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R? 4-1 YALE UNIVERSITY LIBRARY Gift of the School of Medecine Yale University TRANSFERRED TO YALE MEDICAL LIBRARY HISTORICAL LIBRARY Digitized by the Internet Archive in 2012 with funding from Open Knowledge Commons and Yale University, Gushing/Whitney Medical Library http://www.archive.org/details/diseasesofeyeearOOmil The Students* Quiz Series. A series covering the essential subjects of a thorough medical education, arranged in form of question and answer. By qualified teachers and examiners in New York. Illustrations wherever desirable. Priced at uniform low rate of $1.00, except double numbers on Anatomy and Surgery, which are priced at $1.75 each. ANATOMY (Double Number)— By Fred. J. Brockway, M. D., Ass't Demonstrator of Anatomy, College of Physicians and Surgeons, New York, and A. O'Malley, M.P , Instructor in Surgery, New York Polyclinic. $1.75. PHYSIOLOGY— By F. A. Manning, M.D., Attending Surgeon, Manhattan Hospital, N.Y. $1.00. CHEMISTRY AND PHYSICS-By Joseph Struthers, Ph. B., Columbia College School of Mines, NY'., and D. W. Ward, Ph.B., Columbia College School of Mines, N. Y, and Chas. H. Willmarth, M. S. $1. HISTOLOGY, PATHOLOGY AND BAC- TERIOLOGY—By Bennett S. Beach, M.D., Lecturer on Histology, Pathology and Bacteriology, New York Polyclinic. $1.00. MATERIA MEDICA AND THERAPEU- TICS—By L. F. Warner, M.D., Attend- ing Physician St. Bartholomew's Dispen- sary, N.Y. $100. PRACTICE OF MED!C!NE-By Edwin T. Doubleday, M.D., Member N.Y. Patho- logical Society, and J. D. Nagel, M.D., Member N.Y. County Medica* Associa- tion. $100. SURGERY (Double Number)— By R. A. Sands, M.D., Assistant Demonstrator of Anatomy, College of Physicians and Surgeons, N0 Y. §1.75. GENITO- URINARY AND VENEREAL DISEASES— By Chas. H. Chetwood, M.D., Visiting Surgeon, Demilt Dispen- sary, Department of Surgery and Genito- urinary Diseases, New York. $1.00, DISEASES OF THE SKIN-By Charles C. Ransom, M.D., Assistant Dermatolo- gist, Vanderbilt Clinic, N. Y. $1.00. DISEASES OF THE EYE, EAR, THROAT AND NOSE— By Frank E. Miller, M.D., Throat Surgeon, Vanderbilt Clinic, N. Y., and James P. McEvoy, M. D , Throat Surgeon, Bellevue Hospital, Out- Pat ieut Department, New York, and J. E. Weeks, M. D., Lecturer on Oph- thalmology and Otology, Bellevue Hos- pital Medical College, New York. $1.00. OBSTETRICS — By Charles W. Hayt, M. D., House Physician, Nursery ami Child's Hospital, New York. $1.00. GYNECOLOGY— By G. W. Bratenahl, M.D., Assistant in Gynecology, Vander- bilt Clinic, New York, and Sinclair Tousey, M. D., Assistant Surgeon, Out- patient Department, Roosevelt Hospital^ New York. $1.00. DISEASES OF CHILDREN-By C. A. Rhodes, M.D., Instructor in Diseases of Children, N. Y. Post-Graduate Medical College. $1.00. LEA BROTHERS & CO., PUBLISHERS, PHILADELPHIA. The Students' Quiz Series. DISEASES OF THE Eye, Ear, Throat, and Nose. A MANUAL FOR STUDENTS AND PRACTITIONERS. BY FRANK E. MILLER, M. D., Attending Physician, St. Joseph's Hospital; Throat Surgeon, Yanderbilt Clinic, New York, JAMES P. McEVOY, M.D., Throat Surgeon, Bellevae Hospital, Oat-Patient Department, New York, AND JOHN E. WEEKS, M. D., Surgeon, New York Eye and Ear Infirmary ; Lecturer on Ophthalmology and Otology, Bellevae Hospital Medical College, Neiv York. SERIES EDITED BY BERN B. GALLAUDET, M.D., Demonstrator of Anatomy, College of Physicians and Surgeons, New York ; Visiting Surgeon Bellevae Hospital, New York. PHILADELPHIA : LEA BROTHERS & CO. Entered according to Act of Congress, in the year 1892, by LEA BROTHERS & CO., In the Office of the Librarian of Congress, at Washington. All rights reserved. Westcott & Thomson, William J. Dornan, Sterevtypers and Electrotypers, Philada. Printer, Philada. PREFACE. To facilitate the acquisition of a well assorted knowledge of dis- eases of the Eye, Ear, Throat, and Nose we have endeavored to condense into this volume in the most complete and concise man- ner possible the essentials of these specialties. To the student such brief volumes have a double usefulness, not only present- ing the facts, but saving his attention to lectures from interruption , by note-taking. It is also hoped that the volume will serve to refresh the memory of the busy practitioner, as it is in reality a trustworthy digest of the best and latest works on these special- ties. Through the kind permission of Dr. George M. Lefferts, Clinical Professor of the Diseases of the Throat and Nose in the College of Physicians