Mother's Remedies, Thomas Jefferson Ritter [reading well .TXT] 📗

the eustachian tube and middle ear becomes first congested and afterward oedematous (watery swelling). Then a serous or a bloody-serous fluid is poured out into the middle ear; and finally this assumes all the outward characteristics of pus. In a few exceptional cases this pus fluid will find a sufficient passage through the eustachian tube; but in the great majority of cases this passageway becomes closed almost at the very beginning of the attack, and then the free exudation; under an ever increasing pressure and on account of the softening and breaking down of the tissues of the drum forces an opening for itself directly through the drum membrane.

Causes.—The same causes that produce the acute variety will produce this variety of the disease. It occurs more frequently during the spring and fall months as the result of changes in the climate. Acute and chronic catarrh of the nose and pharynx are causes. It frequently occurs in connection with scarlet fever and measles. It complicates nose and pharyngeal diphtheria.

Symptoms.—Pain in the ear is the most striking symptom noticed by the patient. In infants and young children of two or three years of age it may appear and not be recognized until a slight discharge appears at the opening of the external ear. The child is feverish, fretful and peevish, seemingly suffering great pain, and the parents think it is, not very sick or has only an earache. Sometimes physicians fail to recognize the trouble until the discharge appears in the external ear. The symptoms are more severe at night. Any physical or mental exertion increases the plain. The pain is sometimes very severe, and a spontaneous or artificial rupture of the drum eases the suffering very quickly in some cases, and a bloody, serous, pus-like discharge escapes into the external ear canal. Often a patient will say: "I felt something give away in the ear, a watery discharge appeared, and the pain soon subsided." In many cases the rupture of the drum gives little or no relief from suffering. This is due in some cases to the small and insufficient size of the opening in the drum. If the pain persists, after a free opening has been made, it may indicate that pressure exists in some cavity or cavities other than the middle ear proper. A sensation of fullness and sometimes of throbbing or pulsation in the affected ear; roaring, singing, whistling, etc.; impairment of hearing; increased pain, when the jaws are opened and shut, are symptoms of minor importance. If there are no complications after free discharge sets in the pain disappears, the fever gradually returns to the normal point, and the patient drops to sleep. In the course of a week or two the discharge subsides and if the rupture is not too extensive the wound will close and the patient will soon be well. Frequently, however, on account of disease of one or more of the bony parts, the wall of the middle ear or the mastoid cells, the discharge continues for weeks and may become chronic in its character.

[364 MOTHERS' REMEDIES ]

Treatment.—Apply heat or cold first. Open the bowels.

How to apply heat.—With the patient lying on his side with the affected ear turned upward, fill the external ear canal with hot water (about 105 degrees F.), then place immediately over the affected ear a hot flaxseed meal poultice, five or six inches square and one-half inch thick, and spread a folded blanket or shawl over the whole to keep it warm as long as possible. Bread and milk with catnip, or onions will do if flaxseed is not at hand. The flaxseed holds the heat longer. Water is a good conductor of heat, and that which fills the external auditory (ear) canal may rightly be considered as an arm of the poultice which extends down to the drum itself.

Leeches also can be applied in front and below the tragus (front of the opening). If the symptoms do not improve under this treatment and especially if the drum is bulging, an opening should be made at the bulging point of the drum. The canal is now syringed with a warm antiseptic solution—like one part listerine, etc., to twenty parts of warm boiled water, with a clean syringe, or warm boiled water can be used alone. If there is any odor carbolic acid one part, to fifty or sixty of water can be used. A strip of sterile gauze is put into the canal for drainage and protection. This syringing can be done from two to four to five times a day, and gradually decrease the number of times as the discharge lessens. It must be syringed and dressed often enough to allow a free discharge and produce cleanliness.

Recovery.—The result of this disease cannot be told at the outset. The majority of such attacks end favorably, with care and treatment; this in persons of good constitution and health. It may run ten days to three to six weeks. In tuberculous patients the result is not so favorable. Recovery follows as a rule in this disease following scarlet fever and measles, but not so quickly, and there may be a discharge for some time, due to chronic disease of the ears, etc.

Complications and results.—In the majority of cases, in ordinarily healthy persons, this disease runs its course without doing any great amount of damage to the organ of hearing, and without involving any structure lying outside of the middle ear proper. In scarlet fever, measles, la grippe, or nasal diphtheria, actual destruction of tissue often takes place in some part of the middle ear before it is recognized. Sometimes it results the same way even when it is discovered in time.

Caution.—A person who has had this disease should be very careful not to take cold. The patient should take plenty of time to get well and strong. The diet should be liquid mostly.

[EYE AND EAR 365]

CHRONIC SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.—An inflammation that forms pus; hence called suppurative. This is an inflammation that has become chronic (continued) and has one characteristic at least that is very noticeable, and that is the discharge. This may last for an indefinite period. The acute suppurative (pus-forming) inflammation just described in the foregoing pages, may have inflicted various kinds and degrees of damage upon the mucous membrane which lines the cavities, and as a result of the conditions thus established there will be a discharge which may last an indefinite time.

