operation lasts but a few minutes, and 
 except for the fact that the patient is conscious 
 of what is going on about him he would not 
 know that he was being operated upon. With 
 the recent high development of special surgery 
 the success of cataract operations has steadily 
 improved until now the percentage of successful 
 results is more than 95 per cent.; that is to say, 
 95 patients, or more, out of every hundred sub- 
 mitted to cataract operation have good useful 
 vision restored to them. Considering these facts, 
 the word cataract has lost most of its horror, 
 and those who are so unfortunate as to be 
 afflicted with this affection may take courage 
 from the fact that their slowly developing blind- 
 ness need be but a temporary affair, and that 
 they can look forward to the day of restoration 
 of sight.
 
 56 THE EYE. 
 
 TOBACCO AND ALCOHOLIC BLINDNESS. 
 
 The excessive use of alcoholic stimulants and 
 of tobacco affects the eye, as it may every other 
 organ of the body. It is to be borne in mind 
 that what is excessive for one is not for another, 
 and that, while some men use large quantities of 
 these substances without apparent injury, others 
 may find even one cigar a day too many. The 
 injurious effect of tobacco is noticed in the eye 
 by a peculiar and characteristic lesion of the 
 optic nerve that results, eventually, in atrophy 
 of the nerve structure and consequent destruc- 
 tion of its function. As the nerve-fibers, one 
 after another, are destroyed, visual power grad- 
 ually disappears until absolute blindness super- 
 venes, upon complete destruction of the nerve. 
 
 For some people, then, tobacco is a poison; 
 and since no one can determine who will be one 
 of these susceptible individuals, a safe course will 
 be to use it only in moderation and, should any 
 visual defect appear, cease its use immediately. 
 By proper treatment, instituted early, and total 
 abstention from use of the harmful substances, 
 the disease can be checked and further loss of 
 vision than that noted at the time the patient 
 comes under observation can be prevented. 
 Tobacco alone rarely, if ever, produces any
 
 POSSIBLE EYE DISORDERS. 57 
 
 poisonous effect upon the nerve of sight; almost 
 all of the cases observed have occurred in 
 persons who are addicted to alcoholic stimulants 
 as well as to the use of tobacco. Regarding the 
 different ways of using tobacco, considered from 
 the standpoint of their relative danger to the 
 eyes, it may be said that pipe smoking is probably 
 the most dangerous ; after chewing or the use of 
 snuff, cigar smoking is next on the list, and the 
 much-discussed cigarette the least dangerous of 
 all. 
 
 SUBJECTIVE SENSATIONS THAT SHOULD CALL 
 ATTENTION TO POSSIBLE EYE DISORDERS. 
 
 Headaches. We have already emphasized 
 the fact that headache is more commonly caused 
 by eye-strain than by any other single thing. 
 The headache produced by defective eyes has no 
 characteristic form: it may be mild or severe; 
 felt only on use of the eyes or felt at some time 
 after their use ; be limited to the eyes or the brow, 
 or extend over the entire cranium; may be 
 practically constant or may recur at irregular 
 intervals. The point for the layman to bear in 
 mind is that frequent occurrence of headache 
 demands an examination of the eyes by a com- 
 petent oculist, and that it is much better to have 
 such an investigation made early or even need-
 
 58 THE EYE. 
 
 lessly, as it may appear to him, should no re- 
 fractive error be discovered, than to dose himself 
 or to be dosed with drugs for the relief of pain 
 that might be obviated by proper care of the 
 eyes. 
 
 Eye-pain. Distinct pain in the eye, other 
 than that spoken of as headache, usually occurs 
 in connection with some inflammatory condition. 
 The most common inflammation is conjuncti- 
 vitis, in which the pain is of a smarting or sting- 
 ing character, and accompanied by redness of 
 the eye and an excessive flow of tears. When 
 the pain is of a more severe nature there is 
 usually an affection of greater severity, as iritis 
 or glaucoma. The degree of pain cannot, how- 
 ever, be depended upon as a guide to the serious- 
 ness of the disease, since some persons are less 
 sensitive to suffering than are others. Any pain 
 in the eye requires an investigation. 
 
 Flashes of Light or Rainbows. The sensa- 
 tion of light flashes or the appearance of colored 
 rings and rainbow colors about the gas or lamp 
 lights is strong evidence of serious intraocular 
 disease. The latter symptom, particularly, is 
 often the first indication of glaucoma, and as that 
 disease in its chronic form is one of insidious 
 onset and development it is important that ad-
 
 POSSIBLE EYE DISORDERS. 59 
 
 vantage should be taken of this early symptom 
 that proper treatment may be secured. 
 
 Tear Drop. A flow of tears, especially on 
 exposure to cold weather or on windy days, is 
 generally a symptom of obstruction of the chan- 
 nel through which the tears ordinarily escape. 
 Under normal conditions the tears enter a little 
 canal in the lids and flow through the tear-duct 
 into the nose. Any obstruction to this duct pre- 
 vents outflow of tears in the natural way and 
 while in a warm atmosphere the tears may be 
 removed from the eye by evaporation; on cold 
 days, when evaporation cannot readily occur, the 
 excess of tears flows over the lid margin onto 
 the cheek. In the beginning of such a condition, 
 it may be easy to overcome the obstruction and 
 restore the natural channel or to remove the irri- 
 tant that is producing an excess of tears. If 
 neglected, the condition is prone to become much 
 more serious, the tears that are retained in the 
 tear-duct or sac becoming infected and thereby 
 producing an abscess that discharges backward 
 through the small opening in the lids or, in some 
 cases, ruptures through the skin and forms an 
 unsightly and disagreeable fistula upon the 
 cheek. After such an inflammatory condition 
 has been permitted to arise the treatment is, 
 naturally, more difficult and oftentimes taxes the
 
 60 THE EYE. 
 
 skill of even an expert eye specialist. Practi- 
 cally all cases can be cured, but surgical measures 
 will have to be resorted to except in the early 
 stages of the disease. 
 
 Spots Before the Eyes. The appearance of 
 black spots, ''flies," "cobwebs," etc., may indi- 
 cate some disease inside the eyes or the less 
 dangerous condition of eye-strain. They occur 
 quite frequently with the latter condition, and 
 may be taken as a warning that an examination 
 of the eyes is necessary. Those spots occurring 
 with inflammations of the eye are usually more 
 dense in character and are accompanied by other 
 symptoms which force the patient to seek treat- 
 ment. Whenever spots appear in the visual field 
 they may be considered as abnormal and demand- 
 ing attention. 
 
 HOW TO MAKE APPLICATIONS TO THE EYES. 
 
 Remedies prescribed for use in affections of 
 the eyes are generally ordered in the form of 
 drops or salves, sometimes an eye-bath or a lotion 
 is used, and occasionally one may be called upon 
 to apply a bandage. It would seem to be an 
 easy matter to apply drops to an eye, and yet 
 there is a right and a wrong way to proceed, and, 
 while the right way is easy and causes no discom-
 
 HOW TO MAKE APPLICATIONS. 61 
 
 fort, the wrong way may produce a great deal 
 of discomfort and sometimes an injury. It is 
 the common practice now with pharmacists to 
 supply a medicine dropper with all solutions that 
 are to be dropped upon the eye. The first pre- 
 caution in the use of such a dropper to be ob- 
 served is that the instrument should never be 
 inverted after the solution has been drawn into 
 the glass tube; if the dropper is held w r ith the 
 rubber end downward and the fluid allowed to 
 run into the rubber and then back into the glass 
 portion it will be noticed that the solution is no 
 longer clear, but contains fine particles of powder 
 that have been washed off the rubber. This fine 
 dust may prove irritating to the eye, and such a 
 procedure has spoiled the drops. Hold the 
 dropper gently by its soft-rubber end, squeeze 
 the rubber, insert the glass tip into the bottle and, 
 relaxing pressure upon the bulb, suck up a few 
 drops of the solution ; it is not necessary to draw 
 up a whole tubeful, as one or two drops for each 
 eye are all that are ever required. Keep the 
 dropper in an upright position, rubber end al- 
 ways up, without squeezing the bulb until it is 
 desired to eject the drops upon the eye, when 
 gentle pressure will release the fluid one drop at 
 a time. 
 
 The second important point is never to
 
 62 THE EYE. 
 
 drop the fluid directly on the cornea unless in- 
 structed by the physician to so do because that 
 is the most sensitive portion of the eye, and even 
 a drop of water falling upon it will give pain. 
 The application of drops can be made without 
 any pain whatever by the very simple device of 
 drawing the lower lid down and placing a drop 
 on the exposed inner surface thereof, as shown 
 in the accompanying illustration. (Fig. 2.) 
 When the lid is released the drop immediately 
 spreads itself over the surface of the eye. You 
 may even touch the inner surface of the lower 
 lid with the dropper or the finger without causing 
 discomfort, whereas the slightest drop upon the 
 eyeball produces pain. One drop in the eye, or 
 two at most, is quite sufficient, and anything in 
 excess of that is wasted because it flows into the 
 tear-duct or over upon the cheek. 
 
 Applications of ointment may be made in 
 much the same way; the salve being taken up on 
 a cotton-tipped toothpick, for instance, and wiped 
 off on to the everted lower lid. 
 
 There is a very prevalent belief that a daily 
 cold bath of the eyes (opening and shutting the 
 eyes under water) is beneficial and tends to 
 strengthen them. It may render the eyes more 
 resistant to external influences, such as cold, but 
 it could not in any way affect the sight, and
 
 W -tJ/J 
 
 Fig. 2. Proper method of applying drops 
 to the eyes.
 
 HOW TO MAKE APPLICATIONS. 63 
 
 while it may do no harm it does practically no 
 good. As a medical measure in certain inflam- 
 matory conditions of the eye, bathing of the eyes 
 with cold or with hot water may be required. 
 There are several ways of doing this. One may 
 apply the water simply with the hands, as in the 
 act of washing the face, or with the aid of a 
 sponge or soft linen cloth. Again, there is a 
 special "eye cup" made for the purpose; a small 
 oval-shaped glass bowl with concave margins 
 that can be filled with water and held to the 
 eye, fitting neatly over the upper and lower 
 lids, so that the eye is immersed in the fluid. No 
 special apparatus is necessary, however, and the 
 simpler means described above are quite effi- 
 cient. Another means of applying cold or heat 
 to the eye is to cut small round disks of soft linen 
 and, using several of these together, so as to 
 make a fairly thick pad, lay them on a piece of 
 ice, or wring them out of hot water, and apply the 
 pad over the closed eyelids; as fast as the cold 
 pad becomes warm (or the hot one cools off, if 
 heat is being employed), it can be changed for 
 another that has been in preparation. 
 
 Lotions, of whatsoever character prescribed, 
 are to be applied in the same way, similar pads 
 being soaked with the medicine. 
 
 Bandages. In an emergency, a handkerchief
 
 64 THE EYE. 
 
 may be folded into a narrow band, the central 
 portion of which is placed over the affected eye, 
 and the ends tied at the back of the head. Where 
 it is necessary to keep the eye bandaged for any 
 length of time, or to remove and replace the 
 bandage frequently, some device less bulky and 
 more convenient is desirable. One of the 
 simplest methods is to prepare a small pad like 
 that described above, or a pad composed of a 
 layer of cotton between two small disks of gauze, 
 and to maintain this in position over the closed 
 eye by the aid of two strips of narrow adhesive 
 plaster, crossing each other, carried from the 
 forehead to the .cheek. Still another form of 
 bandage easy to make consists of a square of 
 linen, about two and one-half by two and one- 
 half inches, to each corner of which a piece of 
 tape is attached; this is called the four-tailed 
 bandage and the tape ends are to be tied behind 
 the head.
 
