20. EARS, EYES, NOSE, AND THROAT

Last September a salesman, Len McMasters, came into a West Coast television repair shop and smiled at the middle-aged proprietor behind the counter.

"Hi, Bill!" he said loudly. "Six months since I've been in town. Thought I'd better stop in!"

Bill Lanphier smiled back at the salesman.

"You can. turn down the volume," he said. "You don't need it any more."

The salesman's eyebrows went up and he glanced at Lanphier's ears. A slight puzzled frown creased his forehead.

"Hearing aid?" he asked. "I don't see it. Must be a new kind."

"Nope. No hearing aid. Just a lot of luck and a fenestration operation."

The salesman put his brief case down on the counter and lit a cigarette.

"You'd better explain," he suggested.

"The luck was that I'm one who could have the operation. The rest is that they can do it."

Lanphier went on to explain the operation, first outlining for the salesman how sounds waves enter the external ear canal to strike the eardrum and cause it to vibrate.

Directly behind the eardrum are three minute, connected bones: the malleus, incus, and stapes. They form a linkage which carries the impulses to the inner ear. The last bone in the linkage is the stapes, part of which extends through an opening in the bone overlying the inner ear. The inner ear is filled with a fluid surrounded by membrane. Impulses from the stapes travel through the fluid to special nerve endings, and then to the auditory nerve, which takes them to the brain where they are recorded as hearing.

When the stapes becomes rigid and fixed it cannot transmit the sound waves through the opening in the bone to the inner ear. This is called conduction deafness.

In the fenestration operation that Bill Lanphier experienced the surgeon made a tiny opening—a window—in the bone over the inner ear, and covered it with a flexible membrane. This allowed sound vibrations to bypass the three linked bones and travel directly to the inner ear. The operation has helped about 80 per cent of the patients treated.

Another operation, of a more minor sort, is called mobiliza­tion of the stapes. In this technique the eardrum is carefully elevated and the stapes is manipulated with a small instrument until it is movable again. The eardrum is then replaced. The operation is successful in about 60 per cent of the cases treated.

Another operation extends a plastic tube through the middle ear. In another, a new eardrum can be put in place. Tissue may be drawn down from above to make the eardrum in this treatment. Surgery also successfully remedies protrud­ing and folded ears.

Most frequent cause of deafness among the 17 million Americans who suffer some degree of hearing impairment comes from inner ear damage caused by bacteria or viruses.

The U. S. Department of Health, Education and Welfare observes that about 80 per cent of early deafness comes before a child is five years old. Much of this is caused by infection and inflammation resulting from a common cold, mumps, or scarlet fever. Children should have their hearing checked after illnesses of this sort.

About 15 per cent of the mothers who have German measles or other virus infections during early pregnancy may have nerve-deaf children.

New instruments to determine hearing capacity makes it possible to discover when even a small baby may have hearing problems. Doctors repeatedly warn that the earlier a child is given aid for deafness, the sooner and better he may be

helped.

The newly developed hearing aids using transistors and highly advanced electronics techniques make it possible for babies to wear hearing aids, if necessary.

Transistors are the comparatively tiny electronic devices that rapidly are replacing the older and much, much larger "tubes" used for radio, television, sound systems, and other purposes. Usually they operate from very small batteries.

Already on the market, according to reports, is a complete hearing aid unit—microphone, battery, resistor amplifier, and speaker—that fits completely, and virtually invisibly, into the ear. Another is reported to use solar energy for power.

Other hearing aids now are incorporated in the temples of eyeglasses, in a woman's barrette, and in earrings. One type fits in concealment behind the ear. Use of plastic helps to disguise the aids.

Fortunately, infections of the middle ear, which were once by far the most common cause of permanent deafness, now can be quickly cleaned up with antibiotics before permanent damage is done, provided treatment is begun early enough. For this reason it is essential that a doctor be consulted when ear trouble is manifested by earache or discharge.

Folk remedies for earache have been many and varied.

A Mississippi remedy of the last century called for a mix­ture of finely cut tobacco and glycerine to be used in five-drop doses twice a day for acute earache.

A New England treatment consisted of pouring vinegar over a hot brick and conducting the steam into the ear by means of a funnel.

The following pioneer suggestion was frequently used for infants as well as adults: "Take a small piece of cotton-wool, making a depression in the center with a finger, and fill it with as much ground pepper as will rest on a five-cent piece, gather it into a ball and tie it up, dip the ball into sweet oil and insert it into the ear, covering the latter with cotton­wool, and use a bandage or cap to retain it in place."

