Rider speaks of the lodgment of a fragment of a copper percussion cap in the left eye, back of the inner ciliary margin of the iris, for thirty-five years; and Bartholinus mentions a thorn in the canthus for thirty years. Jacob reports a case in which a chip of iron remained in the eyeball twenty-eight years without giving indications for removal.

It was clearly visible, protruding into the anterior surface of the iris, and although it was rusted by its long lodgment, sight in the eye was fairly good, and there was no sign of irritation.

Snell gives an instance in which a piece of steel was imbedded close to the optic disc with retention of sight. It was plainly visible by the opthalmoscope eighteen months after the accident, when as yet no diminution of sight was apparent. Smyly speaks of a portion of a tobacco pipe which was successfully removed from the anterior chamber by an incision through the cornea. Clark mentions a case in which molten lead in the eye caused no permanent injury; and there are several cases mentioned in confirmation of the statement that the eye seems to be remarkably free from disastrous effects after this injury.

Williamson mentions eyelashes in the anterior chamber of the eye, the result of a stab wound of this organ.

Contusion of the eyeball may cause dislocation of the lens into the anterior chamber, and several instances have been recorded. We regret our inability to give the reference or authority for a report that we have seen, stating that by one kick of a horse the lenses of both eyes of a man were synchronously knocked through the eyeb.a.l.l.s by the calkins of the horseshoe. Oliver mentions extraction of a lens by a thrust of a cow's horn.

Lowe speaks of rupture of the anterior capsule of the lens from violent sneezing, with subsequent absorption of the lenticular substance and restoration of vision. Trioen mentions a curious case of expulsion of the crystalline lens from the eye in ophthalmia, through the formation of a corneal fissure. The authors have personal knowledge of a case of spontaneous extrusion of the lens through a corneal ulcer, in a case of ophthalmia of the new-born.

Injury of the Eyeball by Birds.--There are several instances in which birds have pierced the eyeball with their bills, completely destroying vision. Not long since a prominent taxidermist winged a crane, picked it up, and started to examine it, when it made one thrust with its bill and totally destroyed his eyeball. In another instance a man was going from the railroad station to his hotel in a gale of wind, when, as he turned the corner of the street, an English sparrow was blown into his face. Its bill penetrated his eyeball and completely ruined his sight.

There are several instances on record in which game fowls have destroyed the eyes of their owners. In one case a game c.o.c.k almost completed the enucleation of the eye of his handler by striking him with his gaff while preparing in a c.o.c.k-pit.

Moorehead explains a rare accident to an eye as follows:--

"Mr. S. B. A., while attending to his bees, was stung by one upon the right upper eyelid near its center. An employee, who was a.s.sisting in the work, immediately discovered the sting driven in the lid and cautiously extracted it, stating that he made sufficient traction to lift the lid well away from the globe. In a few hours the lid became much swollen, but the pain experienced at first had disappeared. Before retiring for the night he began gentle ma.s.sage of the lid, stroking it horizontally with his finger. The edematous condition was by this means much reduced in a short time. While thus engaged in stroking the lid he suddenly experienced intense pain in the eye as if it had been pierced by a sharp instrument. The suffering was very severe, and he pa.s.sed a wretched night, constantly feeling 'something in his eye.'

"The next morning, the trouble continuing, he came to me for relief.

Upon examination of the lid, no opening could be made out where the sting had penetrated, and a minute inspection of the conjunctival surface with a good gla.s.s failed to reveal any foreign substance.

Cleansing the lid thoroughly, and carefully inspecting with a lens under strong light, a minute dark point was made out about the center of the lid. Feeling that this might be the point of the sting, I had recourse to several expedients for its removal, but without success.

Finally, with a fine knife, I succeeded in cutting down by the side of the body and tilting it out. Examination with a 1/5 inch objective confirmed my opinion that it was the point of the bee-sting.

"The barbed formation of the point explains how, under the stroking with the finger, it was forced through the dense tarsal cartilage and against the cornea of the eye."