 II, 
 
 THE EAR. 
 
 THE question may fairly be asked, How many 
 of our readers have ever given the slightest con- 
 sideration to their ears, really one of their most 
 valuable possessions? If you have ever thought 
 of it at all you have probably considered the ear 
 merely as one of the special sense organs that 
 functions automatically and which you would 
 miss seriously should disease deprive you of its 
 use. But did it ever occur to you that the ear is 
 the most remarkable and the most delicate, if not 
 the most important, of these special sense 
 organs ;rthat the mechanism of the hearing ap- 
 paratus is one of the marvels of nature; that its 
 importance in the human economy is so great 
 that nature has endeavored to guard and protect 
 it better than any of the other special senses ;u 
 that, while consisting of the most delicately co1fi> 
 structed and perfectly adjusted mechanical ar- 
 rangement in the body, it performs its physio- 
 logical functions with the slightest possible 
 intrusion upon the individual's life and the least 
 tax upon his energy and strength? Let us 
 
 os (65)
 
 66 THE EAR. 
 
 consider some of these points briefly in order 
 better to understand how the normal function of 
 the ear may be interfered with and how we can 
 best preserve or reclaim hearing power. 
 
 The important part which hearing plays in 
 our daily life is appreciated by very few people. 
 Do you know that the ear is far more accurate 
 and truthful in its reports to the brain than is 
 the eye? False visual impressions are very 
 common indeed, but false hearing is very un- 
 usual. How often have you had the experience 
 of failing to recognize an old acquaintance until 
 he spoke or laughed; the sound of his voice, 
 though not heard for years perhaps, recalled all 
 of the old memories which sight alone could not 
 stir. Visual memories may be as vivid, at times 
 more so, but they are not so lasting as hearing 
 memories. How striking that advertisement 
 "His Master's Voice!" A writer in one of the 
 magazines, Dr. Thomson, in Everybody's 
 (March, 1909, page 353), calls attention also to 
 the close relationship existing between the ear 
 and the emotions: "Unlike the eye, which 
 chiefly informs the mind, the ear stirs the emo- 
 tions. We can see a fish writhing in its death 
 agony without pity, but no one can so listen to 
 an animal's shrieks of pain. This is as it should 
 be, for, however wrong the head, the heart
 
 GENERAL CONSIDERATIONS. 67 
 
 should keep right. Through the ear the pro- 
 foundest depths of being are revealed." 
 
 The moving picture or the pantomime pro- 
 duces no such effect upon our feelings as a 
 similar performance accompanied by dialogue. 
 It is hearing a recital of humorous or pathetic 
 incidents that moves one. It is not the sight of 
 the beggar nor the particular words of his appeal 
 that reach the charitable chord in your heart; it 
 is the mysterious something in his voice, that can 
 reach you only through your ears, that tells you 
 whether or not he is honest and deserving of 
 help. When you read the daily paper you may 
 construct a mental vision of the scenes described 
 or the controversies enacted, but it is the con- 
 jured-up word-picture, the mental reproduction 
 of things said, and the inflection in tone with 
 which you imagine them to have been said that 
 makes the deepest impression upon you. 
 
 yOf course, the loss of any one of our special 
 senses would be a calamity, but if you want a 
 fair idea of the value of your ears just try the 
 experiment of going for one day with the ears 
 closed by pledgets of cotton so as to keep out all 
 sound. You will find yourselves in an absolutely 
 new world; a world without sound, for it is an 
 axiom that there is no sound where there is no 
 ear to hear it. This appears, at first thought,
 
 68 THE EAR. 
 
 strange to the untutored mind, but it is quite true. 
 The blow struck by the woodchopper, the explo- 
 sion of a gun, or any ofcker sound-producing 
 action is merely the setting in motion of atmos- 
 pheric particles, f Suppose we place a lemon on a 
 board and smack it smartly with another piece 
 of wood, what happens? The lemon is squeezed 
 to the bursting point and its juice spurts out in 
 all directions. Suppose the two pieces of wood 
 had been brought together in the same manner 
 when nothing intervened between them but ai*, 
 what would have happened? -^on may^answer 
 Jtkal a sutm4~er a- noise would be produced. Not 
 exactly ; the coming together of the two boards 
 squeezes or compresses the intervening air and 
 it flows out in all directions ; in other words, the 
 air is set in motion. Now if there is an ear 
 within convenient distance the moving waves of 
 air reach it, touch the drum-head, and start it in 
 motion, and this motion is transmitted to the 
 brain % where it makes an impression which is 
 interpreted as a sound^ Up to the moment of 
 perception by the brain the only effect of the 
 striking boards had been the production of a 
 wave in the atmosphere, a form of motion that 
 we call "sound waves." It is not actually sound 
 until the ear and brain perceive it, and had 
 there been no ear present the wave would have
 
 GENERAL CONSIDERATIONS. 69 
 
 passed on into space and died out without 
 producing any effect other than a slight move- 
 ment in the atmosphere./ Sound waves travel 
 slowly and only for short distances, in striking 
 contrast to light waves, which the eye perceives 
 and transmutes into sight. "The motions giving 
 rise to the sensation of light are too minute to 
 originate the sensation of sound ; and, conversely, 
 motions capable of producing sound are too 
 gross to generate light. Both light and sound, 
 external to the eye and ear, are only modes of 
 motion, but modes of motion that require spe- 
 cially adjusted organs, and organs of different 
 degrees of sensitiveness, for their transmutation 
 into the sensations of light and sound. The kind 
 of motion that is competent to stimulate the optic 
 nerve has no effect whatever upon the auditory 
 nerve. We cannot see a sound and we cannot 
 hear a color." 
 
 A few words may be given to the varying 
 character of sounds. Sound waves that have a 
 regular, rhythmical motion produce sounds 
 which we call musical ; and irregular, non-period- 
 ical movements give rise to sound sensations 
 known as noises. With such a variety of sound 
 waves as it is possible to produce in the world 
 it is not surprising that it is sometimes difficult 
 to draw a sharp distinction as to what is or is
 
 70 THE EAR. 
 
 not musical ; not all noises are unmusical and not 
 all so-called music is pure. The ear that is 
 trained to distinguish to a nicety the little differ- 
 ences in sounds finds for its possessor many 
 delights in nature that the ordinary unobservant 
 person misses, and we could all profit immeasur- 
 ably by cultivating the faculty of hearing. Byron 
 expresses this idea elegantly, when he sings : 
 
 "There's music in the sighing of a reed; 
 There's music in the gushing of a rill ; 
 There's music in all things if men had ears, 
 Their earth is but an echo of the spheres." 
 
 Now, thinking of our ears as mechanical in- 
 struments for the reception and transmutation 
 of sound waves into sensations of sound, we find 
 that we are dealing with a very mysterious piece 
 of mechanism. In the first place, there is the 
 external ear, called the auricle and external 
 auditory canal, for the collection of these sound 
 w r aves. At the inner end of this canal, and clos- 
 ing it over, is the drum-head which receives the 
 impact of the collected sound waves. All of this 
 constitutes what is called the receptive portion 
 of the hearing apparatus. Just internal to this 
 is the drum proper, and in this cavity are sus- 
 pended three small bones, called the auditory 
 ossicles. The outermost one, the malleus, or
 
 GENERAL CONSIDERATIONS. 71 
 
 hammer, has its long process or handle attached 
 to the head of the drum; the middle one, called 
 the incus, or anvil, is attached to the head of the 
 hammer on one side and on the other to the head 
 of the stapes, or stirrup; the stirrup, the inner- 
 most member of the group, is in turn attached 
 by its foot-plate to an opening in the inner wall 
 of the drum, where it comes into contact with the 
 special end apparatus of the nerve of hearing. 
 Within the drum are also two small muscles to 
 control the movements of these bones, and the 
 entire drum, or middle portion of the ear, is called 
 the transmitting apparatus because its principal 
 function is to transmit to the internal ear the 
 sound waves that have been received by the ex- 
 ternal ear, or receptive portion. Now, the inter- 
 nal ear, the so-called perceptive apparatus, 
 consists of a finely developed nerve-fiber sub- 
 stance of the auditory nerve, or nerve of hearing, 
 buried in a bony-walled receptacle deep in the 
 head. This cavity is filled with fluid, and floating 
 therein is this mass of nerve-fibers, the terminals 
 of the auditory nerve, of different lengths and 
 arranged in a spiral form so that there is a 
 gradual increase in the length of fibers from one 
 end of the spiral to the other. It will be impor- 
 tant to remember that the drum of the ear is 
 essentially an air chamber, and that it is con-
 
 72 THE EAR. 
 
 nected with the throat by a special tube so that 
 there can be a regular and constant replenish- 
 ment of air as needed. Having described what 
 constitutes a sound wave and the machinery for 
 utilizing it, let us consider what takes place in 
 the production of a sound, i 
 
 The atmosphere having been set in motion 
 and the sound wave being received into the canal 
 of the ear, it impinges upon the drum-head and 
 sets in motion the first ossicle, the hammer, which 
 strikes upon the second, the anvil, and that, in 
 turn, transmits the force to the third, the stirrup, 
 from the foot-plate of which the motion is trans- 
 mitted to the fluid of the internal ear, where it 
 starts a wave-like motion that spreads until the 
 hair-like nerve-fiber which corresponds in length 
 to that wave of fluid is struck and the impression 
 is conveyed by the nerve-fiber to the brain, and 
 the motion is translated into sound. A com- 
 plicated piece of machinery, you say. Yes, even 
 more so than would appear from this description, 
 for we have endeavored to express the action in 
 the -simplest possible terms, but its very com- 
 plication makes it an instrument of precision, an 
 instrument so delicately '.constructed that it 
 enables us to hear a great variety of sounds 
 even to appreciate, as musical, sounds that are 
 as yet far beyond the power of any humanly
 
 MALFORMATIONS. 73 
 
 devised musical instrument to produce. Our 
 range of hearing for musical sounds alone covers 
 eleven octaves, while the largest organ never has 
 more than eight octaves, the piano, as usually 
 constructed, embraces from seven to seven and 
 one-half octaves, and the violin has but three 
 and one-half octaves ; as a matter of fact, neither 
 the highest nor the lowest octaves of the organ 
 or piano are much used, so their practical range 
 is only about five octaves. 
 
 Very naturally, an instrument of such delicate 
 structure as the human ear presents many oppor- 
 tunities for getting out of order, 'even though it 
 is so well protected by having been placed within 
 the heavy bony walls of the cranium. The ex- 
 ternal portion of the ear is subject to possible 
 accidents, to injuries which may not only cause 
 deformity, but may so distort the auricles as to 
 interfere with its function of collecting sound 
 waves or that may cause obstruction to the ad- 
 mission of these waves into the canal. 
 
 MALFORMATIONS. 
 