Heat was frequently used for the discomfort. Warm poultices and warm oil were popular. Sometimes a small cloth bag was made to hold heated salt which was applied to the ear. If discharge was present, mothers often used warm milk and water to irrigate the ear with a carefully used syringe.

A favorite treatment was three or four drops of arnica in the ear, with cotton plugging the orifice to exclude the air. Another practice involved wrapping a hot roasted onion in flannel wrung out in laudanum and applying the poultice directly to the ear.

Another astringent lotion for a "running ear" was made of white oak bark tea, cold or warm; or of one teaspoonful of powdered alum in a pint of water.

Chemotherapy and modern surgery have eclipsed folk medicine treatment. Today if a cold inspires an earache, fever, or loss of hearing you may get some temporary relief from aspirin and a hot water bottle until the doctor takes over. If you have any other ear disorders, the chances are you'll save time, money, and the risk of dangerous complications by letting your doctor use the modern remedies available to him.

Twenty-five years ago a father and mother waited anxiously outside a surgery in the dead of night. Inside the operating room a tired surgeon was doing his fourth mastoidectomy of the day. This was a bad case. They had waited too long to bring in the child.

Finally he was finished. He went out to face the parents.

"She'll be all right," he told them. "But I had to do a radical mastoidectomy. She'll lose the hearing of that ear. If I could have done a simple mastoidectomy, we could have saved the hearing."

"But she'll live?" the mother asked, tears on her cheeks.

"I don't anticipate any problems," he assured her. "It will be painful, but she should be all right before too long."

This was before the day of the antibiotics and sulfa drugs, and the unfolding of another dramatic story in medicine.

The mastoids are part of the bony skull directly behind the ears. They contain air cells which connect with the middle ear. When a middle-ear infection extends into the mastoid it results in a mastoid infection. Evidences of the infection are a pain behind the ear, pus discharge from the ear, a rise in temperature, a pouching forward of the back wall of the external ear canal, tenderness over the mastoid, swelling of the neck glands, and impaired hearing. Children between the ages of two and twelve usually are victims of the ailment.

If the condition is permitted to go untreated it can result in paralysis of the facial nerve, septicemia, meningitis, or a brain abscess. It can be fatal.

Once, as noted in the above case history, the treatment was usually surgical. Two operations could be performed. One, the simple mastoidectomy, involved removal of the mastoid air cells. A radical mastoidectomy, such as the little girl in the case history had, involves not only removal of the mastoid cells but also of the eardrum and contents of the middle ear.

Today the fear that a mastoid infection once struck to the hearts of parents has all but vanished. Chemotherapy has achieved another great victory.

Dr. Jerome J. Bergida, as Associate Attending Otolaryn-gologist, Jewish Hospital of Brooklyn, summed up the victory in these words:

"Seldom, if ever before, has a common operation become a rarity in so short a period of time. Twenty years ago, the winter months saw the wards of hospitals in temperate climates jammed with children suffering from mastoid infec­tions. Now, thanks to the curative effect of the sulfonamides and to the many wonderful antibiotic drugs, operation for acute infection of the mastoid bone (mastoidectomy) is rarely necessary!"

Recently, Dr. James Readen, a capable and well-trained ophthalmologist, finished an exhaustive eye examination for his patient, Matthew Allain.

Allain was in his thirties, an alert-appearing, energetic newspaperman. He had just received an overseas appointment with a news service and had been taking his physical examina­tion preparatory to leaving with his family.

"Matt, I'm afraid you're going to have to postpone your trip a short while," Dr. Readen told him. "You have a de­tached retina."

"What?" Allain's voice was filled with alarm. "Are you certain?"

The doctor nodded. "With the diagnostic techniques and instruments we have today, there isn't much that can possibly escape us. Fortunately, I caught this early."

Nervously the newspaperman lit a cigarette. "But as I recall— this is very serious."

"Fifty years ago it almost inevitably led to blindness, Matt. It's a different story today."

"You can do something about it?"

"Quite a bit. As you may know, the retina is really an extension of brain tissue. It can't be replaced. Its job is to register images on its nerve endings and send them along the optic nerve to the brain where they become sensations of sight. Sometimes the retina comes loose, or may be knocked loose. It usually starts as a small rip. Those little flickerings of light you were talking about? That bunch of black specks you mentioned? Remember?"

Allain nodded.

"Symptoms," Dr. Readen continued. "But we caught it very early. It's a very small hole. I think we'll do a welding job."

"Welding job!"

