02. THE HEAD AND NECK

HEADACHES | DIZZINESS | SCALP | EYES | EAR | DEAFNESS | NOSE | FACE | LIPS | TEETH + GUMS | TONGUE | PHARYNX | NECK

THE HEAD

The entire purpose of the human body is to maintain and serve the head and its function. As the seat of the soul, the head includes the eyes, ears, nose, mouth, and the face itself.

Examination of the head includes detailed observation of the scalp, the eye, the ear, the nose, the mouth and its contents, and the face itself.

Headaches

Headache, the silent crying of an over-burdened mind, is often traceable to a need for refreshment in some disagreeable part of our lives and only a few headaches have their origin in genuine physical disease. The popular escape from this malady, the Aspirin tablet, is consumed in enormous amounts each year, reflecting the sad fact that over a third of us have headache diffi­culties. Most of us would like to find and eliminate, if possible, the cause of our headache and so it is most interesting to see what headaches really are as well as what causes them.

It is amazing but true that the brain itself is incapable of any feeling and that it cannot possibly ache, even though severely burned. It is only the small blood vessels and coverings of the brain that possess any sensation or ability to feel pain. The pull­ing, stretching and dilatation of these vessels and brain coverings, in addition to a few painful nerve impulses from outside the brain, constitute all head pain.

Fig. 2. Headache and emotional upheavals are closely connected. Headache is the most common of all human complaints, and psycho-mental problems occupy over half of all our U.S. hospital beds.

With this simple picture, we can examine and consider most forms of headache easily.

Blood vessel headaches

The most common headache is a result of blood vessel dilation and stretching. It is found in people with migraine, high blood pressure, diabetes and hardening of the arteries. The brain ar­teries involved, produce the headache pain when stretched or dilated by reflexes starting in fear, anxiety or resentment. An example of a visible blood vessel dilatation, caused by reflex mental activity, is the commonplace blush, caused by embarrass­ment.

Relief from blood vessel headaches, usually requires a fresh approach to a disagreeable situation in our lives, or elimination of the situation altogether. This means the intelligent solving or altering of frustrating problems in our lives. Examples include thwarted ambitions, distasteful work, nagging mates and "keep­ing up with the Jones'."

Migraine headaches

Migraine is a type of blood vessel headache with several iden­tifying marks. It throbs, is usually on one side of the head and recurs in similar circumstances—such as, every Sunday. Known as a sick headache, it is accompanied usually by nausea and vomiting, occasionally by blurring, wavering lines in the vision, difficulty in speech and on rare occasions by sensations of cold­ness and numbness in the upper extremities. Migraine is usually seen in intelligent, ambitious people and more often in women than in men. It is frequently seen after fifty years of age but usually begins many years earlier.

Fig. 3. Migraine headache is concerned primarily with a temporary stretching or enlargement of a brain artery. Deeply involved with emo­tional and psychic factors migraine is a very widespread disease

About four out of five patients with migraine have either par­ents, brothers or sisters with this same difficulty, showing its hereditary link. Effective drugs are now available for the pre­vention and treatment of migraine.

High blood pressure headaches

The headache of high blood pressure is thought to be due to blood vessel dilation and constriction. It is usually a dull ache in the back of the head and most often goes away by noontime.

Most people with high blood pressure complain eventually of headaches, and sometimes headache is the first sign that the blood pressure may be abnormal.

Diabetes headache

Headache in diabetes is due to brain artery dilation when sugar content in the blood gets too low. This occurs after either too much insulin has been given to the diabetic patient, or not enough sugar-type food has been eaten to balance the insulin. This headache, appearing in diabetic people, quickly disappears after eating sugary foods.

Arteriosclerosis (hardening of the artery) headache

Headaches, which begin and are prevalent after sixty years, are most often due to arteriosclerosis damage of the brain blood vessels. This headache is not predictable in location, duration, or time of occurrence, but frequently appears if the head and neck are turned and twisted in certain ways. This is because twisting of the neck also twists blood vessels to the brain, which have already been narrowed by hardening of the arteries. A short rest relief from excitement or exceptional tension most often quickly produces relief from arteriosclerotic headaches.

Tension headaches

Tension headache comprises about one-third of all headaches. In this type of headache, pain does not come from inside the head, but is due to the steady contracture of muscles in the neck and scalp around the head.

Pain from these unrelaxed muscles, as in pain from blood vessels, has its beginning in mental activity of an unwelcome source. Fear, anxiety or tension, results in continual contracture of muscles, as occurs in a sprinter waiting for the starting gun that never goes off. The continual contraction becomes painful in the neck, over the head and into the forehead region. Even the scalp itself may become sore to touch.

Fig. 4. Tension headache is caused by tight, tense, stretching of the scalp across the skull, due to over tensing of scalp muscles located prin­cipally in the neck region and forehead. This is a headache in which aspirin is most effective.