There is a story told in La Medecine Moderne of a seamstress of Berlin who was in the habit of allowing her dog to lick her face. She was attacked with a severe inflammation of the right eye, which had to be enucleated, and was found full of tenia echinococcus, evidently derived from the dog's tongue.

Gabb mentions a case of epistaxis in which the blood welled up through the lacrimal ducts and suffused into the eye so that it was constantly necessary to wipe the lower eyelid, and the discharge ceased only when the nose stopped bleeding. A brief editorial note on epistaxis through the eyes, referring to a case in the Medical News of November 30, 1895, provoked further reports from numerous correspondents. Among others, the following:--

"Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of seventy-eight whom he found with the blood gushing from the nostrils.

After plugging the nares thoroughly with absorbent cotton dusted with tannic acid he was surprised to see the blood ooze out around the eyelids and trickle down the cheeks. This oozing continued for the greater part of an hour, being controlled by applications of ice to both sides of the nose."

"Dr. F. L. Donlon of New York City reports the case of a married woman, about fifty years old, in whom epistaxis set in suddenly at 11 P.M., and had continued for several hours, when the anterior nares were plugged. In a short time the woman complained that she could scarcely see, owing to the welling up of blood in the eyes and trickling down her face. The bleeding only ceased when the posterior nares also were plugged."

"Dr. T. G. Wright of Plainville, Conn., narrates the case of a young man whom he found in the night, bleeding profusely, and having already lost a large amount of blood. Shortly after plugging both anterior and posterior nares the blood found its way through the lacrimal ducts to the eyes and trickled down the cheeks."

"Dr. Charles W. Crumb cites the case of a man, sixty-five years old, with chronic nephritis, in whom a slight bruise of the nose was followed by epistaxis lasting twenty-four hours. When the nares were plugged blood escaped freely from the eyes. A cone-shaped bit of sponge, saturated with ferrous sulphate, was pa.s.sed into each anterior naris, and another piece of sponge, similarly medicated, into either posterior naris. The patient had been taking various preparations of pota.s.sium, and it was thought that his blood contained a deficiency of fibrin. Upon removal of the nasal plugs a catarrhal inflammation developed which lasted a long time and was attended with considerable purulent discharge."

Late Restoration of Sight.--There are some marvelous cases on record in which, after many years of blindness, the surgeon has been able, by operation, to restore the sight. McKeown gives the history of a blind fiddler of sixty-three, who, when one and a half years old, had lost the sight of both eyes after an attack of small-pox. Iridectomy was performed, and after over sixty years of total blindness his sight was restored; color-perception was good. Berncastle mentions a case of extraction of double cataract and double iridectomy for occluded pupils, which, after thirty years of blindness, resulted in the recovery of good sight. The patient was a blind beggar of Sydney.

To those interested in this subject, Jauffret has a most interesting description of a man by the name of Garin, who was born blind, who talked at eight or nine months, showed great intelligence, and who was educated at a blind asylum. At the age of twenty-four he entered the hospital of Forlenze, to be operated upon by that famous oculist. Garin had never seen, but could distinguish night or darkness by one eye only, and recognized orange and red when placed close to that eye. He could tell at once the s.e.x and age of a person approximately by the voice and tread, and formed his conclusions more rapidly in regard to females than males. Forlenze diagnosed cataract, and, in the presence of a distinguished gathering, operated with the happiest result. The description that follows, which is quoted by Fournier and is readily accessible to any one, is well worth reading, as it contains an account of the first sensations of light, objects, distance, etc., and minor a.n.a.logous thoughts, of an educated and matured mind experiencing its first sensations of sight.

Hansell and Clark say that the perplexities of learning to see after twenty-six years of blindness from congenital disease, as described by a patient of Franke, remind one of the experience of Sh.e.l.ley's Frankenstein. Franke's patient was successfully operated on for congenital double cataract, at twenty-six years of age. The author describes the difficulties the patient had of recognizing by means of vision the objects he had hitherto known through his other senses, and his slowness in learning to estimate distances and the comparative size of objects.