"It almost amounts to that. We'll use a Meyer-Schwickerath light coagulator—a German invention. The coagulator will shoot a brilliant beam through the pupil of your eye. The lens of your eye will focus it on the retina and in a second or two the concentrated beam virtually spot-welds the hole. And with no pain."

The operation was successfully performed and Allain sub­sequently went to Europe and was able to continue with his work as a newspaperman.

The spot-weld repair of the detached retina is only one of the seemingly miraculous developments in eye surgery.

Another technique, developed by Dr. Donald M. Shafer of New York, called the vitreous implant is restoring sight to people who had been considered to be hopelessly blind. In the vitreous implant, donor vitreous fluid is injected into the eye chamber of a patient with advanced detachment. The injected vitreous fluid presses the loose retina against the choroid. In a substantial number of cases the retina becomes reattached and remains firmly in place.

Cataracts—cloudiness of the lens at the front of the eye— are now being removed for some 200,000 Americans yearly. They are very common, and it is estimated that one of every 20 persons develops the condition sooner or later. They are the greatest single cause of blindness in the nation.

Surgery for cataracts has become much easier and safer since it was discovered that a chemical called alpha-chymo-trypsin, an enzyme produced by the pancreas of cattle, loosens the lens for quick and easy removal. Previously there was considerable danger, especially in younger persons, in break­ing tiny ligaments, zonules, which hold the lens in place. Alpha-chymotrypsin cuts through the zonules without affect­ing other tissues.

Surgery in glaucoma cases has been vastly improved with the use of new drugs.

Glaucoma is a disease characterized by increased pressure or tension within the eyeball. It may result in irreparable damage to the optic nerve and in blindness.

The causes of the disease are unknown, but the increased tension of the eyeball results when a thin, watery substance, aqueous humor, is blocked from flowing out of a narrow angle between the iris and cornea, where, in the healthy eye, it normally flows in and out without obstruction.

When the outflow is blocked, the aqueous humor backs up within the eyeball. Pressure increases inside the eye.

When the chronic, slowly developing condition is diag­nosed early—a tonometer placed directly upon the cornea registers the pressure—medication usually can control it. Pilo-carpine or eserine are frequently prescribed.

Sometimes, however, it strikes suddenly with great pain in the eyeball. This is acute glaucoma and must be relieved immediately before the increased tension can damage the optic nerve and possibly cause blindness.

If medication does not bring quick results, emergency surgery is necessary.

Until very recently such surgery was laden with danger. The pressure might actually blow the lens against the instru­ments and cause a cataract. The iris could be blown from the eye. Blood vessels might burst. Despite these dangers, the surgeon had to operate to save the patient's vision.

Now, through a discovery made by Dr. Miles A. Galin of the ophthalmology staff of Cornell University Medical Col­lege, an intravenous solution of urea dramatically draws the excess fluid from the eyeball and into the blood stream. Pres­sure goes down within an hour, pain leaves, and the surgeon can operate under relatively safe conditions.

Trachoma, a contagious infection of the eye, is said to have 400 million victims around the world. It is highly prevalent in Egypt (sometimes it is called "Egyptian eye disease"), Pales­tine, Southern and Central Europe, and the Far East.

Trachoma is caused by a virus. The conjunctiva over the eyeballs and the skin of the eyelids become inflamed in an attack and pus is discharged. Blindness frequently results.

The older treatment for this disease, copper sulphate or roller forceps, are now seldom used.

Excellent results in treating trachoma may be had from oral and local sulfonamide therapy, or from systemic treat­ment with chlortetracycline or oxytetracycline.

Because of the tremendous number of persons afflicted with trachoma, intensive research for a vaccine has been underway for some time. Clinical trials made on some 450 Chinese children by scientists from the United States Navy and Na­tionalist China show especial promise of effectiveness against the disease.

For most of us, our demands for eye attention generally are limited to examination for eyeglasses. These are by no means a modern innovation. They have been used for cen­turies and their invention has been attributed variously to an Italian, Alexander da Spina, to another Italian, Sylvinus Ar-matus and to an Englishman named Roger Bacon, all of whom lived in the 13th century.

The day of the patient's trying on spectacles until he found a fairly suitable pair in a do-it-yourself procedure is fairly well gone, although counters of spectacles for do-it-yourselfers still may be found.