Tension headache differs from migraine headache in several ways. It is not severe, does not throb, and creates a soreness of the scalp, neck and forehead. It is not a sick headache but may last for longer periods of time, perhaps even months. Occasion­ally, it follows a blow on the head or neck.

Eye headaches

Contrary to popular belief, improperly focusing eyes, in need of glasses for correct refraction, do not often cause headaches. It is true that headaches may result from some eye diseases, but the widespread belief that many recurring headaches are preveritable with glasses, is incorrect. In the absence of obvious eye disease, such as redness, soreness, infection or injury, only a few eye diseases such as glaucoma remain to cause headaches. How­ever, because of these rare possibilities, a person with unex­plained headaches should always have the benefit of an eye ex­amination to settle any doubt.

Glaucoma headache

Glaucoma headache, beginning about the eyes and spreading into a general headache, is very serious and can be very painful. Glaucoma eye pain is caused by an increase in pressure in the eyeball itself and is serious, not because of pain, but because blindness may follow unless the condition is corrected. Glau­coma, rarely found under the age of thirty-five, increases greatly after the age of forty-five. It appears to be an inherited disease and occurs in families with several members possibly having this same trouble. The inherited factors, however, may be contained in our emotional make-up, because people who develop glau­coma also have easily excitable emotions, often a family trait.

As in so many other headaches, glaucoma and its head pain, often results from a disagreeable mental experience, such as frustration, fear, resentment, etc. In this headache, the pain is excruciating and the eye itself feels hard to the touch.

Chronic or long-standing glaucoma presents a similar picture but the pain is not so severe. A dull aching is present over the eyes, and in susceptible people this leads to headache of variable degree.

Sinus headache

Sinus inflammation is often thought to be the cause of fre­quent recurring headaches, but this is only rarely correct. Less than one headache out of twenty can be traced to sinus diffi­culties.

Sinus headaches usually begin with a fast developing infection in one or more sinuses, such as might follow a sudden severe cold. They are usually accompanied by a clogged nose, and a localized soreness over the sinus involved. The pain of sinus difficulty grows suddenly much worse when the surrounding air pressure is lessened or increased greatly. Thus rapid ascent or descent in airplanes or tall building elevators, may bring about excru­ciating pain.

Application of heat to the face, and aspirin have long been the relief of sinus sufferers but correction of certain nose diffi­culties by a physician often ends the sinus difficulty permanently.

Headache from brain tumor

Headache caused by brain tumors are extremely rare. More than one-half of all people with medical complaint have head­aches, but an extremely small number of them have brain tumor. It is also true, however, that nearly all people with brain tumors, brain abscesses, cysts or brain blood clots will have headaches of varying degree.

The pain of an expanding growth within the skull is due to an increase of pressure which stretches and distorts blood vessels in the brain covering. As previously seen, these are the only structures within the head capable of feeling pain. Brain tumor headache has no distinguishing mark about it. It appears at no regular time of the day. It might be of a throbbing nature or a steady ache, and it may be of a come and go nature. There are often accompanying changes in the personality such as irritabil­ity and forgetfulness, and periods of hallucinations, or sudden vomiting, are frequent. Headaches due to brain tumors are en­dured for long periods of time before their cause is even sus­pected and often these symptoms help in making the diagnosis of the underlying cause.

Although nearly all brain tumors are accompanied by head­aches of some degree, it is well to know that over half of all brain tumors are not cancerous, and that the surgical cure of such tumors is not nearly so formidable as is generally thought.

Dizziness

Dizziness is a common difficulty after fifty. It may mean a faint or unsteady feeling, but usually means a sensation of motion in our surroundings and can be sensed either in daylight or total darkness.
Meniere's Syndrome, disease of the balancing mechanism within the ear, is the most common cause of dizziness. The inner ear is our main organ of balance, and tells us even in the dark, when we are going straight, turning, or falling. Our balance mechanism may be compared to a glass filled with water. When the glass, like the head, is tilted, the water stays horizontal with the earth's surface though not with the glass, and a reflex within the brain tells us we are not level. Without such a mechanism as this, it would be impossible for us to stand or walk.

Fig. 5. The balancing mechanism in the head is similar to water in a glass. Changes in fluid level are determined within the brain as changes of position.

Severe cases of Meniere's Syndrome, can last minutes, hours, weeks or days and may be accompanied by severe nausea and vomiting which force the sufferer to lie motionless in bed to prevent a recurrence of dizziness.

Hardening of the Arteries, or arteriosclerosis of the blood ves­sels in the brain causes about one third of all dizziness. In this disease, blood intended for the brain and certain special nerves, is temporarily decreased because these arteries have too much arteriosclerotic "rust" in them, and the resulting temporary un-dersupply of blood to the brain produces dizziness.