and Surgeons, we are able to place before our readers some of his admirably arranged charts for the study of nose and throat diseases. The credit for most of this work is due to my friends and co-workers, Drs. J. P. McEvoy and J. E. Weeks. The basis of the division on Diseases of the Eye is a course of lectures delivered by Dr. Weeks at the Belle vue Hospital Medical College of New York. The following are the principal authorities consulted in the preparation of this book : On Diseases of the Eye : Becker, Hutchinson, Juler, Knapp, Landolt. Mackenzie, Nettleship, Czermak. IV PREFACE. On Diseases of the Ear : Buck, Burnett, Gruber, Greene, Politzer, Richards, Roosa. On Diseases of the Throat and Nose : Lennox-Browne. Bosworth, Delavan, Fraenkel, Gottstein, Knight, Krause. Lef- ferts, Mackenzie, Sajous, Seiler. F. E. MILLER. 121 West Thirty-fourth St. New York City. CONTENTS. THE EYE. PAGE Diseases of the Lids , . 17 Diseases of the Lachrymal Apparatus * . . 26 Diseases 'of the Conjunctiva 33 Diseases of the Cornea 44 Diseases of the Sclerotic 55 Diseases of the Iris, Ciliary Body, and Choroid 57 Diseases of the Ketina 71 Diseases of the Optic Nerve 76 Diseases of the Visual Field : Color-blindness ; Hemianopsia and its Varieties 79 Sympathetic Ophthalmia 83 Glaucoma 85 Diseases of the Lens ! 87 Diseases of the Vitreous Humor 96 Optical Principles 96 The Eye as an Optical Instrument 102 The Ophthalmoscope 110 The Muscular Apparatus 113 Diseases of the Orbit 121 Remedies and Formulae 123 THE EAE. Anatomy of the Ear 127 Examination of the Patient 132 Diseases and Affections of the Auricle 137 Diseases and Affections of the External Auditory Canal . . 138 Diseases and Affections of the Middle Ear or Tympanum . . 141 Diseases and Affections of the Internal Ear or Labyrinth . 156 5 6 CONTENTS. THE THROAT. PAGE The Pharynx : Anatomy of the Pharynx, Palate, and Tonsils ; Inflammations of the Pharynx ; Syphilis of the Pharynx ; Tuber- culosis of the Pharynx ; Neuroses of the Pharynx ; Tumors of the Pharynx ; Diseases of the Tonsil ; Diseases of the Uvula; Adenoid Vegetations (Hypertrophy of the Pharyngeal Tonsil) 159 The Larynx : Anatomy of the Larynx ; Laryngoscopy ; Inflamma- tions of the Larynx; Tubercular Laryngitis; Syphilitic Laryn- gitis; Benign Tumors of the Larynx; Malignant Growths in the Larynx ; Foreign Bodies in the Larynx 173 THE NOSE. Anatomy of the Nose: Rhinoscopy 195 Inflammations of the Nose 202 Nasal Manifestations of Certain Constitutional Diseases: Syphilis of the Nose ; Tuberculosis of the Nose ; Scrofula ; Lupus . 212 Benign Tumors of the Nose— Polypi 215 Malignant Tumors of the Nose 218 Foreign Bodies in the Nose 218 Epistaxts • 219 Deviations of the Septum . . . 220 Nasal Exostoses 221 Hematoma of the Septum 224 Anosmia and Parosmia - • • 224 THE EYE AND ITS DISEASES. THE LIDS. "What is the structure of the lids? From without inward we have first the skin, which is very thin and studded with very fine hairs. Immediately beneath is the subcutaneous areolar connective tissue, in which is imbedded the sphincter muscle of the lids, the orbicularis palpebrarum. Beneath this is the tarsus, a firm thick plate of connective tissue, measuring in the upper lid i inch in Fig. 1. Section through Upper Eyelid : a, the ciliary muscle of Riolanus ; b, follicles of the eyelashes ; c, opening of the Meibomian follicles. width, in the lower one i inch in width, each being about 1 inch in length. They serve to maintain the shape of the lid, and are attached to the margin of the orbit by a thin strong aponeurosis called the palpe- 2— Eye D. 17 18 THE EYE. bral ligament, which is adherent to their curved borders. The levator palpebrae superioris muscle has its attachment by an expanded tendon to the upper border of the tarsus of the upper lid, which also gives attach- ment to the small muscle composed of non-striated muscle-fibres known as Muller's muscle. Immediately beneath the tarsi and firmly adherent to them is the thin mucous membrane known as the conjunctiva. Im- bedded in the tarsi are the large racemose glands termed the Meibomian glands. These glands are about thirty in number in the upper, and twenty in number in the lower, lids. The Meibomian glands open by their ducts on the inner side of the margin of the lid. Springing from the outer side of the margin of the lid are the cilia, or eyelashes, usually presenting three or four rows, curved and about J an inch in length. The hair-follicles penetrate deeply into the lid ; opening into each follicle is the duct of a small sebaceous gland. Posterior to the openings of the hair-follicles are the mouths of the small glands known as the glands of Moll. Lying between the hair- follicles and the ducts of the Meibomian glands are a few fasciculi of the orbic. palp, muscle, termed the muscle of Riolanus. The orbic. palp, muscle is divided into two portions, the orbital and palpebral. It takes its origin from the inner canthal or tarsal liga- ment, some of the fibres passing beneath and some over the lachrymal sac. The fibres of. the muscle pass outward in a curved direction, and some have their insertion into the external canthal or tarsal ligament. From what source do the lids derive their blood-supply? The greater part of the blood-supply to the lids comes from the inter- nal carotid by way of branches from its ophthalmic division. The lach- rymal and naso-frontal branches of the ophthalmic pass outward into the substance of the lid at the external and internal canthi respectively, and go to form the superior and inferior marginal arteries of the lids. A portion of the supply to the integument and deeper structures conies from the external carotid by the way of the facial artery. From what source is the nerve-supply to the muscles of the lid derived ? The orbic. palp, receives its motor nerve-branches from the facial. The levat, palp, super, receives its nerve-supply from the third cranial, the motor oculi. DISEASES OF THE LIDS. "What is blepharitis? Any inflammation of the lid is termed blepharitis. The term, how- ■ ever, is usually applied to inflammatory affections of the margin of the lid, and is commonly known as blepharitis marginalis, having as synonyms the terms blepharitis ciliaris and blepharo-adenitis. What are the causes of blepharitis ? Blepharitis is usually due to infection of the hair-follicles or the small DISEASES OF THE EYELIDS. 19 glands connected with the hair-follicles. It may also be produced by the constant presence of irritating substances on the margins of the lid, clue to uncleanliness and chronic conjunctivitis, the presence of parasites in the shape of pediculi, fungi, etc. Errors of refraction producing eye -strain may serve to bring about the condition. What are the symptoms? In blepharitis marginalis there is usually more or less irritation of the eyes, a redness of the lids, and in the majority of cases the formation of crusts at the roots of the cilia. The secretion produced by the irrita- tion of the hair-follicles and associated glands dries on the margins of the lids, producing yellow crusts which are difficult of removal. What is the treatment. for blepharitis? The all-important requisite in the treatment of blepharitis is cleanli- ness. This may be obtained by careful bathing with hot water and cas- tile soap. After all crusts are removed applications of various kinds may be made to the inflamed surface. In the ordinary forms the appli- cation of an ointment of the red or yellow oxides of mercury in vaseline as a vehicle, in the strength of from 1 to 2 per cent., to the margins of the lid once or twice daily, will usually effect a cure. Applications of the nitrate of silver in solutions or of the acetate of lead in solution may be employed. In sycosis parasitica total epilation in addition will be necessary. What is hordeolum or stye? This term is employed to designate the painful localized swelling which frequently occurs at the margin of the lid. It has its origin in an acinus of the Meibomian gland, and eventuates in the formation of a pustule. Successive crops are apt to appear. What is the cause of hordeolum ? Probably in almost every case hordeolum is due to a microphytic infection of an acinus of a Meibomian gland. Constitutional derange- ments and eye-strain undoubtedly contribute to its production. What are the symptoms of hordeolum ? The first symptom noticed by the patient is a localized pain at the margin of the lid, which is found to proceed from the locality of a swell- ing, usually of a deep-red color ; lachrymation, photophobia, and inability to use the eyes are frequent accompaniments. The pain increases with an increase in the size of the swelling. This continues for three or four days, at the end of which time formation of pus has taken place and the stye has in all probability ruptured : the pain then ceases and recovery ensues. What is the treatment of hordeolum? Hot applications, made by means of small pledgets of lint dipped in 20 THE