Sight is popularly supposed to be occasionally restored without the aid of art, after long years of blindness. Benjamin Rush saw a man of forty-five who, twelve years before, became blind without ascertainable cause, and recovered his sight equally without reason. St. Clair mentions Marshal Vivian, who at the age of one hundred regained sight that for nearly forty years had gradually been failing almost to blindness, and preserved this new sight to the time of his death.

There are many superst.i.tions prevalent among uneducated people as to "second sight," recovery of vision, etc., which render their reports of such things untrustworthy. The real explanations of such cases are too varied for discussion here.

Nyctalopia etymologically means night blindness, but the general usage, making the term mean night-vision, is so strongly intrenched that it is useless and confusing to attempt any reinstatement of the old significance. The condition in which one sees better by night, relatively speaking, than by day is due to some lesion of the macular region, rendering it blind. At night the pupil dilates more than in the day-time, and hence vision with the extramacular or peripheral portions of the retina is correspondingly better. It is, therefore, a symptom of serious retinal disease. All night-prowling animals have widely dilatable pupils, and in addition to this they have in the retina a special organ called the tapetum lucidum, the function of which is to reflect to a focus in front of them the relatively few rays of light that enter the widely-dilated pupil and thus enable them the better to see their way. Hence the luminous appearance of the eyes of such animals in the dark.

Hemeralopia (etymologically day-blindness, but by common usage meaning day-vision or night-blindness) is a symptom of a peculiar degenerative disease of the retina, called retinitis pigmentosa. It also occurs in some cases of extreme denutrition, numerous cases having been reported among those who make the prolonged fasts customary in the Russian church. In retinitis pigmentosa the peripheral or extramacular portions of the retina are subject to a pigmentary degeneration that renders them insensitive to light, and patients so afflicted are consequently incapable of seeing at night as well as others. They stumble and run against objects easily seen by the normal eye.

Snow-blindness occurs from prolonged exposure of the eyes to snow upon which the sun is shining. Some years ago, some seventy laborers, who were clearing away snow-drifts in the Caucasus, were seized, and thirty of them could not find their way home, so great was the photophobia, conjunctivitis, and lacrimation. Graddy reports six cases, and many others are constantly occurring.

Other forms of retinal injury from too great or too prolonged exposure to light are "moon-blindness," due to sleeping with the eyes exposed to bright moonlight, and that due to lightning--a case, e.g., being reported by Knies. Silex also reports such a case and reviews the reported cases, 25 in number, in ten of which cataract ensued. In the Annual of the Universal Medical Sciences, 1888, there is a report of seven cases of retinal injury with central scotoma, amblyopia, etc., in j.a.panese medical students, caused by observation of the sun in eclipse.

In discussing the question of electric-light injuries of the eyes Gould reviews the literature of the subject and epitomizes the cases reported up to that time. They numbered 23. No patient was seriously or permanently injured, and none was in a person who used the electric light in a proper manner as an illuminant. All were in scientific investigators or workmen about the light, who approached it too closely or gazed at it too long and without the colored protecting spectacles now found necessary by such workers.

Injuries to the Ear.--The folly of the practice of boxing children's ears, and the possible disastrous results subsequent to this punishment, are well exemplified throughout medical literature. Stewart quotes four cases of rupture of the tympanum from boxing the ears, and there is an instance of a boy of eight, who was boxed on the ear at school, in whom subsequent brain-disease developed early, and death followed. Roosa of New York mentions the loss of hearing following a kiss on the ear.

Dalby, in a paper citing many different causes of rupture of the tympanic membrane, mentions the following: A blow in sparring; violent sneezing; blowing the nose; forcible dilatation of the Eustachian ca.n.a.l; a thorn or twig of a tree accidentally thrust into the head; picking the ear with a toothpick. In time of battle soldiers sometimes have their tympanums ruptured by the concussion caused by the firing of cannon. Dalby mentions an instance of an officer who was discharged for deafness acquired in this manner during the Crimean War. He was standing beside a mortar which, unexpectedly to him, was fired, causing rupture of the tympanic membrane, followed by hemorrhage from the ear.