Physiologic Dizziness commonly occurs when we stand up after sitting or lying. It is due to slower reflexes of age and can be explained as follows: in relaxed positions our blood pressure is at a low level, but in suddenly arising, as to answer the tele­phone, the blood in our bodies tends to run down hill like water in a pan. This may mean a slight reduction of blood for the brain, resulting in temporary dizziness. It usually clears up as soon as the body's reflex mechanisms equalizes the blood pres­sure throughout the body.

Many of us have experienced small episodes of dizziness at some time, but severe episodes, especially after fifty, suggest the possibilities of disease in the blood vessels, blood or brain and difficulties with diabetes or thyroid disease. This difficulty should prompt us to seek out our physician for his examination, diag­nosis and treatment, if necessary.

Examination of the Scalp

Stand under a bright light, before a close-up mirror and ob­serve the hair and scalp closely.

1. Note that the hair is lightest where the scalp is thinnest, on top, in the temples, and just back of the very top. The normal scalp has 1,000 hairs per square inch. Baldness begins from this number on down to no hairs at all.
2. Gently scratch the scalp between the hair shafts. A loosening of snowy skin scale from the scalp or under the fingernail, without doubt, means dandruff.
3. Fix the palm on top of the scalp and move it in all directions. It should be freely movable and entirely painless. A painful swelling on the scalp, especially in back, may mean boils or carbuncles.

Scalp difficulties

Common Baldness. More than ninety-six percent of all bald­ness is found in men. Hardly a disease, baldness nourishes a mil-lion-dollar-a-year business for checking, preventing or curing this malady.

Two interesting facts about baldness are known. 1. A strong inherited tendency influences hair growth, and most men can predict their hair life from their father's and grandfather's hair. 2. Male sex hormones are important in baldness because they stimulate scalp oil secretion, usually associated with loss of hair. We see also that the time of greatest hair loss occurs when the male sex hormones flow in the blood stream at the highest level, and if castration should occur before maturity, baldness would be rare. A bald man, therefore, can be comforted with the thought that the loss of his hair is proof of his virility.

Baldness as a Disease. Only about 4 percent of baldness results from disease. Scalp disease and high temperature from bodily disease are most frequently the cause of this baldness. Most of these disease types of baldness are only temporary and therefore, curable.

The best-known and most often cured baldness is the patchy, moth-eaten type called alopecia-areata. This baldness difficulty always clears up regardless of the treatment.

Dandruff is a flaking off of dead skin. It is not serious, and appears to some degree in everyone. Further difficulty however, results when a lack of routine cleaning of the scalp, allows these small flakes to accumulate and form crusts that irritate the scalp, and cause it to itch. This condition with an over-supply of oil, dandruff and crusted lesions about the hair line is called seborr-hea. Prevention of seborrhea demands an effective routine scalp cleaning, for removing excess oil and crust accumulation, plus a diet regulation best prescribed by the physician or skin doctor.

Boils and Carbuncles. These infections usually occur on the neck, and occasionally the scalp. The neck is an ideal region for bacteria to establish infection, because collars and clothing so often erode this skin area and allow bacteria to enter under the skin surface to start boils. If bacteria from boils tunnel in sev­eral directions under the skin and start an accumulation of numerous small boils, a carbuncle is formed. This is often very difficult to cure whether in the neck or scalp.

Covering the infection with a clean bandage gives some pro­tection against further infection but opening and draining a boil is usually necessary for complete recovery. Mother Nature her­self often performs this operation by a heading and bursting process, but when pus accumulation is too deep, an incision and drainage may be necessary. Carbuncles, much more than boils, require a thorough incision and drainage operation of the many infected tunnels in the surrounding skin. Only a doctor should attempt to incise and drain so serious an infection.

Examination of the Eyes

Examine the eye in a mirror with the aid of a strong light. For visual acuity, pin the eye chart on a wall at eye level, and stand back a measured twenty feet.

Fig. 6. The eyes are called the windows of the soul. Our most valuable physical possession, they are much abused and can develop many severe diseases. Eye care is extremely important.

1. Closely scrutinize the inner and outer surfaces of the eyelid, the eyeball itself, and the clear surface of the cornea. Observe any particle, hair or other substance embedded anywhere as a foreign body in the eye.
2. Observe the clear cornea and white of the eye. There should be no redness, large blood vessels or milky growth of tissue present. Presence of these findings may mean eye inflammation, or pterygium.
3. Note the pupils, both of equal size, become smaller in bright light and larger in dim light. Failure of such pupil action, or any unequalness of size, may mean infection or disease within the brain.
4. Fix the vision on a distant light, such as a street lamp, dur­ ing the evening. The appearance of rings, visible around the light with a blurring of the light itself, may indicate glaucoma.
5. With the vision fixed on a lighted object, quickly close and open the eyelids several times. Continuous blurring or distortion of one particular portion of the eye field may indicate astigmatism.
6. At a distance of twenty feet from the eye chart, accurately measured, determine the lowest correctly read line for each eye with glasses off and on. The 20-20 line is considered perfect vision. Determine the smallest readable print on the hand chart of varying size print. Print size No. 1 is considered perfect.

