Diseases of the ear in childhood, by Dr. Gustav Alexander, tr. by Arthur J. Bedell, 130 illustrations, 9 full page inserts in color and black, and 18 colored text illustrations

Front matter

Class _Zl f/ Book._

Gopiglitfl?-

COPYRIGHT DEPOSIT.

Preface

Almost every year new text-books on Otology are published, descriptive of the rapid progress and status of this branch of medical science. The pathological conditions which occur in infancy and childhood are described briefly, but there is no characteristic and exhaustive description of the anatomical, clinical, and therapeutic peculiarities, which are important factors in the child's ear.

The publication of the present volume was prompted by a desire to fill this need, and I willingly complied with the request of the editors of "The Diseases of Children" to write a supplementary volume dealing with the affections of the ear in infancy and childhood.

The many peculiarities of childhood impart a special character to the affections of the ear, and give rise to pathological pictures peculiarly their own.

The consideration of this fact was a sufficient incentive to undertake the work, but other factors rendered its execution imperative, namely, the great frequency of oral affections in infancy and childhood, and their importance in the mental and physical development of the young.

It was difficult, however, to decide upon the amount of detail in which the various sections should be presented, for, if this volume were to adapt itself to the requirements of the pediatrist in accordance with the former ideas on the subject of juvenile otology, it would have been necessary to condense the available material. This, however, would have materially interfered with the scientific treatment of the questions involved.

Feeling that the requirements of the modern pediatrist would not be served by a simple compilation of therapeutic indications, I decided to include all anatomical, clinical, and diagnostic facts, aside from the therapeutic armamentarium, which represent the present knowledge of our specialty. Bearing the practical importance of the latter in mind, I have endeavored to satisfy the demands of the general practitioner, so that he may obtain a clear understanding of the pathological pictures, of their causes and development, of the therapeutic measures to be adopted, and of the correct interpretation of difficult and complicated conditions which should be referred to the otologist for rational treatment. It need not be specially emphasized that a correct procedure on the part of the attending physician is of extreme importance in otological complications.

iii iv PREFACE

The child's ear differs materially from that of the adult in various particulars, which are not only of theoretical but also of clinical importance, and which for purposes of diagnosis and treatment should not be neglected. For this reason the anatomy of the child's ear had to be described in detail. At the same time, this chapter has been so arranged as to facilitate the study of the text when comparing it with anatomical preparations.

In regard to the physiology of the ear, I have confined myself to the most necessary details. The theory of hearing and the physiology of the vestibule have only been discussed in so far as is necessary for a clear understanding of the clinical methods of functional tests.

In the section on clinical methods of examination, I have described those which are in use in my own department, where I have always attached the greatest value to combining exact methods with rapid and convenient application.

In the arrangement of the clinical material, I have followed the method I am in the habit of using in my clinical lectures. In discussing the affections of the labyrinth and the extra- and endocranial affections of the ear, I have selected that method of grouping which has proved to be necessary in keeping step with the progress of modern otology. The oral affections of infancy have been given special consideration.

The increased interest which has been extended to juvenile oral conditions in modern times has been followed by astonishing results in the education and care of the deaf-mute. Accordingly, it was necessary to discuss deaf-mutism, the education of the deaf-mute and those with difficult hearing, as well as the question of school physicians. Deafness in cretins, endemic deafness, and constitutional oral affections have been treated in a special chapter. The book also deals with a number of oral affections which, up to a short time ago, were regarded as diseases of the adult; they include various forms of labyrinthine deafness and otosclerosis, the foundation of which may have been laid in childhood or in utero, as has been shown by anatomical findings.

Diseases of the ear occurring in conjunction with infectious diseases are only mentioned, so far as their characteristic facts are concerned, while the details of the pathological pictures and the. local treatment are dealt with in preceding chapters.

The most important affections to be discussed are those of the middle ear, especially suppurative inflammation and its complications. The extra- and endocranial otogenous affections are, therefore, arranged as independent sections attached to other chapters. Only such operative measures have been mentioned as are at present in use, while I considered it indispensable to include the important question of after-treatment.

Special care has been exercised in selecting the illustrations. The

PREFACE v

wealth of illustrations of the anatomical section, including the diagrams, will no doubt contribute to a better understanding of the descriptive text. The majority of the illustrations have been made from my own preparations and cases, or drawn in accordance with my own clinical observations by the medical draughtsman, Carl Beck, in a very satisfactory manner. A number of illustrations referring to clinical findings have been supplied by Dr. Oskar Binesi; others, among which are the schematic sketches, have been drawn by myself.

Dr. Gustav Alexander.

Vienna.

TRANSLATOR'S PREFACE

No recent work has offered so much of value to the general practitioner and children's specialist as this by Professor Alexander of Vienna. The numerous illustrations assist in the thorough understanding of the many ear lesions and should make a strong appeal to the pediatrist who sees the conditions in daily work and to the otologist because of the exhaustive, authoritative statements relative to the common and more obscure conditions.

In this translation no additional notes have been added, the original text being complete, so that in presenting it to the English reading public a favorable reception is anticipated.

Arthur J. Bedell, M.D.,

Clinical Professor of Ophthalmology, Albany, N. Y. Albany Medical College.