Most of us now have our glasses fitted to meet our individual, specific needs, but a large part of the public still appears to be confused about the proper identification of practitioners who do this and take care of other attentions concerned with eye care—the optometrists, oculists, ophthal­mologists, and opticians. Here is a clarification:

OPTOMETRIST—The optometrist fits about half of all glasses. He is not a medical doctor, but he is a graduate of a school of optometry. The better schools of optometry require at least two years of pre-optometry courses in college and three years of professional training. He is licensed by the state where he practices. Not being a licensed medical doctor, he is not permitted to use medications or perform surgery. The optometrist measures visual defects (refraction), pre­scribes to correct the defects, and fits the lenses.

OPHTHALMOLOGIST (Oculist)—The ophthalmologist— formerly called oculist—is a graduate of a medical school. He must have completed at least a year of internship and, in the majority of states, three years of residency in his specialty of ophthalmology. He is, in actuality, an M.D. who also pre­scribes corrective lenses as a minor part of his specialty in eye treatment, and may also do eye surgery.

OPTICIAN—The optician is defined as "a maker of optical instruments or glasses." The optician can grind lenses for your glasses, but he is forbidden to do the refraction or to prescribe.

Q. I am near-sighted. Who can prescribe new glasses for me?

A. Either an optometrist or an ophthalmologist.

Q. I have some kind of an infection in my eye. Whom shall I see?

A. An ophthalmologist—sometimes called an oculist. He is an M.D.—an eye-specialist physician. He may also do re­fractions and prescribe glasses for you.

Q. May an optometrist treat the infection in my eyes?

A. No. He is not a physician and is not licensed to do so.

Q. May an optician prescribe new glasses for me, or medically treat my eyes?

A. No. He may grind the lenses of your glasses according to the prescription given you by an optometrist or an ophthal­mologist.

Lately, contact lenses have received a great amount of attention, although they have actually been in and out of the news for around 21 years. Actually they were anticipated by Leonardo da Vinci in 1508 and were first made in Europe in the 1880s.

It is estimated that about 6 million Americans use them, and the number increases daily. No one knows how many of these owners wear them consistently, but the sale has taken on the proportions of a small boom.

Unfortunately, get-rich-quick operators saw an opportunity to make fast profits in the field, addressing "hard-sell" adver­tising campaigns—frequently loaded with untruths about their products—to eyeglass wearers. The Federal Tax Com­mission has forced several of the advertisers to tone down their copy.

Meanwhile, improvements have been made in the lenses, especially through the use of plastics. For some people they are very satisfactory. They are a great aid to an increasing number of professional persons—models, actors, actresses and athletes.

Time Magazine, February 8, 1960, reported about wearers of contact lenses: "Among them: Metropolitan Opera So­prano Patrice Munsel, Hollywood's Deborah Kerr, Ann Soth-ern, Debra Paget. Since they can be tinted, they came in handy for turning gray-eyed Nina Foch (a regular wearer anyway) into a brown-eyed Egyptian in The Ten Command­ments."

Some professional football players wear them, as do some skin divers.

At first, contact lenses were large and covered most of the white of the eye, as did the early plastic lenses. New methyl-methacrylate plastics were introduced into the scene. It was also discovered that a small hole in the lenses, to permit pas­sage of tears, made possible elimination of the cushioning fluid formerly necessary. This brought about the introduction of the small corneal lens covering only the eye's iris.

New types of contacts are being developed for various conditions. At present there are two main kinds of bifocals. One is made of concentric circles and can rotate freely in the eye. The other is squared off so that it will not rotate.

Contact lenses are proving to be a big help in some cases where eyes have lost their own lenses as the result of a cata­ract operation.

However, contacts may not be the answer for everyone, as yet, and the American Optometric Association says, frankly, that in some cases satisfaction and comfort just never come together.

The possibilities are, obviously, viewed with extreme in­terest by the public and the medical world. Derrick Vail, M.D., serving as Professor and Chairman, Department of Ophthalmology, Northwestern University Medical School, said in 1954: "Contact lenses, still in the process of evolution, have already shown their value in certain cases of comical cornea and for people who earn a living in the theater and in sports. It is entirely possible that as they are better perfected, contact lenses may supplant entirely the use of spec­tacles, except for presbyopia."

Eye Exercises for the correction of visual defects long have been the subject of much discussion. Thousands have claimed that exercises have helped them. Some say- they have reduced or eliminated nearsightedness, farsightedness, or astigmatism. Some say they have corrected eyes that deviated, or did not work together.

For more than 40 years books have been on the market offering cures for imperfect vision by treatment "without glasses." Some persons have reported enthusiastically that eye exercises enabled them to throw away their glasses. Others label such exercises as so much nonsense. Yet, in the face of similar criticism by the family ophthalmologist, a layman may be puzzled when the same doctor prescribes eye exercises for the layman's child.