Causes.—Improper or lack of treatment for the acute suppurative inflammatory attack. This is the chief cause. The first attack may have been caused by scarlet fever, measles, etc. They are prone to become chronic, especially if not recognized early and treated properly.

Symptoms.—The main symptom is the discharge from the ear. This may be abundant or scanty. It may stop for a time and begin again. The hearing may be slightly or seriously impaired. Such patients are not accepted by life insurance companies.

Treatment.—Cleanliness of the parts and perfect drainage must be secured. Syringing with one to fifty carbolic acid solution (acid one part, warm water fifty parts) is good treatment. The opening in the drum should be made large enough to give free discharge to the pus in the middle ear.

The patient's strength must be built up if necessary.

INFLAMMATION OF THE MASTOID' CELLS. (Acute or Chronic Mastoiditis).—This disease represents one of the most serious terminations of an acute or a chronic suppurative inflammation of the middle ear. This is fortunately a comparatively rare event. There are, however, quite a good many cases of this terrible disease.

Causes.—It occurs as a primary or secondary disease. The first condition is rare and the result from injury, exposure to cold and dampness, or from syphilis or tuberculosis. Secondary disease is catarrhal or pus-like in form. This results from an extension of middle ear disease through the antrum, as a rule. The disease may develop at any time and endanger the life of the sufferer.

Symptoms.—Dull constant pain behind the ear and tenderness on pressure, more severe at night, the tenderness is very apt to be followed in a short time by redness and swelling of the skin in the same region. The pus may drain from the mastoid into the middle ear cavity. If this does not happen it may swell behind the ear and break through some other place. It may involve the structures within the brain. If meningitis develops, the patient has headache and later it becomes very severe. Lights hurts the eyes, The patient is restless, sleepless, may have nausea and vomiting and a constant high temperature. The neck is stiff and rigid. If there is more brain involvement (phlebitis) there will be sudden rise of temperature, followed by a rapid fall of temperature and attended by profuse sweating and chills,—a dangerous condition. There can be abscess of the brain also. In abscess of the brain symptoms are less severe and localized; the rigid neck and fear of light and vomiting are absent.

[366 MOTHERS' REMEDIES ]

Treatment.—If seen early it may be aborted. If an examination of the drum shows bulging, an incision of the drum head should be made. If an opening is there it should be enlarged, if necessary. Cold applications are valuable and should be applied directly over the mastoid behind the ear. Sometimes hot applications are better, hot poultices, cloths, etc., syringing the canal with hot water. These applications, etc., should be constantly used for a day or, so, unless unfavorable symptoms set in, when if a marked improvement, especially in the local tenderness and pain, has not occurred, an operation should be done and the mastoid opened.

The diet should be liquid (milk), nourishing and sustaining. Bowels should be kept open.

This disease must be carefully watched. It is not only dangerous to life, and very quickly, but it is full of disagreeable and dangerous possibilities, lifelong discharge from the ear, an external fistulous opening, a permanent paralysis of the facial nerve, abscess in the brain. Brain symptoms, paralysis and pus symptoms do not now preclude an operation on the mastoid for mastoid disease. The patient should be closely watched and an operation performed as soon as called for.

I have given a longer description of the diseases of the ear than I intended when I began this part of the work. Diseases of the ear are becoming quite frequent, and the subject is important. I did not give much general medical treatment because I consider the local treatment is of more importance in a work of this kind. In treating the baby, I shall give more medical treatment. I shall treat the disease also, especially in relation to the baby. There can be more local applications used than those given. If the hot treatment is thought best, not only hot water and poultices of many kinds can be used, but fomentations of hops, etc., and hot water cloths alone. The intent of such treatment is to keep hot moist applications to the part continually. The use of laudanum in poultices used for ear trouble is not recommended because its soothing power may obscure symptoms that might appear and be dangerous in themselves and need quick and thorough treatment. The syringing of hot water into the external canal is often of great help. Five to ten grains of boric acid can be used in an ounce of water. If there is much odor to the discharge, you can use one part of carbolic acid to fifty parts of boiled water. The water should not be used too hot. One teaspoonful of the acid to fifty teaspoonfuls of water, or that proportion. After using the hot water, the canal should be filled with gauze for protection and drainage. For the fever, the first twenty-four hours, one-tenth to one drop of aconite can be used every one to three hours. By putting one drop in ten teaspoonfuls of water you get one-tenth of a drop at a dose.

[EYE AND EAR 367]

DEAFNESS.—This is usually the result of a disease and is merely a symptom. Diseases of the middle ear, rupture of the drum membrane, and large ulceration of this membrane cause it. Ear wax causes temporary deafness. Diseases of the throat and nose cause it very often, and deafness frequently accompanies catarrh of the nose. Adenoids cause it sometimes, especially in children.

Treatment.—The only way to prevent this trouble is to treat the disease that causes it. Discharge from the ear, due to ear disease should be treated from the first or it may cause permanent deafness in that ear. Many cases of scarlet fever leave deafness behind in one ear at least. This trouble should be closely watched during an attack of scarlet fever, and in other infectious diseases and proper treatment given.

Chronic deafness is hard to cure; so often