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proof of our superiority to brutes as well as expressive of our thoughts; and the privation is most terrible from its fearful dwarfing of the human faculties, or rather limiting of their power to develop. Many are deaf whose external and middle. ears are apparently healthy, the nerves which enable hearing being the affected part. The curious fact that many have alternate seasons, and even moments, of deafness and of being able to hear, should be considered. The diseases which produce deafness are known to be those of the parotid glands, syphilis, diphtheria, scarlatina, variola, and others which manifest themselves in the throat. Some medicines-quinine notoriously-have a similar liability. Deterioration of the nervous system may impair the hearing. It is my desire that this Section will be able, by its discussions of the papers which are presented, to make valuable additions to what is known on the subject.
I may dwell, very properly, with greater emphasis upon Ophthalmic Science. Our eyes and how to preserve them, constitute a theme of vital importance to every one. The value of life itself, certainly so far as our fellow-beings are concerned, is almost totally destroyed by the privation of sight. The life of the blind is unenviable, however we may regard it, and defective vision is a misfortune for which money cannot compensate. As our civilisation progresses, this becomes more and more the fact. We learn and hold communication with others by reading rather than by articulate speech; and whatever interrupts or interferes with this mode is, in many respects, as unfortunate as muteism itself. The blind are shut away from the world about us; those whose vision is defective or impaired, are deprived of many advantages.
The diseases of the eye are numerous, and require unusual skill for successful treatment. As the anatomy of the various coatings and membranes are understood, surgery is becoming bolder to obviate all obstacles which their disorders interpose to vision. The removal of cataracts is an operation comparatively old. Iridectomy, the operation for strabismus, and others that may be named, pertain to a more recent period. It is becoming the judgment of medical instructors that a
student should acquire expertness in this department as well as the more common ones of operative surgery. I am of that opinion myself.
The physiology of the eye also should be considered, with reference to preserving the function of sight. The nearsightedness which is so frequently contracted in our schoolrooms, is a dishonorable characteristic of our educational system. It is no credit to any people that its adolescent members are compelled to wear spectacles. Imperfect light, small type in books and newspapers, and neglect of the eyes, are causes of ophthalmic difficulty which deserve to be classed as criminal.
It is familiar to every intelligent pathologist that every cause that disturbs or enfeebles the nervous system, is liable to be prejudicial to the eye-sight. Sexual excesses, the use of tobacco, narcotic and alcoholic stimulants, and unwholesome habits generally, are among the causes of ophthalmic disorder. The redness of eyes incident to excess in drink, is recorded in Holy Writ. The universality of smoking and the wearing of spectacles in Germany have long been noticed. Heredity has also its share of influence; the sins of the fathers and remote ancestors are visited on their descendants in nervous defect and feeble organs of special sense. Mechanical causes are also numerous; and it is in our province to elucidate them.
I trust that something will be brought out in regard to the injuries to which the eyes of the young are subject. The remedies which are advertised and in the market, which are worse than useless, ought to be exposed. The disorders commonly met with, however, demand more explicit attention.
Myopia, or short-sightedness, is first to be mentioned. The ophthalmoscope informs us that this is the result of an elongation of the globe backward in the socket, so that it becomes ovoid, followed by other morbid changes; the giving way of the retina, optic nerve, choroid and sclera-forming the bulging known as staphyloma. Astigmatism, the paralysis that occurs after diphtheria, scarlatina and measles, weakness of the recti muscles, are also important.
The invention of the ophthalmoscope, by Prof. Helmholtz of Heidelberg, enables us to explore the interior of the eye and detect the slightest variations from a healthy condition. Diseases can be studied more perfectly than those of other parts of the body. Imperfect development of the retina and choroid, a commencing cataract, the opacity of the cornea from pernicious ulceration, are thus brought to knowledge often in season to enable us to take advantage of the fact.
Ophthalmic surgery is rendered more certain. Diseases of the eyelids, obstruction of the lachrymal ducts, strabismus, inflammation of every form, disorders of the conjunctiva, granulations, ulceration of the cornea, glaucoma, amaurosis, cataract, are the principal affections to come within our province. It will be seen that our field, so far from being insignificant and unimportant enough to extenuate neglect, is among the most vitally important. The eyes, more than other organs of special sense, associate us with our fellow-beings and make us citizens of the universe. When we know more of their anatomy, we shall perceive that other nervous diseases are induced by their disorders.