Much of the controversy began with William Horatio Bates, M.D., who in 1920 published a book called The Cure of Im­perfect Sight by Treatment Without Glasses.

A complete explanation of Dr. Bates' system would be long and complicated. He disagreed, it is reported, with the ortho­dox theory in relation to the focusing of the eye and claimed that nearsightedness and farsightedness are caused by abnor­mal actions of certain eye muscles. He believed that refractive errors are temporary phenomena caused by nervous tension and that glasses are not necessary. He stated that glasses al­ways are more or less harmful. Strain and tension are the keynotes he emphasized. When eyes strain to see, he taught, they immediately become farsighted or nearsighted.

He advocated different types of exercising to relieve dif­ferent kinds of tension. He emphasized a connection between mental agitation and poor vision.

Probably his best known exercise was "palming" which consists of closing the eyes and placing the palms of both hands over the eyeballs.

Dr. Philip Pollack, in The Truth About Eye Exercises, describes some of the remainder of the treatment. "If your vision is normal, explains Dr. Bates, you will see a perfect black; but if you are nearsighted or farsighted, you will see clouds of gray, patches of color or flashes of light. To help you see black and thus attain normal vision, Dr. Bates recom­mends that you look at a black object for a while and then close your eyes and palm them. You may then succeed in seeing black by recalling it in memory."

Following in his footsteps have been several disciples, and many patients, including some of national note, have tried his system or variations of it.

These systems are known, generally, as the unorthodox methods of eye exercise and training.

On the other hand, there are orthodox methods of eye exercising that have been scientifically evolved and are medi­cally accepted virtually everywhere. They are frequently pre­scribed by ophthalmologists and optometrists.

These are the exercises not designed to enable a person to throw away his glasses, but to straighten eyes that may be crooked, to bring vision back to a deviating eye—the eye that turns in, or out, up or down.

It is called orthoptic training and much of the work is done with specially devised optical instruments such as the stereo­scope and prisms.

Dr. Pollack, after exhaustive research and study of both methods, echoes the opinion of an impressive number of authorities in his conclusion: "Eye exercises of any kind can­not eliminate or even reduce nearsightedness, farsightedness, or astigmatism. They are completely worthless as far as elimi­nating the need for glasses is concerned. Nor can they remedy or cure or alleviate eye diseases of any kind."

Dr. Pollack also agrees with others that "orthodox" or orthoptic eye exercises are needed "... only if you have a deviation (squint) of one eye, or a tendency to deviate, or if your eyes do not work as a team."

He observes that even in these cases results are not always satisfactory, but that "orthoptic training may be successful in selected cases."

Possibly the most significant turn of events in the contro­versy was the passage of a New York law, passed in 1956, barring all but qualified specialists from administering eye exercises. When Governor Harriman signed the bill he noted, as reported in newspapers, that the bill was to protect the public "against exploitation by untrained and unlicensed per­sons who hold out attractive promises of restoration of vision without glasses or drugs."

Gordon Gray explained his problem to Dr. Inglis.

"I can hardly take a breath through my right nostril, Doctor. It's that dividing piece up through my nose. It's pressed over on the right side and stops the air from getting through."

The doctor made a thorough examination.

"Deviated septum," he explained. "Have you had any sinus trouble?"

"Plenty."

"Weren't you playing football up until a couple of years ago?"

"Three years ago. My last year in school."

"Ever bang your nose then?"

"Plenty of times. I suppose it could have happened that way."

"Possibly. It's a bad one. I don't see how you are able to breathe at all through your right nostril."

"I don't believe I really do, much. What can you do about it?"

"A submucous resection."

"Come again?"

"That dividing wall that's so crooked in your nose—the septum—is made of cartilage covered by membrane. I'll make an incision through the lining membrane on one side of the septum, lift the lining and cut out some of that cartilage. You'll have a straight septum."

"Is this a hospital job?"

"A couple of days. Maybe just a day and a night. We'll have to pack it."

"What kind of an anesthetic?"

"Local. Okay?"

"Sure, Doc. Set the date. I want to take a full, easy breath again."

The operation for deviated septum is only one of the more common types of surgery for the nose. There are many other conditions which can be corrected by a surgeon. Nasal polyps are exceedingly common. Frequently, they are removed under local anesthetic by use of a wire snare. Tumors are frequently removed. Cancer of the nose, however, may necessitate ex­tensive surgery.

One of the most popular uses of plastic surgery to improve the features is plastic surgery of the nose.