Similar cases were reported in the recent naval engagements between the Chinese and j.a.panese. Wilson reports two cases of rupture of the membrane tympani caused by diving. Roosa divides the causes into traumatic, hemorrhagic, and inflammatory, and primary lesions of the labyrinth, exemplifying each by numerous instances. Under traumatic causes he mentions severe falls, blows about the head or face, constant listening to a telegraphic instrument, cannonading, and finally eight cases of boiler-makers' deafness. Roosa cites a curious case of sudden and profound deafness in a young man in perfect health, while calling upon the parents of his lady-love to ask her hand in marriage. Strange to say that after he had had a favorable reply he gradually recovered his hearing! In the same paper there is an instance of a case of deafness due to the sudden cessation of perspiration, and an instance of tinnitus due to the excessive use of tobacco; Roosa also mentions a case of deafness due to excessive mental employment.

Perforation of the Tympanum.--Kealy relates an instance in which a pin was introduced into the left ear to relieve an intolerable itching. It perforated the tympanum, and before the expiration of twenty-four hours was coughed up from the throat with a small quant.i.ty of blood. The pin was bent at an angle of about 120 degrees. Another similar case was that of a girl of twenty-two who, while p.r.i.c.king her ear with a hair-pin, was jerked or struck on the arm by a child, and the pin forced into the ear; great pain and deafness followed, together with the loss of taste on the same side of the tongue; after treatment both of the disturbed senses were restored. A man of twenty was p.r.i.c.ked in the ear by a needle entering the meatus. He uttered a cry, fell senseless, and so continued until the fourth day when he died. The whole auditory meatus was destroyed by suppuration. Gamgee tells of a constable who was stabbed in the left ear, severing the middle meningeal artery, death ensuing. In this instance, after digital compression, ligature of the common carotid was practiced as a last resort. There is an account of a provision-dealer's agent who fell asleep at a public house at Tottenham. In sport an attendant tickled his ear with a wooden article used as a pipe light. A quick, unconscious movement forced the wooden point through the tympanum, causing cerebral inflammation and subsequent death. There is a record of death, in a child of nine, caused by the pa.s.sage of a knitting-needle into the auditory meatus.

Kauffmann reports a case of what he calls objective tinnitus aurium, in which the noise originating in the patient's ears was distinctly audible by others. The patient was a boy of fourteen, who had fallen on the back of his head and had remained unconscious for nearly two weeks.

The noises were bilateral, but more distinct on the left than on the right side. The sounds were described as crackling, and seemed to depend on movements of the arch of the palate. Kauffmann expresses the opinion that the noises were due to clonic spasm of the tensor velum palati, and states that under appropriate treatment the tinnitus gradually subsided.

The introduction of foreign bodies in the ear is usually accidental, although in children we often find it as a result of sport or curiosity. There is an instance on record of a man who was accustomed to catch flies and put them in his ear, deriving from them a pleasurable sensation from the tickling which ensued. There have been cases in which children, and even adults, have held gra.s.shoppers, crickets, or lady-birds to their ears in order to more attentively listen to the noise, and while in this position the insects have escaped and penetrated the auditory ca.n.a.l. Insects often enter the ears of persons reposing in the fields with the ear to the ground. Fabricius Hilda.n.u.s speaks of a cricket penetrating the ear during sleep. Calhoun mentions an instance of disease of the ear which he found was due to the presence of several living maggots in the interior of the ear. The patient had been sleeping in a horse stall in which were found maggots similar to those extracted from his ear. An a.n.a.logous instance was seen in a negro in the Emergency Hospital, Washington, D.C., in the summer of 1894; and many others are recorded. The insects are frequently removed only after a prolonged lodgment.

D'Aguanno gives an account of two instances of living larvae of the musca sarcophaga in the ears of children. In one of the cases the larvae entered the drum-cavity through a rupture in the tympanic membrane. In both cases the maggots were removed by forceps. Haug has observed a tic (ixodes ricinus) in the ear of a lad of seventeen. The creature was killed by a mercuric-chlorid solution, and removed with a probe.