Laryngology is, perhaps, a more familiar topic. The dis eases of the throat, which have become as household words in these later years, have elicited much anxiety on the part of the medical attendant. There is a disposition at the present time to employ local treatment, and the surgical devices. for the purpose are ingenious. Signor Garcia has the reputation of having perfected the invention of the laryngoscope, which enables the exploration of that part of the human structure; and now we have, as the result, laryngotomy, as a distinct branch of physiological research. Dr. George Johnson declares: "The result of the new light thrown upon this region by the throat-mirror has been that within the last twenty years our knowledge of laryngeal diseases, including accuracy of diagnosis, with certain and successful treatment, has made greater progress than that of any other department of medicine or surgery during the same period of time." In making this statement, he adds, "I am not unmindful of the immense advance which has been made in the diagnosis and
treatment of eye-diseases since the genius of Helmholtz conferred upon mankind the inestimable gift of the ophthalmoscope." As the use of that instrument has thrown new light upon numerous remote diseases, especially those of the nervous system, the relation of which to the diseases of the eyes had not even been suspected, so the laryngoscope has added to the facility of diagnosis, enabled us to learn better methods of treatment and attempt surgical operations for the removal of morbid growths of foreign bodies, which were before virtually out of our power.
Dr. Johnson thus eloquently compares the benefits of the two instruments: "By the inspection respectively of the interior of the eye and of the larynx, valuable light is often thrown upon the diseases of remote but physiologically-correlated organs. If, for example, the ophthalmoscopist sees in the eye a retinitis significant of disease, a neuritis involving cerebral tumor, or an embolism, the result of valvular disease of the heart, so in like manner the laryngologist is often led by the observation of the paralytic or spasmodic condition of one or more laryngeal muscles, to the diagnosis of a general neurotic condition to which the term hysteria is often applied, or of a special local disease in the nervous centre, cervical or intra-thoracic, pressing on the pneumogastric nerve or its branches.
We thus perceive the unity of the whole structure. None of our organs exist as apart from the others. If one suffers, all suffer with it. We learn that no one can be successful as a specialist except he knows well the human body, its anatomy and physiology in their entirety.
It is not necessary for me to prosecute these remarks any further; and I shall await the papers and discussions which are assigned to this section, with the deepest interest. Wedo not aim so much to develop what is not yet known, as to assimilate the knowledge within our reach. Nevertheless, we welcome the explorer and the discovery. Our Association comprises the principal introducers of new methods and new remedies, in the whole civilised world. It is our place to be in front-the pioneers; and we are often treated like pioneers
by the men who seek to take advantage of our labors. The cross, the stake, the rack, and medical proscription, have been the reward bestowed on every pioneer of thought who did benefit to mankind. The men who are praised and lauded are seldom the real benefactors. The prophets are slain first, and then subscriptions are started by the children of the murderers, to build monuments to their memory. Those who minister to the follies and vices of mankind are most admired, even in scientific circles; they make the most money.
Let us do our work here with earnestness and thoroughly. We are here to teach and learn from each other. We are organised on the platform of helping one another. We meet as friends and not as rivals and competitors. We have not come for sport and amusement, hardly even for recreation, but for sober work. If we carry away more knowledge than we brought, we have done well to be together. It is the way to do. We are made better, more skillful, more intelligent for our assembling and conferring together; and we are organised as an Association, as well as in a section by ourselves, in order that we can accomplish this the more effectively. With these remarks, we will now proceed to business.
THE EUSTACHIAN TUBE.
ITS ASSOCIATED PATHOLOGICAL AND ETIOLOGICAL RELATIONS TO DISEASES OF THE EAR AND NASO-PHARYNX,
By LEMON T. BEAM, M. D., Johnstown, Pa.
The histology of the middle and internal ear is a terror to the general practitioner, and he has been disposed to excuse himself from the study of it because of the conjectural nature of much that has been written. With relation to the internal ear, Schwartz says: "The pathological histology of the labyrinth of the ear is in the first stage of its development, and needs the services of an extraordinary anatomist, who must work deeply and thoroughly in this most difficult field for