A 16-year-old girl named Mary White came home from high school one afternoon, hurried to her room and closed her door. Mrs. Catherine White, her mother, caught a glimpse of her daughter running up the stairs. Now, outside the closed door, she was certain that she heard sobbing.

She called to her daughter but received no answer. Finally, she opened the door and crossed to the bed where her daugh­ter wept into a pillow.

"Mary . . . darling! What in the world is wrong?" she asked gently.

"I—I overheard some of the boys. They were talking about the dance Saturday night. Jimmy said he was taking Sally and asked Bill Sarner why he didn't take me and double date . . . and—"

The sobs broke out again.

"What, Mary? What did he say?"

Mary sat up and resolutely wiped away the tears from her face with the palms of her hands.

"He said ... he said, 'What? Me? Take The Nose?'"

Catherine White's eyes filled with tears and she put her arms around the girl. "Oh, my darling. . ."

"It's all right, Mother. You can't help it because I've got a hook in my nose. I know how I look. I guess I can't blame Bill. I just wish he could see my mother's cute, turned-up nose." She tried to make her voice light, but tears were in her eyes again.

"Mary, would you like a nose like mine?" Catherine asked thoughtfully.

"Like yours? Oh, Mother! How silly can you be! You've got the cutest nose in town. Maybe I got your eyes—like Daddy says—and your chin, but I don't know where I ever got this awful nose. I hate it." The attempted lightness left her voice and she suddenly was bitter and angry. "I hate it! I hate me—I hate me and my horrible nose!"

"Darling, things aren't that bad. Maybe we can do some­thing about it. I was talking with Mrs. Summers last week and she gave me an idea. A doctor she knows does plastic surgery—"

A strange look of excitement suddenly came into Mary's eyes as she stared into her mother's face. "You mean on my nose? Maybe he could bob it or turn it up at the end like yours?"

"We can certainly find out. And we will!"

That night Catherine and her husband talked over the problem.

"She's developing a complex about it," Catherine said. "It could ruin her life. And how awful to overhear something like that from a boy I know she really likes so terribly much. Jim, we've just got to do it somehow."

"Take her to the doctor, Catherine. I agree with you."

"It may cost a lot, Jim."

"We have some savings. I can't think of a better use for them than to buy our daughter some happiness for the rest of her life."

The plastic surgery on Mary White's nose was completely successful. Before operating, the surgeon made several studies of her profile, the proportions of her face, and made sketches to plan her new profile and the shape of her nose.

Mary had the operation done early in the summer and by the time she returned to school her nose was completely healed. To the few who did not know her well, but who had seen her with a bandaged face, she shrugged and explained a "broken nose."

Within a month after school was in session that autumn, she had become popular beyond her wildest dreams.

Such happy endings are not at all unusual when plastic surgery comes to the rescue.

Sinus trouble affects a tremendous number of persons. Some of it is temporary, some is chronic, some is acute.

Nasal sinuses are air spaces, lined with mucous mem­brane, within the bones of the face and skull. The frontal sinuses are in the bone just above and behind the eyebrows. The maxillary sinuses are within the bones of the cheeks be­neath the eyes. Ethmoid sinuses are near the side of the nose and inner aspect of the eyes, extending back into the skull. The sphenoid sinus is deep in the skull, above the level of the throat. Sinuses lighten the weight of the head and con­tribute to voice resonance. They communicate by small open­ings with the nasal cavity.

When the mucous membrane lining of a sinus becomes in­flamed we have sinusitis.

Usually, sinus trouble may follow colds, or it may result from allergy problems. The chapters on colds and aller­gies explain conditions and treatment in relation to these problems.

Most sinusitis responds to good medical treatment which may include bed rest, heat applications, steam inhalations, nose drops to ease congestion, nasal irrigations and, fre­quently, one of the antibiotics.

Occasionally, surgery is required to obtain adequate open­ings for drainage of pus and to remove diseased mucous membrane or infected bone surrounding the sinus.

Whenever a sinus attack becomes a throbbing pain, accom­panied by fever, muscular pains and aches, weakness, loss of appetite, and a bad-smelling, opaque discharge, it is advisable to see your doctor at once.

There was a time when doctors routinely recommended tonsillectomy and adenoidectomy for virtually all children when they arrived in the three- to five-year age group.

Doctors are now much more conservative about the re­moval of tonsils and adenoids and the present trend is to have them out only when they may be chronically infected or when diseased adenoids are causing nose or ear complications.

Tonsillitis may be caused by many different bacteria and possibly by viruses. It can be treated very effectively with sulfa drugs and antibiotics.