Eye difficulties

Black Eye. This common eye injury, often resulting from a blow, usually is not serious and clears up by itself, but since the eye is very precious and may have been damaged by the blow, an examination by a competent physician is recommended when any doubt about the eye condition is encountered. A safe, im­mediate treatment for black eye is bed rest and application of an ice bag.

Foreign Bodies in the Eye. Particles that get into the eye are called foreign bodies. They usually cause sharp pain and an ex­cessive flow of tears, as nature attempts to float the foreign body out of the eye. Most windswept dust particles are effectively handled in this manner without any more active therapy than a few winks and blinks. Foreign bodies that do not wash out freely with tears, invite rubbing, but it is best to confine any such action to gently stroking the closed eyelids toward the nose. If the particle still remains, a nurse or doctor should examine the eye for a possible injury. When "something in the eye" does not wash out freely, consider no other course but the doctor's recom­mendation. The best of intentions in rubbing the eye can unfortunately, turn insignificant eye injuries into serious ones.

Inflammation in the Eyes. Sties, pink eye and other eye inflam­mations usually caused by bacterial infection, are very common, quite painful and often considered to be contagious. The ever present tear is probably the best eye wash and germ killer in the entire world for these situations, but self treatment still causes much eye damage.

The best rule to follow in eye infection is to do nothing but close it and possibly apply mild heat until it clears up or the physician can see it. Modern drugs and methods of treating eye inflammation have changed considerably and should be consid­ered preferable to home treatment.

Inflammation elsewhere in the body, as well as possible tumor growths, may reflect themselves by eye conditions. Pupils of un­equal size may indicate neurological disease within the brain, re­quiring extensive study. Pupils which do not constrict in the presence of bright light, nor expand in the darkness may be considered a possible indication of systemic disease of the entire body, effecting the eye in this manner. Syphilis, an infectious systemic disease, has long been known to affect the eye pupils in this manner.

Such unusual findings should prompt the individual to pre­sent himself to his physician for examination and possible treat­ment.

Cataract. Cataract is a loss of transparency in the lens of the eye and is usually progressive from the rim inward toward the center. Most cases of cataract occur in the over-fifty group, and seem to be caused by systemic diseases such as diabetes and diffi­culties of the parathyroid gland, among others. They are also caused by difficulties within the eyeball itself such as chronic uveitis (inflammation of one of the eyeball linings), or to exces­sive heat and infra-red rays such as occurs in glass blowers. When cataract occurs without any disease within the eye or without, in the later years of life, the term senile cataract is applied to it.

Fig. 8. Cataract is a disease of the eye lens—growing from clear glass like transparency to an opaque, milky appearance in which some light rays are prevented from entering the eye. Caused by diabetes, infection and other difficulties, it can be removed and sight restored if proper glasses are used.

Removing the lens from the eyeball is the only satisfactory therapy for cataracts. Drugs and other treatments have been found worthless in restoring vision or preventing blindness caused by cataract. The surgical treatment of cataract however, is very successful with well over ninety-five percent recovering good eyesight. Only a physician can diagnose a cataract and per­form the necessary surgery.

Glaucoma. Glaucoma, the thief in the night, is a disease of increased pressure within the eyeball. It afflicts nearly two peo­ple of every hundred, over the age of forty years, and is respon­sible for one out of every eight cases of blindness.

Fig. 9. Glaucoma is caused by greatly increased pressure within the eyeball. Possibly very painful, it may lead to complete blindness unless adequate treatment is ef­fected.

Although pain is not always a prominent factor in glaucoma, a dull aching in the eyes is usually present. Reasons to suspect glaucoma are:
1. Progressively poor vision in one or both eyes. 2. Blurring vision with rings visible around bright lights. 3 So-called "gun-barrel" vision in which the field of vision is nar­rowed to a small "target" with difficulty in seeing toward the sides.

The eye doctor has drugs and other measures effective for the treatment of this disease of our senior years.

Astigmatism. Astigmatism is the eye fault of unequal curva­ture in the eyeball, particularly of the cornea. It is very common and causes most eye strain and vision distortion. Theoretically,

Fig. 10. Astigmatism, unequal curvature of the eyeball, distorts entering light rays, possibly to very slight degree. This out-of-round situation of the front of the eye dis­torts vision and creates eye strain. Effectively treated with glasses, it is a most common if not universal eye difficulty.

because nothing in this world is perfect, no eyeball is perfectly round and therefore, everyone has some astigmatism. It is usu­ally relieved with suitable glasses.