EYE. hot water and changed every two or three minutes, or the application of small moist flaxseed poultices, will probably give the greatest relief in the early stage. As soon as there is evidence of the presence of pus the swelling should be freely incised and the contents thoroughly evac- uated. Occasional bathing with a saturated solution of boric acid or with a weak solution of bichloride of mercury will suffice to effect a cure. Treatment directed to the general condition and the occasional application of ointment of the red or yellow oxide of mercury to the margin of the lids will aid greatly in preventing recurrences. What is meant by the term chalazion? The term is applied to the cyst i form enlargement of an acinus of a Meibomian gland. It is supposed by some to be an aborted hordeolum. It usually appears somewhat removed from the margin of the lid, rarely reaching a size exceeding one-third of an inch in diameter, and may be single or multiple. It contains a gelatinous material. The inflammatory action producing it may involve the adjacent connective-tissue elements of the lid. The growth is perfectly benign. Chalazion may be said to be due to the same causes that produce hordeolum. What is the treatment of chalazia ? They should be incised, their contents scooped out with a sharp spoon, and the interior of the sac treated with a strong solution of the nitrate of silver, or they may be entirely excised. Recurrences are possible only on incomplete removal of the contents and sac. However, so long as the Meibomian glands exist chalazia may appear. What are the so-called fibrous tumors of the lid ? They are chalazia which have passed to a stage of development in which their contents is converted into or replaced by connective tissue. The causes are the same as those producing chalazion, and the treat- ment is excision. What are naevi? Naevi are slightly-elevated, frequently-pigmented patches, congenital in nature, which appear on the lids. They resemble in structure the naevi which appear in other parts of the bod}''. What is cavernoma of the lid ? Cavernoma is a vascular structure composed of anastomosing spaces resembling dilated veins which occurs in the connective areolar tissue- structure of the lids, either originating in the lids or being an extension of the same growth from adjacent parts of the face. They are not in- frequently congenital, and have a tendency to increase in size. In addi- tion to cavernoma we have an allied growth due to the dilatation of capillaries and small arteries, known as angioma. DISEASES OF THE EYELIDS. 21 What is the treatment of cavernoma ? Complete extirpation is by far the most satisfactory plan of treatment, and should be employed whenever it can be done with safety. Electrol- ysis is frequently employed with good results by making multiple punc- tures around the base of the tumor with the electrolytic needles, with the object of cutting off the blood-supply. Complete strangulation or complete excision prevents recurrence. What is xanthalmasia ? Xanthalmasia is characterized by the appearance of small yellowish- white patches in the skin of the lids, having their location most fre- quently on the upper lid near the inner canthus. They come in advanced life. Ophthalmoscopic examination shows them to be composed of nu- merous granular cells, some of which are pigmented, located in the skin. They have no pathological significance, and are only objectionable because of the cosmetic effect produced. They may be easily removed by ex- cising the portion of the skin affected. What is epithelioma of the lid ? Epithelioma is a malignant growth usually affecting the margin of the lid and advancing slowly : if not interfered with, it goes on to the de- struction of the lids and deeper structures, eventuating in the death of the patient. It is composed of epithelial cells which have become per- verted in their growth and location. What are the symptoms of epithelioma ? The patient's attention is generally first called to the presence of a small elevation, usually accompanied by a little redness or other inflammatory symptoms, covered with a light scab, situated on the margin of the lid. It may also appear as a small papilloma or bluish-looking wart on the lid or face in the immediate vicinity, which takes on an ulcerative change. The scab covering the ulcerated surface is frequently removed, but the ulcer shows no tendency to heal. The epithelioma may continue in the condition described for months