Frequently a sore throat and tonsillitis may be confused. Actually, tonsillitis is a specific disease, although the tonsils are usually involved when there is inflammation at the back of the throat.

A sore throat should call for a doctor's attention when it advances beyond the "ordinary" sore throat stage (one that clears up very quickly with sensible care at home). When there is pain on swallowing, or tonsils are enlarged, red and often covered with white spots, a swelling and vivid redness of the throat, fever, chills and weakness, it is quite possible that it is a streptococcus sore throat.

Many suggestions for the care of sore throats have come down through folk medicine. Some of the soothing medica­tions that were prescribed for coughs, were popular for sore throats, too. Alum water, sage tea, honey, borax and water, were used as gargles along with drinks such as flaxseed tea, gum arabic, or slippery elm water.

Children who could not gargle, back in the last century, frequently had finely powdered alum or borax blown into a sore throat through a quill or folded paper.

One time-tested home remedy for ordinary sore throat is still efficacious: one half teaspoonful of salt in hot water used as a gargle.

Occasionally, a virus sore throat may settle in the voice box to cause laryngitis, with resulting hoarseness or loss of voice and a tight cough.

Another familiar treatment often brings relief: steam in­halations. Along with the steam treatment, patients are ad­vised to use their voices as little as possible until the condition is relieved.

Disorders of the larynx can be serious and there should be no hesitation in calling a doctor, especially for children. Abscesses may form, foreign bodies may get stuck in the larynx (as in the case of children swallowing coins), severe croup, injuries, burns from hot liquids or live steam, and in­halations of irritating vapors, may all bring about obstruction of the larynx. In this case immediate medical attention is imperative.

Difficulty in breathing, pallor and restlessness, blueness of the lips, rapid pulse and respiration, signify suffocation from a larynx obstruction.

Sometimes, to save a life, a tracheotomy is performed—an opening is made through the lower middle of the neck below the Adam's apple into the windpipe and a tube inserted to allow air to reach the windpipe.

Antibiotics bring most infections of the larynx under control.

Benign tumors are removed surgically from the larynx, and surgery for cancer of the larynx is about 85 per cent successful.

The old pioneer grandfather eyed his young grandson with sympathy.

"Open your mouth, young'un," he commanded.

The boy opened his mouth wide and the grandfather sol­emnly inspected an offending "baby tooth" with its small cavity.

He straightened up and looked up at the hill at a scarred and battered stump of a tree.

"See that tree, young'un—the one that was hit by lightnin'? Get a splinter from it and pick that tooth. Best cure for toothache there is I Better'n a coffin nail like some say, or the middle toe of an owl, or a woodcock's tongue. 'N so ye don't have no more, we'll hang three mice with a string and then tie the string round ye're neck, boy. Stops more toothaches from comin' fer sure."

Some years later, in the early part of the 19th century, dentistry was beginning to make a small impression on the country. In the 1820s, a few dentists were available in the larger towns in the West, and had been practicing for some time in the Eastern cities.

Caries were filled with tin foil or gold. Many teeth were pulled. Artificial teeth were making an appearance with greater frequency. In most instances the dentistry of those early days was practiced in conjunction with medicine.

Toothache "cures" used in many homes throughout those years and into this century—and, possibly, today in some instances—included a strong solution of ammonia on cotton applied to the affected tooth. Collodium flexile with Calvert's carbolic acid were frequently soaked into a piece of lint and placed in a cavity.

Other substances often used on cotton for application in the caries of teeth include oil of cloves, powdered alum and salt, and creosote.

Today tooth decay is probably America's most prevalent "nuisance disease." Nine out of ten Americans have some degree of caries.

To repair the damage done by tooth decay, dentists now use greatly improved techniques, equipment, and materials. New high-speed drills spin at 300,000 revolutions a minute to do a cleaner, quicker, better and, frequently, painless job of cut­ting, trimming, polishing. As a matter of fact, pain is seldom experienced in the dentist's chair under any circumstances with the use of anesthesia—usually local—at the dentist's command. In some instances, dentists also use hypnotism for this purpose.

Oral surgery is efficient and effective. Periodontia, the treatment of diseases of the soft tissues surrounding the teeth, has had great help from the new wonder drugs. Orthodontia, the correction of irregularities of teeth pertaining to proper positioning and malocclusion, now is common among growing children. Plastics and new alloys have done much to aid new techniques and bring about better results in prosthodontia, the replacing of lost natural teeth by artificial ones.

The big challenge in dealing with tooth decay obviously is prevention.

