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.

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    dark, it is well to use a piece of black cloth, such as photographers use in focussing, or a black rubber sheet which can cover the heads of examiner and patient, and when tightly held under the chin shuts out effectually every ray of light. A small electric light (Heryng's is good, but there are a num- ber of others) is placed in the mouth above the tongue and the lips are tightly closed. All tooth-plates should be removed. When the electric light is turned on, the healthy antrum should allow the light to pass through it and show a crescentic bright area under the eye, and sometimes the pupil is lighted up (see Plate 14). The patient should also have the subjective sensation of light in the eye with the eyes closed. In case the antrum is filled with pus or any opaque substance, this area and sensation of light are entirely wanting. This method is often of great value as corroborative evi- dence ; but too much reliance should not be placed on it, because there are cases in which the face fails to be lighted up when the antrum is empty, even when the bony walls are not abnormally thick. But I think we may safely say that where there is a discharge of pus under the middle turbinal and that side of the face remains absolutely dark without sensation of light in the eye, while the other side is brightly illuminated with sensation of light, the chances are very greatly in favor of our having to deal with empyema of the antrum (see page 970). To make sure that the antrum is the part affected we can wash it out in various ways. A hollow cannula, such as Hartmann's, can be passed along under the middle turbinal till it comes to the neighborhood of the natural opening and then turned outward, and it can sometimes be felt to enter the opening. A syringe attached to the cannula may be used to suck the pus out, or warm water may be forced in, and the stringy flocculent pus which appears shows its antral origin. In case the opening is not found, it is possible to perforate the outer wall of the middle meatus with a trocar and wash out through this artificial opening, the pus escaping through the natural opening or one or more accessory openings which may exist. Care should be taken not to puncture too deep for fear of entering the orbit. Cocain should be used for these manipulations, both to produce anesthesia and also to cause a shrinking of the tissues and gain room. It may be necessary to remove the anterior end