There is a common superst.i.tion that centipedes have the faculty of entering the ear and penetrating the brain, causing death. The authors have knowledge of an instance in which three small centipedes were taken from the ear of a policeman after remaining there three days; during this time they caused excruciating pain, but there was no permanent injury. The Ephemerides contains instances in which, while yet living, worms, crickets, ants, and beetles have all been taken from the ear. In one case the entrance of a cricket in the auditory ca.n.a.l was the cause of death. Martin gives an instance in which larvae were deposited in the ear. Stalpart van der Wiel relates an instance of the lodgment of a living spider in the ear.

Far more common than insects are inanimate objects as foreign bodies in the ear, and numerous examples are to be found in literature. Fabricius Hilda.n.u.s tells of a gla.s.s ball introduced into the auditory ca.n.a.l of a girl of ten, followed by headache, numbness on the left side, and after four or five years epileptic seizures, and atrophy of the arm. He extracted it and the symptoms immediately ceased. Sabatier speaks of an abscess of the brain caused by a ball of paper in the ear; and it is quite common for persons in the habit of using a tampon of cotton in the meatus to mistake the deep entrance of this substance for functional derangement, and many cases of temporary deafness are simply due to forgetfulness of the cause. A strange case is reported in a girl of fourteen, who lost her tympanum from a profuse otorrhea, and who subst.i.tuted an artificial tympanum which was, in its turn, lost by deep penetration, causing augmentation of the symptoms, of the cause of which the patient herself seemed unaware. Sometimes artificial otoliths are produced by the insufflation of various powders which become agglutinated, and are veritable foreign bodies. Holman tells of a negro, aged thirty-five, whose wife poured molten pewter in his ear while asleep. It was removed, but total deafness was the result.

Alley mentions a New Orleans wharf laborer, in whose ear was poured some molten lead; seventeen months afterward the lead was still occupying the external auditory meatus. It is quite remarkable that the lead should have remained such a length of time without causing meningeal inflammation. There was deafness and palsy of that side of the face. A fungous growth occupied the external portion of the ear; the man suffered pain and discharge from the ear, and had also great difficulty in closing his right eyelid. Morrison mentions an alcoholic patient of forty who, on June 6, 1833, had nitric acid poured in her right ear. There were no headache, febrile symptoms, stupor, or vertigo. Debility alone was present. Two weeks after the injury paralysis began on the right side, and six weeks from the injury the patient died. This case is interesting from the novel mode of death, the perfect paralysis of the arm, paralysis agitans of the body (occurring as hemorrhage from the ear came on, and subsiding with it), and extensive caries of the petrous bone, without sensation of pain or any indicative symptoms.

There is an instance in a young girl in which a piece of pencil remained in the right ear for seven years. Haug speaks of two beads lying in the auditory ca.n.a.l for twenty-eight years without causing any harm.

A boy of six introduced a carob-nut kernel into each ear. On the next day incompetent persons attempted to extract the kernel from the left side, but only caused pain and hemorrhage. The nut issued spontaneously from the right side. In the afternoon the auditory ca.n.a.l was found excoriated and red, and deep in the meatus the kernel was found, covered with blood. The patient had been so excited and pained by the bungling attempts at extraction that the employment of instruments was impossible; prolonged employment of injections was subst.i.tuted.

Discharge from the ear commenced, intense fever and delirium ensued, and the patient had to be chloroformed to facilitate the operation of extraction. The nut, when taken out, was found to have a consistency much larger than originally, caused by the agglutination of wax and blood. Unfortunately the symptoms of meningitis increased; three days after the operation coma followed, and on the next day death ensued. In 75 cases collected by Mayer, and cited by Poulet (whose work on "Foreign Bodies" is the most extensive in existence), death as a consequence of meningitis was found in three.

Fleury de Clermont mentions a woman of twenty-five who consulted him for removal of a pin which was in her right ear. Vain attempts by some of her lay-friends to extract the pin had only made matters worse. The pin was directed transversely, and its middle part touched the membrane tympanum. The mere touching of the pin caused the woman intense pain; even after etherization it was necessary to construct a special instrument to extract it. She suffered intense cephalalgia and other signs of meningitis; despite vigorous treatment she lost consciousness and died shortly after the operation.