Anyone who is normally aware of public health problems is probably acquainted with the pros and cons of fluoridation.

Dr. Spock, famous authority on child care, believes that controlled fluoridation of drinking water is the most effective and the least expensive way to save children's teeth from decay. He considers it to be safe and answers doubters by reminding them that "committees of experts of the American Public Health Association, the American Dental Association, the American Medical Association, and the United States Public Health Service reviewed the evidence before publicly recommending fluoridation."

In one comprehensive study of the safety of fluoridation, Dr. A. L. Russell of the National Institute of Dental Health reported that 20,000 children in New York, Colorado, and Texas were checked to learn if fluoridated water hurt the gums of their mouths. The study revealed no evidence of damage.

Boys and girls reared in areas that have controlled water fluoridation, including Grand Rapids, Michigan, Evanston, Illinois, and Newburgh, New York, are reported to have shown no mottled tooth enamel, and no tendency toward gingivitis. No differences were reported in bone structure, growth, hearing, vision, or kidney function from those of the children reared in communities where water was not fluori­dated. But the children in test cities using fluoridation were reported to have as much as 60 per cent fewer tooth cavities.

Despite these encouraging reports, a serious and constant war is waged against fluoridation. The National Committee Against Fluoridation, Washington, D.C., was founded in 1952. Its membership is reported by the organization to em­brace "Laymen, doctors, dentists, and scientists who believe in trying to protect our 'inalienable' individual rights under the Constitution, including medical freedom. To oppose mass medication and combat this menace to our individual liberties inherent in the compulsory fluoridation of drinking water." (Encyclopedia of American Associations, Second Edition, 1959)

One of the most vocal opponents of the fluorides has been Prevention magazine, edited by J.I. Rodale, Emaus, Penn­sylvania, who is well known in the area of health foods, organic farming, and publishing.

In the April 1959 issue of Prevention the magazine summed up its basic recommendations in an article by Rodale. It recommends raising your own food organically, or buying it from advertisers in another Rodale magazine. It condemns white sugar as being a worthless food; favors a low-carbo­hydrate, high-protein diet; frowns upon bread; suggests that excessive table salt may be an important factor in cancer, heart disease, sinus trouble, obesity, and hives, to mention only a few disorders. It indicates that large quantities of citrus fruit juices may harm teeth, and health in general. It points out the danger of eating canned foods, advises keeping to a minimum of animal fat in the diet and shunning hydrogenated vegetable fats. It does not favor adults drinking milk; advo­cates lots of nuts, fruits and vegetables in the diet; states, "Never use aluminum cooking utensils" and warns against plastic utensils. It advocates drinking water that is not chlorin­ated and believes that drinking artificially softened water is dangerous.

Other points are observed in the article, but the above serve to establish the climate from which the magazine's following statement about fluoridation is made:

"We condemn the practice of adding fluorides to the water in order to reduce tooth decay in young children. From the research that has been done, any possible decrease in tooth decay is only temporary, and teeth become brittle and give trouble later on. Fluorine is one of the most dangerous chem­icals and there is evidence that over a period of many years the cumulative effect will endanger such organs as the heart, liver, kidney, etc."

Most organized opposition to fluoridation also emphasizes the "unconstitutionafity" of the practice. In Chicago, hearings on an injunction suit to halt Chicago's water fluoridation program, which was begun in 1956, have been going on for two years.

Evidently the over-all attack has been effective in some areas. The March issue of Prevention reports "On The Fluori­dation Front" that the elections in November, I960, "brought rejections of water fluoridation in 29 communities, according to U.S. News and World Report for December 5, 1960. The measure was defeated by margins ranging from 24,000 votes in Cincinnati to 1 vote in Weyauwega, Wisconsin. Saginaw, Michigan defeated the proposition for the second time; Fari-bault, Minnesota, where fluoridation had been in effect by order of the city council, voted to discontinue."

Today, about 28 million Americans live in more than 1000 cities that have fluoridation programs. In addition to the four eminent health organizations mentioned by Dr. Spock, the World Health Organization and the National Re­search Council apparently are satisfied that fluoridation is safe and effective, and that no harm has come to the health of persons using it.

One brand of fluoride toothpaste finally received a condi­tional approval from dentists in 1960, and in some places where water is not fluoridated many dentists are applying fluoride compounds directly to the teeth.

Meanwhile, dentists warn that too many sweets, soft drinks, cereals and starches can cause tooth trouble, and they advocate brushing after every meal, when possible. This, they say, is the single most effective method for reducing the tendency to caries.

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