 There is such a thing as congenital malfor- 
 mation of the ears, that is, there may be only a 
 distorted bit of cartilage more or less resembling 
 the natural ear, or there may be several of these
 
 74 THE EAR. 
 
 little tubercles, in addition to the normal ear, the 
 so-called supernumerary auricles. Malposition 
 of the ear is more common than malformation; 
 the ear may lie flat against the side of the head 
 or, more commonly, may flare out at right angles 
 thereto. This condition of sail-like ear is more 
 common in boys than in girls, and possibly is due, 
 in some measure at least, to the boyish habit of 
 drawing the hat or cap so far down as to force 
 the ears away from the head. When there is a 
 natural tendency to flaring of the ears in early 
 childhood it can sometimes be prevented by the 
 regular wearing of a nightcap or bandage, but 
 when firmly established or in adult life such ears 
 can be corrected only by an operation. 
 
 FOREIGN BODIES IN THE EAR. 
 
 Anything which interferes with sound waves 
 reaching the drum-head will, of course, reduce 
 the hearing power. Children not infrequently 
 introduce foreign bodies into the ear. Little" 
 Johnny has reached the age where sleight-of-hand 
 begins to be considered an accomplishment, and 
 he proceeds to introduce a glass bead or a dried 
 green pea into the ear and bring it out his nose. 
 Younger sister Mary proudly emulates the 
 example of her skillful brother and succeeds only
 
 FOREIGN BODIES IN THE EAR. 75 
 
 in so far as the first part of the trick is concerned. 
 Perhaps neither has the courage to tell mother 
 what has happened, and the foreign body may 
 remain in the ear for many years, without caus- 
 ing any particular discomfort, until a mass of 
 earwax accumulates about it t0 'close the canal 
 and obstruct hearing; I have removed foreign 
 bodies that had been in the ear for more than ten 
 years. A clean foreign body of the mineral type 
 is not likely to do harm in consequence of its mere 
 presence in the ear; of course, important struc- 
 tures like the drum-head may be injured in the 
 act of entrance if the substance entered under 
 force, or if any foreign body reaches the depth 
 of the canal and rests in contact with the drum- 
 head it is likely to occasion considerable discom- 
 fort. Vegetable substances like peas and beans 
 may swell and even germinate under the influ- 
 ence of the natural heat and moisture of the 
 canal, and ths cause trouble. Animate bodies 
 such as gnats, flies, spiders, and bugs of various 
 kinds occasionally find their way into the ear, 
 and may occasion mucfrdislTess'by craT\ r lffl"g r o^ver 
 or fastening their tentacles into the" sensitive 
 drum-head. The practical thing for you to re- 
 member in connection with the subject of foreign 
 bodies in the ear is that more harm can be done 
 by misdirected or unskillful efforts to remove
 
 76 THE EAR. 
 
 the substance than is likely to result from its 
 mere presence. Never attempt to remove a 
 foreign body from the ear with instruments; .and 
 among instruments I may class that very useful 
 but dangerous implement, the hairpin. The only 
 measure you may employ with safety is an ear 
 syringe. If you cannot wash out the foreign 
 body by frequent syringings you had better con- 
 sult a physician ; it joften requires considerable 
 skill to remove a foreign body without doing 
 damage to the ear itself. 
 
 ACCUMULATION OF EARWAX. 
 
 What has 'been said of foreign bodies carried 
 into the ear from without applies equally well to 
 collections of wax in the ear. j^ome persons are 
 subject to accumulations of this wax, or cerumen 
 as it is technically called, a substance which 
 nature provides for the purpose of catching and 
 holding particles of dust and small foreign bodies 
 which enter the canal, thus preventing their 
 reaching the drum-head. 'There are several pos- 
 sible reasons for this recurrence in certain indi- 
 viduals ; one may secrete more wax than another 
 or for some reason does not get rid of that which 
 is formed. Its repeated accumulation is not a 
 sign of.uncleanliness; in fact, it more frequently
 
 DISEASES OF THE DRUM. 77 
 
 results from excessive efforts to keep the ears 
 clean. The employment of aurilaves, toothpicks, 
 hairpins, or the moistened corner of a towel or 
 wash-cloth is more likely to push particles of wax 
 deeper into the canal than to remove them. 
 Nature provided a fairly efficient means of dis- 
 posing of the wax, and if that fails one can only 
 submit to the necessity of having the secretion 
 periodically removed. 
 
 DISEASES OF THE DRUM OF THE EAR. 
 
 The middle <*ar,,pr drum cavity, is the portion 
 of the hearing^ .apparatus most frequently sub- 
 jected to disease. Through its- connection with 
 the throat and nose there is always the possibility 
 that an inflammation of the latter structures may 
 invade the drum and produce an inflammation or 
 an abscess in the ear. Thus a common cold in 
 the head or an attack -of grippe may be accom- 
 panied by or produce an involvement of this part 
 of the ear. Chronic diseased conditions in the 
 nose or throat, enlarged or infected tonsils, or 
 adenoids may in the same way, by direct exten- 
 sion of the inflammation to the drum, produce 
 lesions in the hearing organ. Really, about 70 
 per cent, of all ear diseases arise in just this way. 
 A middle-ear trouble thus induced may pursue
 
 78 THE EAR. 
 
 one of two courses : it may result in an abscess of 
 the drum or it may be less severe and cause only 
 a mild inflammation, without the formation of 
 pus, a condition often called catarrh of the ear. 
 Either condition is more or less serious to the 
 function of the organ. 
 
 In the case of an abscess you have some 
 destruction of tissue and the danger of extension 
 ^ the brain cavity, possibly giving rise to 
 meningitis, brain abscess, or involvement of the 
 upper end of the large jugular vein, spreading 
 the infection to all parts of the body, through 
 the general circulation. Any of these complica- 
 tions may result in death unless an operation can 
 be promptly performed. The less serious cases 
 show no such immediate complications, but sub- 
 side after a few days or weeks of discharging 
 pus from the canal, or become chronic and con- 
 tinue indefinitely to discharge such matter. Now, 
 this latter group of cases is much more serious 
 than the public understands. It is unfortunate 
 that in some localities there is a notion that a 
 running ear is of no consequence and that any 
 effort to suppress the discharge will result in 
 trouble, that the "discharge will break out else- 
 where." There is absolutely no substantial basis 
 for such a belief. It seems to have been con- 
 structed on the idea that a running ear indicated
 
 DISEASES OF THE DRUM. 79 
 
 the presence of an objectionable humor in the 
 body requiring an outlet. Well, in the first place, 
 the ear is not a sewer for the rest of the body, 
 and, in the second place, the deductions as to the 
 nature of the discharge are absolutely false. ' Pus 
 running from the ear is an indication of a purely 
 local disease, a chronic abscess of the drum. 
 There is no danger in stopping it, but great 
 danger in permitting it to continue. So long as 
 it is allowed to persist it is a constant source of 
 possible danger. There are numerous instances 
 of persons having had running ears for many 
 years, even as long as fifty years, without any 
 other trouble than the annoyance occasioned by 
 the discharge itself, but, on the other hand, medi- 
 cal records are literally filled with instances of 
 neglected running ears that. ( suddenly set up 
 trouble by extension of the disease to the brain 
 and caused death before the surgeon could insti- 
 tute treatment or in spite of his best efforts to 
 eradicate the disease at that late hour. It is 
 known to all experts in the matter that a run- 
 ning ear is a constant menace to the life of the 
 person having it, and that there is never a day 
 when it may not suddenly flare up and cause 
 serious trouble. 
 
 Perhaps you may think the medical man takes 
 such a view because he is an interested party. I
 
 80 THE EAR. 
 
 can understand that to be a natural thought, 
 though a very unjust one to my profession. Let 
 me place the situation before you in another way. 
 You all have great respect for the business man's 
 view of things, especially when he is risking 
 money on his opinion. Well, do you know that 
 no reputable life-insurance company will assume 
 a risk on the life of a person who has or recently 
 has had a running ear ? That tells the tale better 
 than anything a physician can say to you. Do 
 not misunderstand me regarding the character 
 of the disease. Running ears are serious and 
 dangerous, but the danger lies chiefly in neglect 
 of them. Practically every running ear is sus- 
 ceptible of cure by one form of treatment or 
 another, and no one should be permitted to go 
 without treatment under the mistaken notion 
 that his affection is a trivial one. 
 
 "CATARRH" OF THE EAR. 
 
 To revert to a consideration of the second 
 type of middle-ear inflammation, the catarrhal 
 affection, we find here no great risk to life, but 
 .the products of such an inflammation impair the 
 motility of the ossicles and drum-head and, con- 
 sequently, diminish the hearing ability; further- 
 more, such changes are apt to be of a chronic
 
 CATARRH OF THE EAR. 81 
 
 character and, once started, the ear continues to 
 deteriorate unless the original exciting cause is 
 removed. A large majority of this group of ear 
 affections might be prevented by early and proper 
 attention to the predisposing factors. Many of 
 the abscesses and nearly all of the so-called 
 catarrhal affections of the ear, as I have said, 
 occur to persons suffering with adenoids or dis- 
 eased tonsils. The history of such cases usually 
 is that the child is a mouth-breather and snores 
 in his sleep ; he has occasional attacks of earache, 
 the pain varying in severity but always subsiding 
 after a short time, with or without treatment; 
 repeated attacks occur and, finally, the parents 
 notice that he does not respond when spoken to, 
 or that what they considered a slight degree of 
 deafness is increasing. In the case of an adult 
 the picture is somewhat different ; often the deaf- 
 ness creeps on insidiously after a series of head 
 colds or in association with an apparently inno- 
 cent but persistent nasal catarrh. If your child 
 is having repeated attacks of earache there is 
 almost surely an adenoid growth in his throat 
 or enlarged tonsils, and the sooner you have 
 either of these abnormal growths properly re- 
 moved the more certain will you be able to prevent 
 injury to his hearing. Medicine will do little 
 good; a thorough and complete operation is re-
 
 82 THE EAR. 
 
 quired and should be performed only by one 
 especially skilled in this branch of surgery. 
 
 NERVE DEAFNESS AND DEAF-MUTISM. 
 
 Diseases of the deeper portion of the 
 need ba^eljr^nientlon. The nerve f, may become 
 involved by extonmonof one of the middle-ear 
 diseases of which I have spoken, or it may be 
 affected "I5y "$y51mie-trr hereditary influences. 
 Most of these conditions cannot be forseen, and 
 are therefore not preventable. Their considera- 
 tion belongs rather to a medical convention than 
 to a public discourse. A child born deaf will not 
 attempt to talk, because we acquire speech 
 through repeating what we hear. If a young 
 child becomes deaf as the result of disease he 
 will cease to talk, even dropping so much of the 
 art as he had acquired. These two classes con- 
 stitute our deaf-mutes. Deaf-mutes brought 
 under instruction at the proper time may learn to 
 speak, certainly may be taught to understand the 
 language of others, by reading the lip move- 
 ments, and to talk, if not orally, at least with 
 their fingers and hands; thus growing up into 
 useful, self-supporting members of the com- 
 munity. 
 