Exophthalmos. This uncommon eye condition makes the eye­ball appear enlarged, staring, and frightened; often as the result of disease. This appearance is caused by the eyeball being pushed outward, sometimes by a swollen or congested area be­hind the eye. It is frequently seen in over-activity of the thyroid, but can also occur from high blood pressure, kidney disease or

Fig. 11. Wide, staring eyeballs, called exopthalmus, sometimes are caused by thyroid disease. En­larged thyroid (goiter), along with wide, staring eyes, shows the ori­gin of the medical term, "exopthal-mic goiter."

as an inherited family characteristic. It is seen mostly in men, and develops toward middle age. Even after effective treatment, it is usual for the exophthalmos to remain as a permanent fea­ture.

Senile Ectropion. In later years, when skin has lost some of its elasticity and firmness, the facial skin may sag. The lower eye­lids are often affected, and may sag so that they no longer touch the eyeball, and the inner surface of the eyelid visible to others. This difficulty, called ectropion, does not reflect any systemic disease, other than aging of the skin and its loss of tone.

Fig. 12. In the years past middle age, sagging, drooping eyelids, called senile ectropion, are due to a loss of skin tone of later life and occur mostly in thin-skinned per­sons of the outdoor type, such as farmers. This difficulty can be cured by plastic surgery.

Ectropion frequently brings about irritation of the eyeball and promotes constant, annoying tearing and so treatment is often recommended in the form of a minor surgical operation. This consists of removing a portion of the sagging lower eyelid, and stretching out the remainder to a normal appearance. Such a procedure must be undertaken by a surgeon skilled in plastic surgery, and the results of this treatment are highly gratifying.

Pterygium. A Pterygium is an accummulation of scar tissue over the eyeball resulting from exposure to dust, wind, sun and general outdoor life. This scar tissue is nature's attempt to heal areas of constant irritation, to which the eye is frequently sub­jected in outdoor life, and is usually seen on the eyeball as a pie-shaped wedge of milky tissue extending outward from the nasal border of the eye. It may grow to cover the pupil and cause partial blindness.

Fig. 13. Growth of eyelid-type tissue over the eyeball, usually from the nasal side, is called pterygium. Affected by long years of outdoor life, wind, and dust, the growth may grow completely over the pupil to blur vision or even cause blindness. It is very slow growing, never cancerous, and easily cured with surgery.

The treatment of a pterygium is its removal by surgical means. While not a fatal disease, its progress may lead to perma­nently impaired vision or blindness when allowed to go on untreated. The prevention of a pterygium calls for care of the eyes with goggles and other protection, especially during out­door activities.

Examination of the Ear

With a mirror and good light, examine closely the ear skin and shell; look for any obvious blocking of the ear canal and test the ear's hearing ability in the suggested manner.

1. Examine the external ear for any soreness, bleeding or discharge from the ear canal. These findings can mean infection, skin cancer or infection from the inner ear.
2. Gently pull the ear upward and backward, and use a double mirror to sight into the ear canal. Blockage probably means impacted wax, or if it is painful, an infection in the ear canal.
3. Tap the hard mastoid bone, directly behind the ear with the fingertips and note any soreness or tenderness which may indicate infection in the middle ear.
4. Achieve complete silence by holding a pillow to both ears, and note any ringing or buzzing noise, which usually means otosclerosis.

Fig. 14. The design of the out­side ear traps sound waves for de­livery against the eardrum. There are many different shapes and sizes, all apparently effective. The covering skin is subject to several skin diseases, including skin cancer.

1. Note any dizziness after rapidly turning the head from side to side twenty times, and then facing directly forward. Dizziness or unsteadiness may indicate labyrinthitis, an irritation of the balance mechanism in the far inner ear.
2. Test hearing ability by holding a ticking watch six inches away from the ear and check against the other. Inability to hear watch ticking can mean drum or nerve deafness.
3. Wrap the handle of an ordinary table knife in a cloth and grasp firmly between the teeth. Pluck the blade to start it vibrating and note the ability to hear the  "vibration." When vibration cannot be heard, nerve deafness may be present.

Difficulties of the ear

The most widely known purpose of the ear is hearing, but it also has the important function of balance and equilibrium. Difficulties of the ear involve hearing, the balance mechanism and the external ear.

Deformity of External Ear. The shape of the ear is quite vari­able and of slight importance in actual hearing ability. Huge or oddly formed ears can be a source of embarrassment, but rarely interfere with work or real hearing.

An example is cauliflower ear deformity, which faintly re­sembles the surface of cauliflower. It is caused by bleeding and clot formation under the skin with resulting permanent de­formity. Loss of hearing is slight and plastic surgery can achieve very good cosmetic results which are seldom appreciated.

Infection. Most infections of the external ear are fungus infec­tions or eczema. (See skin diseases). They are prevented largely through cleanliness and by avoiding the use of frequently used medicine and healing agents.

Routine gentle cleaning of the ears, inside and out, is recom­mended as prevention against skin infections, but an ear or skin disease which does not respond in two or three weeks to simple cleansing, might be serious and should be seen by a physician.