Winterbotham reports an instance in which a cherry-stone was removed from the meatus auditorius after lodgment of upward of sixty years.

Marchal de Calvi mentions intermittent deafness for forty years, caused by the lodgment of a small foreign body in the auditory ca.n.a.l. There is an instance in which a carious molar tooth has been tolerated in the same location for forty years.

Albucasius, Fabricius Hilda.n.u.s, Pare, and others, have mentioned the fact that seeds and beans have been frequently seen to increase in volume while lodged in the auditory ca.n.a.l. Tulpius speaks of an infant, playing with his comrades, who put a cherry-seed in his ear which he was not able to extract. The seed increased in volume to such an extent that it was only by surgical interference that it could be extracted, and then such serious consequences followed that death resulted. Albers reports an instance in which a pin introduced into the ear issued from the pharynx.

Confusion of diagnosis is occasionally noticed in terrified or hysteric persons. Lowenberg was called to see a child of five who had introduced a b.u.t.ton into his left ear. When he saw the child it complained of all the pain in the right ear, and he naturally examined this ear first but found nothing to indicate the presence of a foreign body. He examined the ear supposed to be healthy and there found the b.u.t.ton lying against the tympanum. This was explained by the fact that the child was so pained and terrified by the previous explorations of the affected ear that rather than undergo them again he presented the well ear for examination. In the British Medical Journal for 1877 is an account of an unjustified exploration of an ear for a foreign body by an incompetent physician, who spent a half hour in exploration and manipulation, and whose efforts resulted in the extraction of several pieces of bone. The child died in one and a half hours afterward from extreme hemorrhage, and the medical bungler was compelled to appear before a coroner's jury in explanation of his ignorance.

In the external ear of a child Tansley observed a diamond which he removed under chloroform. The mother of the child had pushed the body further inward in her endeavors to remove it and had wounded the ca.n.a.l.

Schmiegelow reports a foreign body forced into the drum-cavity, followed by rough extraction, great irritation, teta.n.u.s, and death; and there are on record several cases of fatal meningitis, induced by rough endeavors to extract a body from the external ear.

In the Therapeutic Gazette, August 15, 1896, there is a translation of the report of a case by Voss, in which a child of five pushed a dry pea in his ear. Four doctors spent several days endeavoring to extract it, but only succeeded in pushing it in further. It was removed by operation on the fifth day, but suppuration of the tympanic cavity caused death on the ninth day.

Barclay reports a rare case of ensnared aural foreign body in a lady, aged about forty years, who, while "picking" her left ear with a so-called "invisible hair-pin" several hours before the consultation, had heard a sudden "tw.a.n.g" in the ear, as if the hair-pin had broken.

And so, indeed, it had; for on the instant she had attempted to jerk it quickly from the ear the sharp extremity of the inner portion of its lower p.r.o.ng sprang away from its fellow, penetrated the soft tissues of the floor of the external auditory ca.n.a.l, and remained imbedded there, the separated end of this p.r.o.ng only coming away in her grasp. Every attempt on her part to remove the hair-pin by traction on its projecting p.r.o.ng--she durst not force it INWARD for fear of wounding the drumhead--had served but to bury the point of the broken p.r.o.ng more deeply into the flesh of the ca.n.a.l, thereby increasing her suffering.

Advised by her family physician not to delay, she forthwith sought advice and aid. On examination, it was found that the lower p.r.o.ng of the "invisible hair-pin" had broken at the outer end of its wavy portion, and seemed firmly imbedded in the floor of the auditory ca.n.a.l, now quite inflamed, at a point about one-third of its depth from the outlet of the ca.n.a.l. The loop or turn of the hair-pin was about 1/2 inch from the flaccid portion of the drumhead, and, together with the unbroken p.r.o.ng, it lay closely against the roof of the ca.n.a.l.