 A very considerable percentage of the chil-
 
 NERVE DEAFNESS AND DEAF-MUTISM. 83 
 
 W" 
 
 dren classified as "deaf-mutes" are found, on 
 careful examination, not to be totally deaf. If a 
 child is partially but not absolutely deaf, his hear- 
 ing should be accurately measured and then 
 developed by training, making use of mechanical 
 devices whenever such afford real assistance, to 
 improve the function and enable him to employ 
 to the fullest extent his fragment of hearing 
 power. Before placing such a child in any school 
 or under any form of instruction, it would be wise 
 to have a careful investigation of the ears, nose, 
 and throat by an expert and, if abnormalities 
 such as adenoids, diseased tonsils, or obstructing 
 growths in the nose (conditions that might affect 
 the physiological function of the ear) be found, 
 or if there exists any inflammatory affection of 
 the ears, the proper corrective treatment should 
 be instituted. Later, having removed, as far as 
 possible, those factors which could cause further 
 trouble or might, at least, interfere with develop- 
 ment of the organ, educational measures may be 
 employed with greater assurance of benefit. 
 
 It is to be hoped that in this short discourse 
 we may have succeeded in calling your attention 
 to the importance of the organ of hearing, to the 
 necessity for preserving it in good order, and to 
 the fact that most of its diseases could be pre- 
 vented or cured by a little judicious care at the
 
 84 THE EAR. 
 
 right time. As it is sometimes easier to tell 
 people what not to do than to lay down specific 
 rules for positive guidance, let us conclude with a 
 few "Don'ts": 
 
 Don't permit your boy to drag his cap down 
 on his head in such a way as to force his ears 
 forward into false position; the deformity pro- 
 duced is unsightly and will not enhance his beauty 
 nor improve his chances with the girls when he 
 enters the social whirl. 
 
 Don't pick your ears with hairpins, tooth- 
 picks or ear-spoons, and don't try to see how far 
 you can insert the end of a wash-cloth or towel; 
 be satisfied with cleansing so much of the ear as 
 you can see or feel with the finger, depending on 
 nature to look after the deeper parts. 
 
 Don't try to remove wax or any foreign body 
 from your own or anyone's ear with forceps or 
 any of the above-named implements; if you be- 
 lieve there is a foreign body in the ear and you 
 cannot remove it by gentle syringing, you had 
 better consult a competent physician. 
 
 Don't neglect a child's complaint of repeated 
 earaches nor delude yourself into the notion that 
 his failure to respond to questions or to partici- 
 pate in conversation is due to lack of attention; 
 when a child is apparently hard of hearing or 
 complains of occasional pains in the ear it is time 
 to have the ears, nose, and throat examined.
 
 NERVE DEAFNESS AND DEAF-MUTISM. 85 
 
 Don't imagine that a running- ear is a trivial 
 affection; it is always a serious affair and some- 
 times an extremely dangerous one; proper care 
 of running ears nearly always results in cure, 
 while neglect of such conditions frequently re- 
 sults in an early death. 
 
 Don't ignore or neglect a failing ear, one 
 that is simply becoming progressively deafer,, 
 because the newspaper advertisements of patent 
 medicines and quack doctors have led you to 
 believe that catarrh is some horrible and incurable 
 disease. Catarrhal deafness is a serious affec- 
 tion, but often it can be cured and almost always 
 it can be checked in its course and prevented from 
 getting worse. 
 
 Don't buy a set of artificial ear-drums; they 
 will not help you. Ear affections that can be 
 benefited by such means are very rare. 
 
 Don't believe any newspaper advertisements 
 claiming to restore hearing; they are all false. 
 Your own common sense ought to tell you (i) 
 that even the most expert physician could not 
 explain the nature of your trouble nor the line 
 of treatment required without making an ex- 
 amination of you; (2) that advertisements bear- 
 ing the signature of "Doctor Anybody" are fraud- 
 ulent, for only "quacks" advertise, and all quacks 
 are liars.
 
 86 THE EAR. 
 
 Don't apply poultices to the ear under any 
 circumstances, and don't pour heated oils #or 
 ins^--stteh--ahHiiinj^ 
 
 taps- into the ear for relief of pain; the only 
 benefit to be derived from such remedies is due 
 to the application of heat, and this can be ob- 
 tained in a more cleanly and satisfactory way by 
 use of the hot-water bag; furthermore, oils and 
 fats congeal in the canal and on the drum-head 
 and cause trouble later.
 
 Ill, 
 
 NOSE AND THROAT. 
 
 THE two special senses that are housed here 
 are by no means of such importance as those 
 considered in the previous chapters. Each adds 
 something^to the pleasures, of life, but neither 
 is indispensable. The sense of smell^ enables us 
 to extract from nature an additional appreciation 
 of many of her delights ; how much more enjoy- 
 able are flowers when, added to their visual 
 beauty, we have the pleasure of their delightful 
 odors ! It is almost purely an esthetic sense, only 
 a very few people finding it of any economic value 
 in their lives. To a less degree, the same thing 
 may be said of the sense_of taste, _a^j^nse__that 
 adds_very_greatly to our pleasures, but which is 
 not at all necessary to life or happiness, nor of 
 material value in the pursuance of ordinary oc- 
 cupations. There are_a. .few persons in the world 
 who make a living from the use of these senses; 
 judging perfumes, testing the values of teas by 
 their taste, etc., but their proportion in the whole 
 laboring population is an insignificant percentage. 
 Total loss of ability to smell or to taste things, 
 
 (87) '
 
 88 NOSE AND THROAT. 
 
 especially the latter, would deprive one of much 
 of the pleasure ordinarily derived from eating, 
 would convert what is generally a delightful 
 pastime into a mere compulsory process and per- 
 functory function for the sustentation of life; 
 all food tasting alike, the eater would not care 
 much what was served to him and would eat 
 solely for the purpose of maintaining existence. 
 
 Partial loss of these senses would, in the 
 same way, be considered a deprivation in that it 
 interferes with tha^ full enjoyment of many 
 things that tend to make us happy and contented, 
 but could not be callecKa serious calamity. So 
 there is a marked distinction between the two 
 very important senses considered heretofore, 
 sight and hearing, senses so important to the 
 personal economy as well as to the pleasure- 
 producing elements, and the two lesser special 
 senses that have their terminal apparatus in the 
 nose and mouth. 
 
 Unlike the eye and ear, which are organs 
 designed solely for the production and develop- 
 ment of function of the special senses of sight 
 and hearing, the nose and throat are only in- 
 cidentally concerned in the elaboration of smell 
 and taste. \The nose, and throat, ajre of much 
 greater importance in the human economy be- 
 cause of their relationship with the organs of
 
 NASAL STRUCTURE. 89 
 
 respiration and of nutrition, the. channels for 
 admission of air to the lungs and of food to the 
 stomach. Consequently in considering their care 
 we shall have to treat them more particularly 
 with reference to these functions and have but 
 little to say about the special senses, f 
 
 Anything like a complete description of the 
 anatomical structure of the nose and throat 
 would be an inexcusable waste of space in such 
 a short chapter as this must be, because so much 
 of it is of so little importance to the layman. It 
 would be more to the point to take up for detailed 
 consideration some parts that ought to be better 
 understood by all intelligent persons, and to ex- 
 plain their position, formation, and abnormal 
 development. 
 
 NASAL STRUCTURE. 
 
 The nose is divided into two equal portions, 
 right and left nasal chambers, by a cartilaginous 
 septum, and this median wall is covered on both 
 sides by smooth mucous membrane. The lateral 
 or outer walls of both sides are of irregular con- 
 tour, being constructed of three scroll-shaped 
 bones placed one above the other, the lower one 
 being the largest. These bones are rather thin, 
 and by an arrangement which permits their
 
 90 NOSE AND THROAT. 
 
 overlapping and extending out into the nasal 
 chamber, as well as forming the lateral wall, their 
 mucous-membrane-covered surface is more than 
 double what would have existed in a plane-sur- 
 faced wall. The reason for providing this ex- 
 tensive area of vascular tissue is found in the 
 fact that one of the functions of the nose is the 
 warming and moistening of inspired air prepara- 
 tory to its admission to the lungs; the mucous 
 membrane covering the bones and the septum is 
 very vascular, carries a large blood-supply, and 
 the air in passing over this heated membrane has 
 its chill removed and is thus rendered less irri- 
 table than cold air would be to the sensitive lung / 
 tissue. The roof of the nasal chambers is parv 
 of the bony floor of the skull, directly over which / 
 lies brain substance. Posteriorly the nasar 
 chambers open into the upper and back part of 
 the throat by orifices that correspond in a measure 
 to the external orifices opening on the face. Be- 
 tween the turbinate bones (those referred to 
 above as scroll-shaped) there are several small 
 openings of canals or cells that connect the nose 
 with neighboring structures. For instance, the 
 tear-ducts, which convey tears from the inner 
 margins of the lids, open into the nose under the 
 inferior turbinates ; the big cavities in the cheek- 
 bones (antrum of Highmore) and behind the
 
 Fig. 3. Showing lateral aspects of nasal cham- 
 bers and neighboring structures. The turbinate bones 
 are especially well depicted.
 
 NASAL STRUCTURE. 91 
 
 eyebrows (frontal sinuses), as well as the so- 
 called bone sinuses in the center of the head 
 (ethmoid and sphenoid sinuses), communicate 
 with the nose in a similar way, and empty their 
 secretions into the nasal chambers. 
 
 From this it will be seen that the physiological 
 function of the nose is threefold. Primarily, it is 
 the organ through which we appreciate odors. 
 In the second place, it is of importance in the 
 act of breathing, not only constituting a channel 
 for the ingress of air, but preparing that air for 
 admission to the lungs. Thirdly, it is a drainage 
 canal for the removal of the mucus and watery 
 secretions of the neighboring cavities and struc- 
 tures of the head. Abnormalities in formation, 
 deformities resulting from injury, or changes 
 resulting from disease may interfere with any 
 or all of these functions. If the turbinate bones 
 are abnormally large or if the septum be deflected 
 to one side, there will be an obstruction of respi- 
 ration and impaired breathing through that side 
 of the nose. Such deformities may be congenital, 
 that is, present from the time of birth, or may 
 result from injury a broken nose often heals 
 with deformity of the septum or there may be 
 a slowly progressive growth of the turbinates 
 until they reach obstructive size. Inflammations 
 of the mucous membrane alone may be accom-
 
 92 NOSE AND THROAT. 
 
 panied by so much swelling that the nasal 
 chambers are occluded and breathing through the 
 nose becomes difficult or even impossible. 
 
 RHINITIS (COLD IN THE HEAD). 
 