Skin Cancer. Skin cancers about the ear have long been noted for their confusing appearance. The ear may be the seat of many chronic infections, but skin cancer about the earshell is also quite common. The ear's exposed position openly invites irrita­tion from sunlight, chemicals, windburn and many other agents. Any external ear sore over two weeks old, might be a cancer and should be seen by the physician. (See Skin Diseases).

Infection of the Inner Ear. Infections of the hearing part of the ear are called "otitis media," and are usually seen in child­hood, but rarely may begin after fifty. Accompanied by intense pain in the ear and high temperature, these ear infections are apt to be followed by a perforation of the eardrum with a run­ning ear commonly following.

With infections in the inner ear, as in other parts of the body, it is important that general health be maintained at a high level, to combat this lingering type infection. The aid of the experi­enced physician is necessary for the successful treatment of in­fection in the inner ear.

Otosclerosis (Buzzing in the Ear). Otosclerosis is a chronic disease of the ear's hearing mechanism which reduces fine hear­ing and produces a buzzing, ringing sound in the ear. When the three small bones that transmit sound within the ear become diseased, they acquire a stickiness and pass a continual message. The result is the constant buzzing, ringing or roaring noise which seems loudest when it is most quiet, as in bed at night. This does not interfere completely with hearing and is least no­ticed in noisy public places. Otosclerosis is very common in the upper age bracket and is most difficult to cure, but a good ear doctor can be of considerable help in this disease.

Deafness Due to Ear Canal Blockade. Occlusion of the exter­nal ear canal often is the sole cause of reduced hearing and re­moval of the block produces sudden and definite improvement. Wax is sometimes the offender, but occlusion may be due to a boil-like infection in the canal or a formation caused by accumu­lated dust particles. Irrigation of the ear with warm water is sometimes sufficient to clean out the ear canal and improve the hearing.

Deafness Due to Eardrum Difficulties. Perforation or destruc­tion of the eardrum may result in decreased hearing, but not a complete loss of hearing. Perforations of the drum are common, usually a result of old middle ear infections. The eardrum with a

Fig. 15. Like the skin of a drum, the human eardrum vibrates when struck by sound waves. Damaged ear­drums still may function satisfactorily.

small hole in it will continue to function fairly well until the eardrum is almost all gone, and then clear distinct hearing is lost. Loss of the entire eardrum however, does not cause total deafness, since sound can still be conducted through the bones of the ear and the skull.

Nerve Deafness. A person is not really deaf until the hearing nerve loses its function. This is particularly important in the over fifty age group since there is distinct loss of hearing (especially for higher tones) with each decade of life. Thus, like the eye, the ear has a gradual decline in hearing power with age. A simple test of nerve deafness is to hold a buzzing object,

Fig. 16. Inside-ear machinery gives us our sense of balance. Like a glass of water, it contains fluid which remains stationary when we turn or tilt. The position of the fluid allows recognition of body position even in darkness. When faulty, this mechanism may be a source of annoying dizziness and a spinning sensation.

such as a tuning fork, or kitchen knife tightly against the skull or between the teeth. When the fork or knife is plucked and caused to vibrate, hearing the buzzing means that the nerve is intact. If it is not heard, improving the hearing may be very difficult or impossible since this indicates that the nerve itself is not working. A hearing aid may possibly be of help for partial nerve deafness, but not for total nerve deafness.

Inner Ear Infection; Labyrinthitis; Dizziness. The innermost ear, a fluid filled compartment within the bone, containing the balancing mechanism may become irritated or infected to pro­duce a labyrinthitis. Because the enclosed fluid within this area acts much like water in a glass, motion of the head creates mo­tion of the fluid. In diseased or irritated labyrinths, such motion is exaggerated in its impulse to the brain, so that we feel a spin­ning unsteady or moving sensation to our surroundings. When labyrinthitis becomes severe, balancing becomes of such great effort, that it is not possible to stand erect, or even get out of bed. Effective treatment of this difficulty can be prescribed only by the physician, who alone can identify this uncomfortable inner ear disease.

Examination of the Nose

The nose should be examined by close-up mirror observation with a good light in various positions of the head.

1. Observe the skin of the nose for any unhealing sore, warty growth, soreness, redness, recent enlargement or bleeding areas. These findings may indicate skin cancer or other growths.
2. Observe the profile and centering of the nose on the face. Both nostrils should be equal with the nasal septum in the center. Major differences indicate the very common external nasal deformity.
3. Determine the patency of each nostril by rapid inhaling and exhaling. An obstructed nostril may mean an internal nasal deformity, allergic rhinitis or sinus disease.

Fig. 17. The nose encloses large volumes of air passageways above the mouth and deep behind the visible nose. Disease in these cham­bers is very common and is termed "upper respiratory disease."

