An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    717/1336 (page 685)
    if the plug has been so long retained as to have become at all lardaceous, by the use of such stronger alkalies, as solution of caustic potash, carried on a cotton-tipped probe into the center of the mass, for the purpose of forming with the fatty acids resulting from the lardaceous degeneration of the epithe- lium, a soap which can be easily washed away, to favor the breaking up of the epithelial mass and its removal piecemeal by syringing or the forceps. In all cases of the use of the caustic potash in this manner the skin of the external canal should be moistened with weak acetic acid to neutralize the effect of any excess of caustic potash which would otherwise irritate the skin. In the fluctuating hyperemias of the auricle, which are often a great source of discomfort in neurotic subjects, there is demanded not only the local application of cold and mild astringent solutions, but also an attention to the general health which comes more distinctly within the domain of the general practitioner; while for the chronic hyperemia the application of astringent solutions and of cooling ointments may be further accompanied by galvanization of the sympathetic. As primary erysipelas of the auricle is very rare, and as the implica- tion of the skin of the auricle occurs usually in the course of an attack of erysipelas originating elsewhere, the general treatment is that indicated by the demand for antipyretics and antiphlogistics ; and the local treatment may be limited to the application of cooling solutions, antiseptic or astringent, as, for instance, of oleates and powders, oxid of zinc, and starch—exception being taken to such as discolor the skin, and thereby interfere with local observation of the progress of the case. In the treatment of eczema the different manifestations of this skin- disease must be considered, and these vary not only with the stage of the disease, but in the external auditory canal with the portion of the skin impli- cated. At the outer end of the canal, for instance, where the skin is thick and studded with cerumen and oil-glands, a very considerable edema some- times marks that stage of the affection in which the skin of the inner por- tion may be bathed in a serous exudation or firmly encased in dried serum crusts. In the moist stage the surface should be carefully dried and powdered, either with simple rice-powder or rice-powder mixed with equal parts of powdered calomel; and in the cases of intertrigo in children, in addi- tion a light gauze compress may be placed behind the auricle, in order to support it and prevent the apposition of the denuded surfaces of the posterior portion of the concha and mastoid region. Where crusts have formed as a result of the drying of the serum mingled with the desquamated epidermis, they should be removed only with care, and may require softening to effect this, which may be done with vaselin applied by means of the cotton-tipped probe or a camel's-hair brush. After removal of the crusts the exposed parts should be smeared with a diachylon ointment or with some astringent oint- ment having vaselin for its base, the auricle being protected at night by com- presses soaked in ointment, and the external auditory canal carefully anointed ' in a similar manner by means of a cotton-tipped probe. In cases of obsti- nate exudation at the inner end of the canal pencilling with weak solutions of nitrate of silver are of service, and this application is also especially useful in the squamous stage. Internal treatment, except in so far as direc- tions as to general hygiene and diet are concerned, is rarely demanded, except in children, in whom the administration of tonics, especially iron, the iodids, and arsenic are sometimes indicated. Herpes, which is an exceedingly rare disease and which requires very little local attention, is accompanied by very severe pain, which may be sometimes