 The so-called "cold in the head" is an acute 
 inflammation of the membrane lining the nose 
 and is caused by micro-organisms. The influence 
 of cold alone does not produce the condition 
 usually referred to when we speak of a cold in 
 the head; the condition is generally an infection, 
 the result of germs gaining entrance to the 
 tissues. The part played by cold is merely a 
 predisposing one. Prolonged exposure to cold 
 reduces the resisting power of the mucous mem- 
 brane because the effect of cold upon any vascular 
 tissue is to diminish its blood-supply by causing 
 a contraction of the smaller blood-vessels. When 
 the nasal tissue has become weakened and less 
 resistant in this way, germs, which are always 
 lurking about the nose and mouth, take advan- 
 tage of their opportunity for an attack and pro- 
 duce an inflammation. As elsewhere, the first 
 effect of inflammation is swelling and exudation, 
 which accounts for the stuffy sensation of a 
 "cold" in the nose and the very free flow of 
 secretion that soon follows. Pain and fever are
 
 RHINITIS. 93 
 
 the other symptoms of inflammation, and we 
 have them in a "cold" in proportion to the amount 
 of area involved and the virulence of the infec- 
 tion. Thus, if the inflammation spreads over the 
 nasal chamber and into the sinuses or channels 
 described, the absorbing surface is larger and the 
 systemic effects greater than if the disease be 
 limited to the walls of the nose proper. The pain 
 is greatly increased if some of the purulent secre- 
 tions get penned up in the sinuses and the swollen 
 tissues prevent their escape; thus causing a 
 condition of abscess, as it were. So you see a 
 cold in the head is not always a simple thing; it 
 may cause great distress from the local effect 
 only, or it may spread to other regions and even 
 invade the brain with fatal effect. The type of 
 micro-organism has much to do with the char- 
 acter of inflammations that we are accustomed 
 to group under the general head of "colds." The 
 germs most commonly concerned are the simpler 
 pus-producing ones, but sometimes there are espe- 
 cially virulent organisms to be considered, as in 
 the epidemic influenzas, the grippes, where a 
 large percentage of the population may be affected 
 by a specific germ introduced into the community 
 and favored in its dastardly work by an accom- 
 panying cold wave. While these "colds" differ 
 in minor details they are in general much alike,
 
 94 NOSE AND THROAT. 
 
 and even the most simple of them, under ordinary 
 circumstances, may in some instances prove to be 
 very dangerous. 
 
 A cold in the head should never be neglected. 
 First, because it is not of itself a dangerless 
 thing. Secondly, because it may readily become 
 a chronic inflammation or may cause lesions or 
 modifications in structure of the nose that leave 
 it an injured organ. 
 
 CHRONIC RHINITIS (NASAL CATARRH). 
 
 A chronic cold in the head, one that has 
 existed for some months or even years, is com- 
 monly spoken of as "catarrh," and right here let 
 me say that this is a very much abused word. 
 The outrageously deceptive advertisements of 
 "catarrh cures," promulgated by the patent 
 medicine manufacturers or the quack doctors 
 who prey upon the all too credulous public with 
 humbuggery in various forms, have so played 
 upon this word that perhaps the majority of 
 people believe "catarrh" to be a horribly dis- 
 gusting, terribly dangerous, and almost incurable 
 disease. Now, as a matter of fact, it is seldom 
 any of these things. They have used the super- 
 lative adjectives when those of less degree 
 would better explain the true condition. It is
 
 CHRONIC RHINITIS. 95 
 
 true that the affection is always unpleasant, 
 sometimes quite objectionable; rarely disgusting 
 either to the victim or his friends. It is true 
 that it sometimes spreads to neighboring struc- 
 tures and causes complications of a serious 
 nature, but only in a very small percentage of 
 cases does it actually endanger life. It is true 
 that it is inclined to be chronic and persistent 
 unless properly treated, but it is not at all to be 
 classed as an incurable affection, the percentage 
 of cases that resist treatment by a competent 
 physician being very small. If colds in the 
 head were properly regarded and wisely cared 
 for in the beginning, there would be very few 
 cases of the chronic, or so-called "catarrhal," 
 type resulting. Catarrh comes, in the main, from 
 the neglect of simple colds or from failure to 
 safeguard one's self against repeated attacks, and 
 may, therefore, be said to be to a large extent 
 a preventable disease. But supposing' that inclem- 
 ent weather or unavoidable exposure or inability 
 to take care of one's health results in a condition 
 of chronic nasal inflammation, it is still a disease 
 amenable to treatment, and if treated in the 
 proper w r ay it will almost invariably respond 
 promptly with a cure. The use of a "snuff," the 
 swallowing of pills or potions, the carrying of an 
 electric battery in the pocket, or the wearing of
 
 96 NOSE AND THROAT. 
 
 some fol-de-rol in the shoes is not, however, 
 proper treatment; that is the sort of treatment 
 occasionally advised by quacks or set forth in the 
 advertisements of patented articles, and designed 
 rather to catch the dollars of the foolish than to 
 cure the disease. 
 
 Let us consider what "catarrh" really is, that 
 we may understand its most disagreeable and 
 dangerous features, recognize the necessity for 
 getting rid of it, and appreciate the nature of the 
 treatment required to bring about its cure. 
 
 In the first place the word "catarrh" is defined 
 in the medical dictionary as "inflammation of a 
 mucous membrane, with a free discharge." Now, 
 that does not sound very terrifying. Any inflam- 
 mation of any mucous membrane of the body 
 must be accompanied by a discharge; conse- 
 quently they are all "catarrhal" inflammations, 
 strictly speaking. Pink-eye is a catarrhal inflam- 
 mation of the eyes; a running ear is a catarrhal 
 inflammation of the ear; appendicitis is a catar- 
 rhal inflammation within the appendix; a simple 
 cold in the head is, from a scientific point of view, 
 just as much a catarrh as is the chronic type of 
 nasal inflammation. Why then has the word 
 come into such disrepute? All inflammations 
 must have a beginning, an acute stage. If the 
 inflammation naturally subsides quickly, or is
 
 CHRONIC RHINITIS. 97 
 
 either cured or proves fatal within a short time, 
 no serious consideration is given by the public to 
 the name applied to it. If the inflammation, from 
 any cause, tarries long and passes into the 
 chronic, meaning long-continued, stage it be- 
 comes not only more of a nuisance, but, usually, 
 more dangerous to one's welfare, and its name 
 attracts more attention. Quite naturally, then, 
 the term "catarrh" has attached itself rather to 
 the long-continued inflammations that are marked 
 by a discharge; and since chronic inflammations 
 of the air passages are by all odds the most com- 
 monly observed of this type of affection, the word 
 has grown to be rather limited in its use by the 
 public to persistent inflammations of the nose and 
 throat. Unfortunately a considerable number of 
 physicians, feeling the backward pressure of the 
 public mind in this matter, have carelessly fallen 
 into the habit of using the word in the same way, 
 though it is to be hoped still with a better under- 
 standing of the actual conditions. As there are 
 in almost every community that is at all thickly 
 settled some persons who from ignorance or 
 neglect have allowed a nasal or throat inflam- 
 mation to pass into a stage of seriousness, and 
 as the charlatans have by a continuous perform- 
 ance kept before the public artfully contrived 
 pictures of these poor victims, as horrible
 
 98 NOSE AND THROAT. 
 
 examples of what any nasal inflammation might 
 become, a great many laymen have finally ac- 
 cepted the word "catarrh" as describing a very 
 serious group of purulent infections of the nose, 
 throat, or lungs. The condition is utterly un- 
 justifiable and unreasonable, but there is little 
 wonder that the word has come to mean some- 
 thing dreadful to the average person, or that 
 many patients say, with a worried expression on 
 their faces, "Don't tell me I have catarrh." Well, 
 if you have a persistent discharge from your nose 
 or a more or less constant hawking and spitting 
 of something from the throat, you have catarrh; 
 but having said that, we have not pronounced 
 your doom nor put upon you the stigma Biblically 
 applied to the leper unclean. 
 
 Having defined the word, let us now study 
 more particularly the conditions to which it is 
 applied; and since the profession as well as the 
 public generally mean a chronic inflammation of 
 the nose when the term catarrh is used, we shall 
 limit the description to that region. It has been 
 explained that an acute inflammation of the nose, 
 a cold in the head, arises from the action of 
 micro-organisms upon the nasal mucous mem- 
 brane that has been weakened by exposure to the 
 influences of cold. Exposure to cold may, of 
 course, be of various kinds; having to remain
 
 CHRONIC RHINITIS. 99 
 
 out for a long time in a cold wind, in a rain or 
 snow storm; being transported suddenly from a 
 warm into a much colder atmosphere; sitting in 
 a cold place with improper or insufficient clothing 
 to protect one against chilling of the body; get- 
 ting the feet wet and not being able soon to 
 secure dry footwear, and so a hundred different 
 means might be mentioned. As a general rule, 
 an acute cold in the head is for the normal healthy 
 individual a self-limited disease lasting on the 
 average about nine days. Why should some 
 cases become chronic ? There are many reasons ; 
 the person may not have a normal, healthy re- 
 sistance, and his weaker tissues fall an easy prey 
 to the germs ; the germs may be of an especially 
 virulent nature and produce a more serious or 
 more chronic form of inflammation than usual; 
 instead of taking care of himself and trying to 
 get rid of the cold, the patient may be subjected 
 to continuous or repeated exposures; finally, 
 neglect or inappropriate treatment may result in 
 prolonging an acute infection into a chronic one. 
 The longer the inflammation exists, the more 
 it tends to spread beyond the original site of in- 
 fection, and the greater will be the destruction of 
 tissue. Very few chronic cases, then, are limited 
 to inflammation of the mucous membrane of the 
 lateral walls or the septum of the nose. Instead,
 
 100 NOSE AND THROAT. 
 
 the disease has caused an ulceration of the deeper 
 tissues or has invaded the neighboring sinus 
 spaces of which we have spoken. Secretions 
 formed in these sinuses and large cells drain into 
 the nose only imperfectly, and the portion that 
 fails to flow out, the residuum retained in these 
 spaces, tends to keep up a constant reproduction 
 of more inflammation and more pus. In the 
 majority of cases of chronic nasal catarrh an 
 examination discloses the presence of diseased 
 bone or of abscess cavities in these cellular spaces. 
 In this connection it may be noted that this ex- 
 plains why proper treatment resolves itself into 
 providing drainage from these spaces, so as to 
 permit complete removal of the products of 
 inflammation and the taking away of as much 
 dead or diseased bone as interferes with proper 
 drainage and ventilation of the nasal cavities or 
 the presence of which serves to promote further 
 inflammatory action. 
 
 The symptoms of chronic nasal catarrh are 
 not difficult of recognition, and little need be said 
 about how to determine the existence of the dis- 
 ease; the exact points of diagnosis do not come 
 within the scope of the layman, it being suffi- 
 cient that he should recognize the fact that certain 
 symptoms indicate chronic nasal disease and call 
 for the attention of a skilled physician, whose
 
 CHRONIC RHINITIS. 1Q1 
 
 duty it is to ascertain the location and extent of 
 the trouble and to prescribe the proper treatment. 
 When evidences of a cold in the head are con- 
 stantly present or recur frequently upon slight 
 provocation, it may be taken for granted that 
 there is something abnormal within the nose. 
 Inability to breathe freely through either side of 
 the nose is proof of some unnatural obstruction, 
 inside the nose or behind it, where it should open 
 into the upper portion of the throat, and if this 
 condition be accompanied by mucous or purulent 
 secretions from the nose the obstruction is most 
 probably caused by inflammatory swelling result- 
 ing from a catarrhal process. When there is 
 regularly present a thick, clear mucous discharge 
 or a yellowish purulent discharge from the nose, 
 requiring frequent employment of a handker- 
 chief, there is almost surely a chronic catarrhal 
 inflammation that has extended to the cellular 
 spaces. If the sense of smell is impaired, or if 
 the breath of a person having such a nasal secre- 
 tion is foul of odor, the chances are that an ex- 
 tensive, destructive nasal inflammation is the 
 cause. Headache is a not uncommon sign of 
 nasal disease, especially when the pain is most 
 pronounced over the eyebrows or deep in the 
 bone below the eyes. 
 