4. Tap along the bony ridge of the eyebrow, cheekbone and bridge of the nose with the knuckles. Tenderness in these regions and continuous discharge from either nostril usu­ally denote sinus trouble.

Diseases of the nose

Skin Cancer and Other Growths. Skin cancers often begin on the skin of the nose, especially where the nostril flares into the cheek. Other skin growths, for instance, warts and blood-filled tumors, oftentimes are found in the skin of weather-beaten faces such as farmers and outdoors men. (See Skin Diseases).

External Nasal Deformity. Irregularities of the nose are very common. It is rare to find both sides of any nose exactly alike and the inside of the nostril varies slightly in size and shape, al­though such variances have no importance at all.

The septum of the nose, which should be nearly in the mid-line, is often somewhat off to one side, possibly as a natural oc­currence or as a result of trauma. This is of no significance unless it results in breathing difficulty.

Deformities in the profile of the nose claim most people's attention because of cosmetic appearance. It can be reshaped considerably with plastic surgery, however, patients are rarely satisfied after nose surgery.

Allergy (Rhinitis). Allergic rhinitis, or hay fever, produces a wet, dripping nose through which it is usually very difficult to breathe. Considerable irritation and redness of the nose may be present along with swelling and soreness and tears often flow from the eyes because they cannot drain into the nose as they normally should.

In seasonal rhinitis, air-borne pollen from trees, grasses, and weeds are most frequently the offenders. However, in the type which is present the year round, allergic factors such as animal danders, house dust, feathers or mattress stuffing are more than likely the cause. People with allergies should avoid these offend­ing substances as determined by an exact investigation, and testing by the allergist, the doctor who specializes in the investi­gation and treatment of allergic diseases.

Fig. 18. Sinuses are room like cavities within the skull, communicating with the nose. They lighten the skull and "hollow out" the voice. The biggest sinuses form the eyebrows and cheekbones. Frequently infected, they often cause bad breath and continual throat dripping.

Sinus Trouble. The sinuses are hollow, air filled spaces in the bones of the eyebrows, cheekbones and face and are similar to small rooms opening directly into the nose chamber. They are easily infected, do not drain easily, and are prone to carry infec­tious material for long periods.

A large proportion of people living in humid climates have difficulty with their sinuses, but definitely more than average sinus trouble follows: 1. Nasal Deformity. 2. Allergy. 3. Low Body Resistance.

Nasal Deformity. A broken nose sometimes blocks the sinus communication within the nose, presenting an obstacle to free drainage of the sinus, which is a necessity for a disease free sinus.

Allergy. Swollen, boggy, and inflamed mucous membranes in the nose tend to block the sinus openings, irritate the sinus linings and stimulate them to produce infectious material which cannot drain out easily.

Low Body Resistance. Improper diet and nutrition can pro­duce very low resistance to infection. This applies particularly to areas prone to infection like the sinus areas.

Because chronic sinus infection is often a focci of infection for many other ailments, it is well to consult a physician so that he may prescribe proper treatment for this difficulty. Heat applica­tion is a popular and safe home remedy, but all other forms of treatment should be under the direction and guidance of a physician, who alone has the knowledge, ability and experience to treat the sinus sufferer.

Examination of the Face

Examine the face before a close-up mirror using a secondary mirror as required.

1. Examine the texture of the facial skin. Note any recent growth, bleeding points, long unhealed sores, or any painful swollen areas on the entire face. These abnormalities indicate skin growth possibilities, cancerous or benign.
2. Observe any involuntary movement of the face, eyes or mouth, note any difference in motion between sides of the

Fig. 19. The face is our most important human feature and is the reason for existence of the rest of the body. It has its own diseases and difficulties found in no other region of the body.

face during facial movements; raise the eyebrows, squint the eyes, bare the teeth widely as in smiling, pucker the lips in a whistling motion. Such findings may indicate tics or facial paralysis.

3. By placing two mirrors at right angles, mirror the face so that the left side of the face is a mirror of the right. Differ­ence between the right side of the face and left side, imme­diately seen show any facial deformity or asymmetry.

Diseases of the face

Skin Cancer and Other Growths. The skin of the face is the site for most skin cancers. This is because the face is the body area most exposed to sunlight, wind, and weather of all sorts. A skin cancer may begin as a small pearly growth which is con­tinually unhealed, possibly crusted or bleeding, and probably oozing most of the time. Other growths of the skin such as warts, blemishes, moles and blood-filled growths are very common on the face. (See Skin Diseases).

Face Growths. In the face, growths of large or small caliber, may appear beneath the skin. One of the common sites for these growths is on the side of the head, just in front of the ear. This is the region of the parotid salivary gland, which gives rise to

Fig. 20. Mumps-like enlarge­ments of the parotid salivary gland occur below and in front of the ears in later life, possibly due to in­fection or tumor growth. Tumors of the parotid gland are slow-grow­ing, painless and questionably can­cerous; they can be dealt with sur­gically.

frequent enlargements. Often the enlargement is only tempo­rary, such as an enlarged lymph node similar to those seen in the neck. Growths of the parotid or anywhere underneath the skin, however, may be of cancerous nature, and should be strongly suspected until proven otherwise by the physician.

