ON BATHING, SWIMMING, AND DIVING, AS CAUSES OF AURAL DISEASE.

BY

LAURENCE TURNBULL, M.D.,

FELLOW OF THE AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE; AURAL SURGIOS TO JEFFERSON COLLEGE HOSPITAL; PHYSICIAN TO THE DEPARTMENT OF DISEASES

OF THE EYE AND EAR, HOWARD HOSPITAL, PHILADELPHIA.

SWIMMING and diving in cold water seem to me to be important and frequent causes of disease of the external auditory canal and anterior surface of the membrana tympani, as also of the middle ear, though bathing in river or sea water is, when wisely and properly regulated, both healthful and pleasant. The evils attending bathing and swimming in cold water are the entrance of this cold fluid, not only into the external meatus, but as far as the membrana tympani, causing inflammation of the lower portion of the auditory canal, and of the anterior surface of the tympanic membrane. But a still greater evil is from sudden deglutition, during diving or swimming, by which-the mouth, nose, and pharynx being filled with cold water, and the mouths of the Eustachian tubes open-a portion of the water passes into the middle ear. This result rarely occurs in expert swimmers or divers, but is most common in beginners, who suddenly, from cold, or the shock of the contact of the water, breathe or swallow in a sobbing manner. I have, however, known it to occur in old and experienced swimmers while plunging headforemost, owing to the intense coldness of the water-the act of deglutition being entirely involuntary.

If the water is not removed by placing the head to one side, and drawing the external ear forcibly outwards, shaking the head at the same time and opening the mouth, it is apt to cause inflammation, with the formation of pus, followed by perforation of the membrana tympani; or the inflammation, if neglected, may pass inwards to the cochlea and labyrinth, and, implicating the brain, may terminate in death.

It is a well-recognized maxim among those who devote special attention to diseases of the ear, that no cold fluid should be allowed to enter even the external auditory canal; still this important fact is not suffi ciently recognized by the profession at large. The entrance of warm water into the ear is less objectionable, but even this is not quite free from danger, and has its disadvantages; and the water should in all cases contain a few grains of a saline ingredient, like borax, soda, or common salt, when employed in washing out the ear. The symptoms of water in the middle ear are, in the first stage, an uncomfortable sensation, followed by earache or pain, which after a time becomes agonizing, and is accompa nied with great tenderness behind the auricle. In proof that water in the ears is injurious, and causes deafness, I might cite a number of instances, and it is a well-known fact that dogs which are thrown into water become deaf.

Many cases of this form of disease, in its chronic stage, come under treatment during all seasons, but acute cases, from swimming and diving, occur during the summer months, and chiefly in boys from eight to six

teen years of age; a much smaller number occurring in the fall and winter. If the acute form be promptly treated, entire recovery takes place; but should the case not be seen until after the chill, it is always followed by a discharge of shorter or longer duration. In cases not recognized, the symptoms of violent headache, furious delirium, and coma, give the physician the impression that disease of the brain is present, and the case thus improperly treated terminates in death. The morbid condition in the first stage consists in acute inflammation of the extremely delicate mucous membrane lining the middle ear. This inflammation is followed by effusion of fluid, and, after twenty-four hours, by the formation of pus; it is in every instance attended by fever, with swelling and inflammation of the nasopharyngeal space, and great pain. If this fluid or pus be removed by incision into the membrana tympani, followed by the use of the air douche, and injections of hot saline water, the patient recovers, and the ear is saved. The patient is apt to remain deaf for several weeks, and the local application of tincture of iodine, with or without some anodyne, brushed around the back of the auricle, facilitates the removal of the inflammatory thickening. To diminish the discharge of pus, should it continue, we may employ a powder of salicylic acid and starch, blown into the meatus and after a time washed out, and reapplied twice a day, until the discharge shall have ceased and the perforation have become closed.

64

SECTION ON SANITARY SCIENCE.

PRESIDENT OF THE SECTION.

STEPHEN SMITH, M.D.,

OF NEW YORK.

VICE-PRESIDENT.

JOHN S. BILLINGS, M.D., U. S. A.,

OF WASHINGTON.

SECRETARY.