 It is not intended to discuss here the methods
 
 102 NOSE AND THROAT. 
 
 and forms of treatment that may be employed 
 for the cure of disease; it is the function of this 
 book only to make it possible for the non-medical 
 reader to recognize the existence of an abnormal- 
 ity or of diseased conditions, and to distinguish 
 in a measure between the simple and the danger- 
 ous affections. Self-medication is a curse to any 
 people. The accurate diagnosis and scientific 
 treatment of disease is an art that requires years 
 of painstaking study to even fairly comprehend; 
 leave the practice of medicine to those who have 
 endeavored to fit themselves for its onerous and 
 responsible duties. Not even everyone who 
 holds the title of doctor is competent to treat all 
 diseases. All legitimate practitioners of medicine 
 are expected to know something of all diseases, 
 but the entire field of medicine is so large that it 
 is impossible for any but the most exceptional 
 men to know all about it; hence the growth and 
 development of specialism, men devoting their 
 time to the study of the diseases of one or two 
 organs. It is reasonable to expect that specialists 
 in diseases of the nose and throat should be more 
 capable of understanding and more skillful in the 
 treatment of affections of these organs than the 
 family physician, whose duties require attention 
 to many subjects; and so it is wiser to consult 
 such a one when disease of this region is sus-
 
 CHRONIC RHINITIS. 1Q3 
 
 pected. Further, the mere proclamation that one 
 is a specialist does not necessarily mean that he 
 is the most learned or skillful of his class ; he may 
 really be little better than the general family 
 physician who makes no pretense of special 
 knowledge or training. Unfortunately, the laws 
 at present permit almost anyone possessed of the 
 degree of Doctor of Medicine, and many who 
 have not that much tangible evidence of medical 
 knowledge, to declare themselves to the public as 
 specialists in some branch of medicine. In no 
 other department of medicine has this fact been 
 more abused than in the consideration of diseases 
 of the nose and throat, and there are far too 
 many incompetents prescribing for and even 
 operating within this area. There is no infallible 
 rule for selecting a competent physician or sur- 
 geon. The man with the greatest reputation is 
 not always or necessarily the most capable and 
 skillful in his vicinity; an intelligent young man 
 may excel in capability and skill his gray-haired 
 neighbor who is better known in social and pro- 
 fessional circles; it can only be said that when 
 the services of a specialist are needed one should 
 carefully consider to whom he will entrust his 
 case and, before deciding, make honest endeavor 
 to secure the best available assistance. If such 
 a rule had been more generally followed in the
 
 104 NOSE AND THROAT. 
 
 past, instead of the haphazard method of permit- 
 ting anybody to tamper with the nose, or of let- 
 ting its diseases entirely alone, "catarrh" would 
 never have come to be looked upon with such 
 terror. It has been shown to be a condition that 
 is susceptible of cure if properly treated, but it 
 must be stated that its proper treatment requires 
 the aid of a competent, specially trained physician. 
 
 AFFECTIONS OF THE TONSILS. 
 
 On either side of the throat, hear the base of 
 the tongue and just below the soft palate, may 
 often be seen a small, soft, glandular structure 
 called a tonsil. In the normal adult human being 
 it is scarcely visible, but in children it can fre- 
 quently be seen as an almond-shaped body pro- 
 jecting slightly from the lateral wall of the 
 pharynx. If the tonsil has any useful function 
 in nature that fact has never been discovered, and 
 at the present time the best medical opinion seems" 
 to be that it is a useless, functionless appendage 
 much more likely to be a nuisance than a benefit 
 to its possessor. It is most desirable to be born 
 without tonsils, at least without visible evidences 
 thereof ; but being so unfortunate as to have them 
 present at birth,- one can only hope that they will 
 disappear early by a process of atrophy. Very
 
 AFFECTIONS OF THE TONSILS. 1Q5 
 
 many children miss this blessed occurrence, how- 
 ever, and in them the tonsil shows a tendency to 
 increase in its size, to grow and to become what 
 is technically called "hypertrophied," when they 
 may interfere seriously with the child's health; 
 first, through interference with the acts of breath- 
 ing and swallowing; secondly, through the ease 
 with which they become infected and inflamed 
 (tonsillitis) ; thirdly, by their deleterious influence 
 upon the child's speech and hearing. 
 
 One can readily understand how the enlarged 
 tonsils, projecting into the throat until they 
 almost or quite meet each other, obstruct the 
 natural act of swallowing and prevent the free 
 ingress of air; nature probably did not intend 
 that we should rely to any great extent upon 
 the mouth for breathing purposes, but, since en- 
 larged tonsils so frequently occur coincidently 
 with nasal obstructions, they interfere at times 
 with this reserve method of respiration. These 
 very large tonsils, however, do much more than 
 merely obstruct the passage of air and food; by 
 their pressure upon neighboring soft tissues they 
 interfere with the muscular action of the soft 
 palate necessary to distinct enunciation in speech, 
 and close the orifices of the tubes which lead from 
 the throat to the ear (the Eustachian tube, that 
 opens just above and behind the soft palate and
 
 106 NOSE AND THROAT. 
 
 the posterior openings of the nose) for the ad- 
 mission of air to the ear-drums. As has been 
 explained elsewhere, closure of these tubes causes 
 a rarefaction of the air in the drum-cavities, a 
 sinking in of the drum-head and either a mild 
 catarrhal inflammation in the ears or a diminu- 
 tion of hearing power, or both. Furthermore, 
 such tonsils are especially prone to infection and 
 to suffer from the effects of cold, so that children 
 having enlarged tonsils are subjected to frequent 
 attacks of sore throat (tonsillitis), and often these 
 attacks are accompanied or followed by com- 
 plaints of earache, occasionally even by abscesses 
 in the drums. 
 
 The influence of the tonsils on the voice is a 
 matter worthy of much more consideration than 
 it has generally received. Children with tonsils 
 almost invariably have a thick voice or a nasal 
 twang, and speak indistinctly. A full, rich, 
 mellow voice is next to impossible for a person 
 whose throat space is restricted by abnormal 
 growths, like hypertrophied tonsils or adenoids. 
 It is important that this should be clearly under- 
 stood because patients often explain their hesi- 
 tancy to submit to operation by saying that they 
 fear removal of the tonsils will affect the voice; 
 it will affect the voice, but the effect will be in 
 the nature of an improvement. . By removing
 
 AFFECTIONS OF THE TONSILS. 107 
 
 the abnormal growth that encroaches upon the 
 resonance space, for the throat is a resonance 
 chamber for the musical voice; by reducing the 
 state of chronic inflammation of the throat that 
 generally accompanies diseased tonsils, and thus 
 getting rid of irritating secretions, the voice is 
 generally much improved in quality and can be 
 used more easily and for longer periods of time 
 without fatigue. Thus singers, lawyers, minis- 
 ters, and other public speakers who have been 
 seriously handicapped by failure to produce cer- 
 tain notes clearly or inability to speak distinctly, 
 or without effort for more than a few minutes, 
 find themselves able to sing purely, or to speak 
 distinctly and for a prolonged period, after 
 having had their affected tonsils removed. 
 
 When the tonsils persist on into adult life 
 they are not only subject to the above-named 
 conditions, but have a further series of disorders 
 peculiarly their own. The very large, hyper- 
 trophied tonsil is rarely seen in persons beyond 
 the age of puberty. Any visible tonsil after this 
 time of life is probably abnormal and should be 
 carefully examined to ascertain whether it is 
 diseased and a possible source of trouble com- 
 plained of, perhaps, at a remote point. It has 
 come to be a recognized fact now that not only 
 are many cases of deafness and other aural
 
 108 NOSE AND THROAT. 
 
 affections directly traceable to diseased tonsils, 
 even though small in size, but that such systemic 
 affections as rheumatism may be attributable to 
 toxins absorbed through or manufactured within 
 the tonsil. Peculiarly enough, it is not the grossly 
 enlarged tonsils that are the worst offenders in 
 this respect, but the small, so-called "submerged" 
 tonsils (tonsils that may be of considerable size, 
 but are not visible as projecting large tonsils 
 because they have been overgrown by and lie 
 buried under the loose tissues of the palate), with 
 cheesy-looking, yellowish particles collected in 
 their crypts that cause the systemic infections. 
 
 Every child that is a mouth-breather or that 
 has frequent attacks of sore throat or earache, 
 and every older person who shows signs of begin- 
 ning or advancing deafness, or who has repeated 
 sore throats or suffers from joint troubles and 
 other complaints of a rheumatic character, should 
 have a careful investigation made of the nose 
 and throat, particularly with reference to the 
 tonsils. The enlarged tonsil of early childhood 
 is not difficult of recognition, even by the parents, 
 but it requires more skill to determine the exist- 
 ence and condition of the smaller diseased tonsils 
 of adults. Many cases of ear disease are cured, 
 many more are checked in their downward 
 career by prompt and proper attention to the
 
 Fig. 4. View of throat in which can be seen 
 small diseased tonsils and parts of an adenoid hanging 
 below the soft palate on either side of the mouth.
 
 AFFECTIONS OF THE TONSILS. 109 
 
 tonsils and to coincident nasal or throat condi- 
 tions. Many cases of rheumatism, affecting in 
 some instances the large joints of the body, have 
 been relieved and recurrence entirely prevented 
 by the removal of small, but diseased tonsils the 
 existence of which had perhaps not been sus- 
 pected by the patient. In addition, it may also 
 be said that many cases of such affections of the 
 ears and of the joints cannot be cured nor 
 materially benefited by any other treatment until 
 the diseased tonsils have been removed. 
 
 While, as has been stated before, it is not de- 
 sirable to enter upon a discussion of the treat- 
 ment of disease here, it seems necessary in this 
 matter to give some advice on the subject. This 
 is necessitated by the fact that the only treatment 
 worthy of consideration is of a surgical nature, 
 and by the further fact that many people are 
 averse to acknowledging the plain, palpable truth 
 of the situation. It is perfectly natural to desire 
 to avoid any sort of an operation; no one is 
 anxious to be operated upon for any ailment 
 whatsoever. It is not, therefore, surprising that 
 some persons should beg that their tonsils be 
 "treated," that applications be tried or medicines 
 administered in the hope of "shrinking" the 
 tonsils or driving them away. Parents not in- 
 frequently inquire whether, if the child be let
 
 HO NOSE AND THROAT. 
 
 alone, the tonsil will not atrophy and disappear 
 at about the age of puberty. There is no satis- 
 factory proof and no reasonable assurance that 
 such a thing can or will take place, and while 
 waiting for such an unlikely event to transpire 
 the child is subjected to all the dangers and dis- 
 comforts that attend retention of the tonsils; the 
 dangers are not inconsiderable in this connection, 
 because such diseases as scarlet fever, whooping- 
 cough, and diphtheria are much more serious 
 when occurring in children with enlarged tonsils 
 than in those with free throats. Medicines may 
 be, and should be, employed to reduce an acute 
 inflammation of the tonsil before attempting an 
 operation, unless an emergency demands a dif- 
 ferent course; to operate during the stage of 
 acute inflammation increases the risk of infection 
 of the wound and prolongs the period of healing 
 after operation. It must be acknowledged, how- 
 ever, that there is no known medicinal remedy 
 that will by application or injection dispose of a 
 diseased or an enlarged tonsil. To spray and 
 gargle and paint the tonsil, or to swallow pills 
 and potions, for any other purpose than the allay- 
 ing of acute symptoms of inflammation, is a waste 
 of time and a delusion, if the object is to get rid 
 of the diseased tonsil. 
 
 In this connection, and for the purpose of
 
 AFFECTIONS OF THE TONSILS. HI 
 
 public education, it may be well at the same time 
 to advise that, having decided upon an operation 
 upon the tonsil, complete removal is the thing to 
 be recommended. The oldtime operations of 
 clipping the tonsils, cutting bits off by an instru- 
 ment acting like a guillotine, or of cauterizing 
 them with electrically heated wires are obsolete 
 and are performed only in exceptional cases at 
 the present time by the best authorities. The 
 modern operation of complete removal of the 
 tonsil is a major operation, comparable to re- 
 moval of the appendix, and requires quite as 
 much, often more, surgical skill than the last- 
 named operation. It should be performed only 
 by thoroughly trained men, and patients should 
 fully appreciate the fact that they are to undergo 
 not a simple but a serious operation. Consider- 
 able trouble has arisen from the failure of the 
 public, and not infrequently of the general mem- 
 bers of the profession, to recognize the true 
 character of the change that has taken place in 
 consequence of the introduction of this operation. 
 Having grown accustomed to the simple, though 
 often inefficient operation of tonsillotomy (taking 
 off a piece of the tonsil) where the operation was 
 performed and the patient walked off to attend 
 to his regular business of the day, they have 
 failed to understand that tonsillectomy (com-
 
 112 NOSE AND THROAT. 
 
 pletely dissecting out every particle of the tonsil) 
 is a matter of graver consequence. Tonsillectomy 
 is unquestionably the better operation because it 
 accomplishes what every operation should at- 
 tempt to do full and complete removal of the 
 abnormal or diseased structures. It is, however, 
 attended by dangers that seldom appeared in the 
 old, incomplete operation; it requires a' high 
 degree of skill for its proper performance, and 
 it produces in most instances a considerable 
 degree of shock, which necessitates a period of 
 complete rest for the patient, varying from three 
 days to a week, according to the constitutional 
 strength of the individual. By recognizing these 
 facts, selecting a competent, specially trained 
 surgeon to perform the work, and preparing one's 
 self as for submission to any other major opera- 
 tion, with a sufficient period of rest following to 
 permit of an untrammeled convalescence, much 
 good and little danger can come from the 
 operation. 
 
 ADENOIDS. 
 
 In the upper part of the throat, behind the 
 nose, the space that is called the vault of the 
 pharynx or the postnasal space, there is some- 
 times found a mass of glandular tissue which is 
 spoken of as an "adenoid growth." Under
 
 ADENOIDS. 113 
 
 normal conditions the vault of the pharynx is 
 simply a large air chamber : its roof is a part of 
 the base of the skull ; its posterior wall, a portion 
 of the back of the throat, is a thin layer of soft 
 tissues covering the upper cervical part of the 
 spinal column; its lateral walls of mucous-mem- 
 brane-covered muscular tissues present, on either 
 side, the orifices of the Eustachian tubes which 
 permit the transmission of air to the ear-drums ; 
 anteriorly it is marked by the posterior openings 
 of the nasal chambers; it has no floor. Physio- 
 logically, air enters this space through the nose 
 and, aside from that small portion that is re- 
 quired for the ears, passes downward into the 
 larynx and bronchial tubes on its way to the 
 lungs. In the soft tissues of the vault there 
 exists in the infant a segment of a ring (com- 
 pleted by extension through the tonsils and the 
 base of the tongue) of gland-like cells. Under 
 certain conditions this may develop into a gland- 
 ular structure and project into the pharyngeal 
 space, when it is recognized as an adenoid 
 growth. In some instances the growth increases 
 rapidly and may reach such size as to completely 
 fill the postnasal space and even extend below the 
 soft palate so that it is visible on looking into the 
 open mouth. In the majority of cases it does not 
 approach this enormous size, but any adenoid
 
 114 NOSE AND THROAT. 
 
 projection whatsoever in the pharyngeal vault is 
 abnormal and may possibly cause trouble. The 
 growth may appear in one more or less solid 
 mass or may develop as a mass of fimbriated, 
 partially separated projections. Sometimes 
 quite a large mass is present at birth, but more 
 frequently it develops gradually during the early 
 years of life. 
 
 Adenoids produce trouble in various ways. 
 First, by completely or partially occluding the 
 mouths of the Eustachian tubes they prevent 
 ingress of air to the ears and cause inflammation 
 in the drum, followed by progressive deafness. 
 Secondly, by covering the posterior openings of 
 the nose the mass acts like a ball-valve to ob- 
 struct respiration; air enters the postnasal space 
 through the nose, by forcing the adenoid back, 
 but as expiration takes place the mass falls down 
 again over the orifices and, as the air must escape 
 then through the mouth, that well-known but 
 disagreeable sound called a "snore" is produced. 
 Thirdly, being very susceptible to the influences 
 of cold, adenoids keep the child in an almost con- 
 stant state of cold in the head with all its conse- 
 quent disagreeable features. Fourthly, by virtue 
 of the more or less constant state of inflammation 
 maintained and of their absorptive properties 
 they produce a state of autointoxication which
 
 ADENOIDS. 115 
 
 makes the child delicate and sickly, as the result 
 of which a generally stunted growth, an im- 
 perfect physical development, retarded mental 
 development, or a general susceptibility to sys- 
 temic disease is the common outcome. 
 
 The symptoms of adenoids are generally easy 
 of recognition. If your baby has "snuffles," can- 
 not feed properly (that is, sucks the breast for a 
 few moments and then has to cease in order to 
 breathe), snores, or is restless in its sleep, con- 
 sider whether it may not have adenoids. If your 
 older child is a mouth-breather, snores in his 
 sleep, is "hatchet-faced" and "pigeon-breasted," 
 is not up to the average size of children of the 
 same age, has attacks of asthma or of croup, or 
 is dull and stupid at schoolwork, look out for 
 adenoids. If, in addition to any of these symp- 
 toms, the child has repeatedly recurring attacks 
 of earache, mild or otherwise, there certainly are 
 adenoids present. 
 
 The disastrous effects of adenoids upon the 
 general health can hardly be overstated and are 
 equalled only by the counterbalancing marvelous 
 improvement that takes place when the abnormal 
 growth is removed. It is a common occurrence 
 to see children of 12 to 14 years of age who, be- 
 cause of adenoids, have not progressed in intellect 
 beyond the average child of 7 or 8, and the same
 
 116 NOSE AND THROAT. 
 
 may be said of their stature. In contradistinc- 
 tion to this, it is a delight to watch the rapid 
 physical growth and the mental development that 
 follows the removal of adenoids from such a 
 child. 
 
 Nearly all of the things that were said about 
 the evil influences and the dangers of enlarged 
 and diseased tonsils might be here repeated with 
 equal truth about adenoid growths, and the same 
 things are, likewise, true as to what should be 
 done for them. Surgical removal is the only 
 treatment worthy of consideration, and that 
 should be instituted at the earliest convenient 
 moment. Do not wait for the child to outgrow 
 them; he will not do so, and while you are wait- 
 ing in vain for relief by that means his hearing 
 or his general health may become seriously and 
 permanently impaired, or death may carry him 
 off through some intercurrent disease that is 
 made doubly dangerous because of the presence 
 of these abnormal growths. The child does not 
 need to be "built up" for the operation; he re- 
 quires the operation in order that he may build 
 up. 
 
 The operation is not a serious one, always 
 acknowledging that any operation, however 
 simple it may be, carries with it a certain element 
 of risk, but should be performed by a competent,
 
 ADENOIDS. 117 
 
 skilled surgeon and with every possible precau- 
 tion against accident and provision for safe 
 convalescence. In all young children the opera- 
 tion should be done under a general anesthetic. 
 An operation attempted without anesthesia is al- 
 most sure to be an incomplete, imperfect, and 
 unsatisfactory one. Recurrence after a complete 
 operation is possible, but not probable; recur- 
 rences are generally due to the fact that the 
 growth was not completely removed at the right 
 time. In the necessary haste attending an opera- 
 tion upon a child not anesthetized the surgeon 
 cannot be sure he has taken all of the mass, and 
 the chances are strongly against his ability to do 
 so. As after any major operation, there should 
 follow a period of quiet rest with the proper safe- 
 guards against possible infection. Finally, bear 
 this point strongly in mind; if your child has an 
 adenoid or enlarged or diseased tonsils, do not 
 hesitate to submit him to the operation for 
 removal even though he seems to be suffering 
 no inconvenience from these abnormalities at the 
 time, because the risks of the operation are 
 infinitesimal, while the dangers of leaving the 
 thing alone are many and great.
 
 INDEX. 
 
 Abscess of eardrum, dangers 
 of, 78 
 
 middle ear, 78 
 
 Accommodation, ocular, 16 
 Adenoid operation, 116 
 Adenoidectomy, 116 
 
 risks of, 117 
 Adenoids, 112 
 
 as cause of colds, 114 
 
 bad effects of, 115 
 
 cause of ear affections, 81 
 
 cause of ear trouble, 114 
 
 causing; snuffles, 115 
 
 description of, 112 
 
 growth of, 113 
 
 how they produce trouble, 
 114 
 
 interfering with Eustachian 
 tube, 114 
 
 obstruction to respiration, 
 114 
 
 recurrence of, 117 
 
 removal of, 116 
 
 symptoms of, 115 
 Alcohol, as cause of blind- 
 ness, 56 
 
 Antrum of Highmore, 90 
 Anvil, the, 71 
 
 Apparatus for transmitting 
 sound waves, 71 
 
 hearing, 70 
 
 perceptive, of the ear, 71 
 Applications to eyes, how to 
 
 make them, 60 
 
 Astigmatism, combined with 
 hypermetropia, 22 
 
 combined with myopia, 22 
 
 correction of, by glasses, 32 
 
 discomfort produced by, 23 
 
 explanation of, 21 
 
 simple, 22 
 
 Auditory nerve, 71 
 
 ossicle, 70 
 Auricle, 70 
 Auricles, supernumerary, 74 
 
 Babies, inflammations of 
 their eyes, 38 
 
 Bandage, for the eyes, 63 
 
 Bathing eyes, how to per- 
 form, 63 
 
 Blindness, due to ophthalmia 
 
 neonatorum, 38 
 due to tobacco and alcohol, 
 56 
 
 Books, best paper for, 44 
 best plan of columns and 
 
 lines, 44 
 type to be used in, 44 
 
 Broken nose, 91 
 
 Buried tonsils, 188 
 
 Camera, nature's, 12 
 Car-sickness, due to defective 
 
 eyes, 28 
 Cataract, 53 
 description of, 53 
 development of, 54 
 in relation to eye-strain, 53 
 recovery from, 55 
 ripeness of, 54 
 treatment of, 54 
 Catarrh of the ear, 78, 80 
 
 prevention of, 81 
 nasal, 94 
 
 cause of ear disease, 81 
 treatment of, 95 
 nature of, 96 
 Cerumen, in the ear, 76 
 Childhood, care of eyes dur- 
 ing, 41 
 errors of refraction in, 41 
 
 (119)
 
 120 
 
 INDEX. 
 