EZRA M. HUNT, M.D.,

OF METUCHEN, NEW JERSEY.

THE PRESENT CONDITION OF THE EVIDENCE CONCERNING "DISEASE-GERMS."

BY

THOMAS E. SATTERTHWAITE, M.D.,

OF NEW YORK.

THE object of this paper is to give a sketch of the prominent theories now held as to the nature of disease-poisons. It seems hardly necessary for me to say that the short space of time at my disposal will prevent me from attempting to furnish either a detailed account, or even a review, of the ample material that may be brought to bear upon these matters. I desire, however, to state this clearly at the outset, because I am sure that in the presence of the vast number of observations that have been made, especially during the past few years, nothing short of a very extended treatise could be made to fairly represent the whole subject. Fortunately, my task is limited by the title of my paper, but I find myself at the same time in the difficult position of one who is called upon to define the proper limits of the subject, or, in other words, to mark out the debatable ground.

In doing this, I have thought it desirable to direct the attention of the Section chiefly to a certain number of important topics bearing upon the subject, as in this way we can get a better idea of its present status, and I have naturally included among the topics those with regard to which I have had the most personal experience.

It is a matter of regret that I shall be obliged to omit many facts of historical interest, as well as the names of well-known men, who, like Pasteur, Sanderson, Salisbury, and others, have enriched the field by original research. I shall also have to run the risk of appearing dogmatic, in assuming that certain questions have virtually been settled, or that others do not concern us. I shall thus take it for granted that the minute, vegetable organisms, called bacteria, exist pretty generally in

nature, both in and out of the body; and, following the acceptance of this idea, that the question of spontaneous generation need not be introduced into the present matter in hand.

Almost any one, who for the first time follows the discussions on these subjects, encounters a little difficulty in the word germ, which is, perhaps, not a happy one to have come into use as expressing that from which a disease is derived. This, however, is its true meaning, and neither indicates a vegetable nor an animal character, nor even that it is living, though this latter notion is held by Beale. For even should a disease-poison turn out to be a chemical substance, the term "germ” is equally applicable to it, according to the proper definition of the word. In fact, under this threefold character, we are called upon to study these active principles, for about these three possibilities, of a vegetable, an animal, or a chemical, character, are grouped the three prominent theories that have been framed to explain the origin of infective diseases. These theories, or hypotheses, as they might be more properly called, are (1) the vegetable-germ, (2) the bioplasm, and (3) the physico-chemical, theory. The infective diseases are such, in a general sense, as are either propagated by direct contact, or through the medium of the air, various gases, fluids, or common objects. Inquiries have mostly been directed to such of these as are called septic, viz., erysipelas, pyæmia, septicæmia, and puerperal fever, and to others known as contagious, miasmatic, and the like, such as smallpox and typhoid fever.

I shall try to sketch these theories briefly:

"

I. The vegetable-germ theory" is the one that heretofore has attracted more attention and interest than any other. Though we have known it under this name for only a comparatively short time, it is not of recent origin, and has in reality been recognized from very early times in the history of medicine. It was at first, of course, merely a hypothesis of the flimsiest character, though it soon came to be regarded as a possible one, when the microscope showed that both animal and vegetable organisms, of exceedingly minute size, lived and grew in the interior of the body.

More color was given to this theory by the labors of Schwann, Cagniard de Latour, and Kützing, who found that in fermenting matters there was a growth and multiplication of minute organisms, which they regarded as vegetable; when at a later period Pasteurs asserted that these particles were conditions essential to fermentation, then it came to be assumed that the phenomena of disease, which in many respects resembled them, might be due to an analogous cause. It was in this way that the doctrine of vegetable germs as the cause of disease came to be regarded as having good à priori evidence in its favor. This belief was further strengthened by Schönlein, who, in 1838, published his account of the fungus plant found in Favus, which is now almost universally believed to be caused by the deposit and development of the plant in the diseased part. As further investigations were made, the silk-worm disease, and the potato-rot, or murrain, were also admitted to be caused by growths of a similar nature.

More recently it has been held that a great many of the infective dis

I Disease-Germs, p. 10.

Schützenberger on Fermentations, pp. 36-7. 3 Bastian; Lancet, April 10, 1875, p. 502.