 Chorea, due to eye-strain, 30 
 Choroid, description of, 14 
 Chronic catarrh, causes of, 99 
 dangers of, 99 
 symptoms of, 100 
 treatment of, 102 
 Ciliary muscle, description of, 
 
 14 
 
 power of, 25 
 small size of, 24 
 Cold applications, to eyes, 62 
 Colds, cause of, 92 
 caused by adenoid, 114 
 dangers of, 93 
 in head, 92 
 nature of, 92 
 treatment of, 95 
 Conjunctivitis, an infection, 
 
 52 
 
 cause of, 51 
 treatment of, 52 
 Convergence, associated with 
 
 accommodation, 18 
 Cornea, description of, 13 
 Crossed eyes, 44 
 cause of, 44 
 treatment of, 46 
 
 Deaf-mutes, education of, 82 
 
 treatment of, 83 
 Deaf-mutism, 82 
 Deafness, congenital, 82 
 
 from nasal catarrh, 81 
 
 nerve, 82 
 
 resulting from adenoids, 81 
 Desks, in the schoolroom, 43 
 
 relation of seat to, 43 
 Disease of the tonsils, 104 
 Dropper, how to use for eye 
 
 drops, 61 
 
 Drops, how to put in eye, 61 
 Drum of the ear, 70 
 
 diseases of, 77 
 Drumhead, 70 
 
 Dyspepsia, due to eye-strain, 
 30 
 
 Ear, 65 
 abscess of, 78 
 
 Ear, accumulation of wax in, 
 76 
 
 anatomy of, 70 
 
 catarrh of, 78, 80 
 
 description of, 70 
 
 drum of the, 70 
 
 drumhead of, 70 
 
 external, 70 
 
 flaring, 74 
 
 foreign bodies in, 74 
 
 internal, 71 
 
 malformations of, 73 
 
 malposition of, 74 
 
 special sense organ, 65 
 Earache, never neglect, 84 
 Ear-drums, artificial, 85 
 
 diseases of, 77 
 Education of deaf-mutes, 82 
 Emmetropia, 18 
 Epilepsy, excited by eye- 
 strain, 31 
 Ethmoid sinus, 91 
 Eustachian tube, 72 
 External auditory canal, 70 
 
 ear, 70 
 Eye, 11 
 
 accommodation of, 16 
 
 bandages, 63 
 
 bath of, 62 
 
 compared to camera, 12 
 
 external muscles of, 17 
 
 foreign bodies in, 48 
 
 function of, 13 
 
 inflammation of baby's, 38 
 
 its care in infancy, 38 
 
 organic defects of, 18 
 
 structure of, 13 
 
 yellow spot of, 17 
 Eyeball, description of, 13 
 Eye-cup, for bathing eye, 63 
 Eye-headaches 28 
 Eye-pain, meaning of, 58 
 Eyes, how to bandage, 63 
 Eye-strain, cause of digestive 
 disturbances, 29 
 
 cause of headache, 28 
 
 cause of stomach disorders, 
 30
 
 INDEX. 
 
 121 
 
 Eye-strain, due to errors of 
 
 refraction, 24 
 in childhood, 41 
 in chorea, 30 
 in nervous affections, 30 
 local evidences of, 27 
 manifestations of, 26 
 part played in causing epi- 
 lepsy, 31 
 
 reflex symptoms of, 27 
 remote evidences of, 27 
 removal of, 31 
 styes in, 27 
 variation of symptoms in, 
 
 28 
 without local symptoms, 27 
 
 Far-sight (see Hypermetro- 
 pia), 19 
 
 Far-sighted (hypermetropic), 
 
 19 
 meaning of, 19 
 
 Far-sightedness, a mislead- 
 ing term, 19 
 
 Flaring ears, 74 
 
 Flashes, of light in the eye, 
 58 
 
 Flies, in visual field, 60 
 
 Foreign bodies in ear, 74 
 
 removal of, 76 
 in eye, 48 
 how to remove, 49 
 
 Frontal sinuses, 91 
 
 Glasses, value of, in relief of 
 
 eye-strain, 36 
 Glaucoma, 52 
 Granular lids, 49 
 
 Hairs, wild, 48 
 Hammer, the, 71 
 Headache, cause of, 28 
 
 due to defective eyes, 28 
 
 nasal origin, 101 
 
 ocular origin, 28 
 
 when attributable to eyes, 
 
 57 
 Hearing apparatus, 70 
 
 Hearing, a marvel of nature, 
 65 
 
 physiology of, 72 
 
 power, accuracy of, 66 
 
 range of, 73 
 Highmore's antrum, 90 
 Hot applications, to eyes, 63 
 Hypermetropia, action of the 
 lens in, 19 
 
 cause of squint, 45 
 
 correction of, by glasses, 32 
 
 its meaning, 19 
 
 shape of eye in, 18 
 Hypertrophied tonsils, 105 
 
 Incus, 71 
 
 Indigestion, caused by de- 
 fective eyes, 29 
 Infancy, care of eyes in, 38 
 Internal ear, 71 
 Iris, description of, 14 
 Iritis, 52 
 
 Lens, action of, 15 
 
 description of, 15 
 Lids, granulation of, 49 
 Light, in the schoolroom, 43 
 
 flashes, in the eye, 58 
 Lights, best position for 
 reading, 47 
 
 value of different, 47 
 Lotions, use on eyes, 63 
 
 Malformations of the ear, 73 
 Malleus, the, 70 
 Middle ear, abscess of, 78 
 cure of, 80 
 dangers of, 78 
 catarrh, 78 
 diseases of, 77 
 Mouth-breathing, 108, 115 
 Muscle, ciliary, 14 
 
 power of, 25 
 
 Muscles, external ocular, 17 
 Mutism, from deafness, 82 
 Myopia, 20 
 
 action of lens in, 21 
 correction of, by glasses, 32
 
 122 
 
 INDEX. 
 
 Myopia, reason for distant 
 
 vision in, 21 
 shape of eye in, 20 
 
 Nasal catarrh, 94 
 
 a cause of deafness, 81 
 chronic, treatment of, 102 
 cold, 92 
 headaches, 101 
 mucous membrane, 90 
 septum, 89 
 sinuses, 90 
 
 infection of, 100 
 structure, 89 
 Near-sightedness (myopia), 
 
 20 
 
 Nerve-deafness, 82 
 Nerve of hearing, 71 
 Nervous disorders, due to 
 
 eye-strain, 30 
 
 prostration, due to eye- 
 strain, 30 
 Nose, 87 
 anatomy of, 89 
 deformities of, 91 
 fracture of, 91 
 physiology of, 91 
 structure of, 89 
 turbinate bones of, 90 
 
 Oculist, the broad importance 
 
 of his work, 32 
 the work of the, 32 
 varying skill of, 36 
 Ointments, how to apply to 
 
 eye, 62 
 Old-age sight (presbyopia), 
 
 23 
 
 Ophthalmia neonatorum (in- 
 flammation of baby's 
 eyes), 38 
 
 a preventable disease, 38 
 blindness from, 38 
 danger of, to others, 40 
 how to prevent, 39 
 treatment of, 40 
 virulence of, 38 
 of newborn babe, 38 
 Optic nerve, entrance into 
 eye, 14 
 
 Optician, legitimate field for 
 
 his skill, 34 
 work and limitations of the, 
 
 33 
 
 Ossicles, auditory, the func- 
 tion of, 72 
 ear, 70 
 Overflowing tears, 59 
 
 Pain, in the eye, 58 
 Perceptive apparatus of the 
 
 ear, 71 
 Physiology of hearing, 71 
 
 nose, 91 
 
 vision, 13 
 
 Pink-eye (conjunctivitis), 51 
 Presbyopia, action of lens in, 
 23 
 
 explanation of, 23 
 Prevention of ear catarrh, 81 
 
 ear disease, 81 
 
 earache, 81 
 Pupil, explanation of, 15 
 
 Rainbow lights, in the eye, 58 
 Reading, position of body in, 
 
 47 
 
 position of light in, 47 
 while lying down, 47 
 Refraction of light, 18 
 Removal of adenoids, 116 
 foreign bodies from ear, 75 
 
 from eye, 49 
 tonsils. Ill 
 
 Retina, description of, 16 
 Rheumatism, caused by ton- 
 sils, 108 
 Rhinitis, 92 
 acute, 92 
 causes of, 92 
 chronic, 94 
 
 Risley's (Dr. S. D.) advice 
 on school arrangements 
 for children, 42 
 Running ears, 78 
 dangers of, 79 
 never neglect, 85 
 treatment of, 80
 
 INDEX. 
 
 123 
 
 Schools, desks in, 43 
 lighting of, 43 
 Dr. Risley's advice on 
 means to save chil- 
 dren's eyes, 42 
 Sclerotic, description of, 14 
 Sense of smell, loss of, 101 
 Septum of the nose, 89 
 Shrinking of tonsils, 109 
 Sick-headache, due to accu- 
 mulative eye-strain, 29 
 Sight, appreciation of, 11 
 Sinus, ethmoid, 91 
 frontal, 91 
 sphenoid, 91 
 
 Sinuses, nasal, disease of, 100 
 Smell, loss of sense of, 101 
 
 sense of, 87 
 Snoring, because of adenoids, 
 
 114 
 Snuffles, caused by adenoids, 
 
 115 
 
 Sound, explanation of, 68 
 musical, 69 
 waves, 68 
 
 Spasm of eyelids, 26 
 Spectacles, assistance of, in re- 
 lieving ocular defects, 
 36 
 
 Sphenoid sinus, 91 
 Spots, before the eye, 60 
 Squint, 44 
 cause of, 45 
 
 relationship to errors of re- 
 fraction, 45 
 treatment of, 46 
 Stapes, 71 
 Stirrup, the, 71 
 Stomach disorders, due to 
 
 eye-strain, 30 
 Structure, nasal, 89 
 Styes, associated with eye- 
 strain, 27 
 cause of, 51 
 prevention of, 51 
 treatment of, 51 
 Submerged tonsils, 108 
 
 Taste, sense of, 87 
 Tear drop, meaning of, 59 
 treatment of, 60 
 
 ducts, 90 
 Throat, the, 87 
 Tobacco blindness, 56 
 
 effect of, on the eyes, 56 
 Tonsil operations, 111 
 
 risks of, 112 
 Tonsillectomy, 111 
 
 risks of, 112 
 Tonsillitis, 105 
 Tonsillotomy, 111 
 Tonsils, affections of, 104 
 
 as cause of rheumatism, 108 
 
 atrophy of, 104 
 
 cause of ear affections, 81 
 
 cheesy particles in, 108 
 
 dangers of, 110 
 
 disappearance of, 104 
 
 effect of diseased, 105 
 
 failure to atrophy, 110 
 
 function of, 104 
 
 hypertrophy of, 105 
 
 influence on ears, 105 
 
 influence on voice, 106 
 
 removal of, 111 
 
 shrinking of, 109 
 
 submerged, 108 
 
 treatment of, 189 
 Trachoma, 49 
 Transmitting apparatus of 
 
 the ear, 71 
 
 Turbinate bones of nose, 90 
 Twitching of lids, 26 
 Type, size of, for easy read- 
 ing, 44 
 
 Voice, affected by tonsils, 106 
 
 Waves, sound, 68 
 
 Wax, accumulation of, in the 
 
 ear, 76 
 
 Wild hairs, 48 
 Wrinkles, due to eye-strain, 
 
 27 
 
 Yellow spot, of the retina, 17
 
 UNIVERSITY OF CALIFORNIA, LOS ANGELES 
 
 THE UNIVERSITY LIBRARY 
 This book is DUE on the last date stamped below 
 
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