The treatment of facial growths, of the parotid gland or other regions, is essentially a surgical operation, in which the removal of the growth is usually curative. However, in cases where facial enlargement is only one site of many enlargements all over the body, other treatment may be necessary, depending upon the physician's judgment.

Tics, Unintended Facial Movements. Tics are unusual nerv­ous twitches in the face, caused by spasms of local facial muscles. Some twitching can be stopped at will, but others are entirely uncontrollable. Tics are not serious when they represent tem­porary excessive nervousness, but when they become persistent, they may represent serious underlying disease. They most com­monly involve the face about the eye, nose, and mouth.

Tic Douloureux is a well-known type of tic usually seen in the later years of life. It is very painful, strikes without warning and usually affects only one side. It produces a savage lancing pain in the temple, jaw, or teeth, and is sometimes brought about by the slight stimulation of shaving, exposure to cold or draught, and sometimes without any stimulation at all. The pain usually does not last long, it may recur with agonizing fre­quency.

Fig. 21. Tic Douloureux, facial neuralgia, trigeminal neuralgia are one and the same difficulty. Savage pain in one side of the face may begin with a mild trigger action, such as shaving, a cold breeze or light touch. Pain is caused by a nerve defect of the fifth (trigeminal) cranial nerve; cutting this nerve is sometimes necessary for relief. At­tacks may stay away for years at a time.

Tic Douloureux involves a cranial nerve, which is the nerve of sensation to the entire face, teeth, nose, and eyes. The exact cause of this painful disease is unknown but medical and sur­gical measures, in the hands of the physician, are definitely avail­able for adequate relief.

Facial Palsy. Paralysis of portions of the face is very common. Palsies of only one side of the face, frequently occur as a result of exposure to cold, or extreme emotional disturbances. They may accompany an impending or recent stroke, especially in the older age group and they may also be accompanied by paralysis of some other portion of the body.

Another type of facial palsy is called Ptosis of the eyelids and appears as an eyelid which opens only partially. Ptosis of the eyelid, especially when confined to one side, may be associated with more serious underlying disease. An example is Horner's Syndrome, a most complex difficulty, involving not only the eyelid, but other complex body structures as well. Only a skilled physician can recognize and prescribe the necessary treatment for such difficulty.

Facial Deformity and Irregularity. No two sides of anybody's face are exactly alike. The ears differ; the eyes differ; the sides of the face or the nose or the mouth are not equal and facial movements also differ on each side of the face. Characteristic facial expressions such as smiling are done more with one side of the face than another, and so are many other facial expressions. In our examination above, the mirror image of each side of the face is reproduced for observation. It becomes readily ap­parent that one side of the face is more handsome than the

Fig. 22. Trouble with ingrown hairs begins with the shaving proc­ess. The very short remaining hair grows into the overhanging skin to begin an infection. Most often it is seen in men whose beard hair grows on a slant.

other. Obscure history would have us believe that one side of the face represents a man's soul, while the other side represents his will. Which side is which, must be determined by each individual.

Ingrown Hairs. As is well-known, most hair grows outwardly. At times however, there are hairs which grow underneath the skin rather than over it. The difficulty arises where shaving is a daily issue in beards with whiskers which do not stand up straight, but which grow sideways in one or more directions.

The treatment of ingrown hairs requires the elimination of each involved hair, with patient cleanliness to prevent infection. Prevention of ingrown hair is possible by changing shaving habits to eliminate the close shave. When it is learned that only the closely-shaven hair can become an ingrown hair, it also be­comes obvious that the longer hairs cannot be troublesome. Some find electric razors of value in preventing ingrown hair, whereas, others have found that blade razors work best for them.

Examination of the Lips

The lips are examined also in a close-up mirror with the aid of a good light. If artificial dentures are used, they should be removed for better inspection of the lips' inner surface.

1. Closely examine the lips externally and internally. Note any area of bluish discoloration or a whitish leathery form­ation especially on the inner aspect of the lips. These find­ings may represent birth mark discoloration or leukoplakia.

Fig. 23. The lips are the junction between the external skin and the in­ternal lining of the body, called the mucosa. Because they are a sensitive region, the lips play a great role in routine living, as well as disease.

2.  Note any definite cracking in the skin in the corners of the mouth where the lips join. Cracking here may have defi­nite meaning in vitamin deficiency.

3.  Look closely along the lip surface for any cracking, bleed­ing points, ulcer or long unhealed sores. They may repre­sent fissure in the lips or cancer in this location.

4. Observe the contour and motion of the lip. Note any pa­ralysis, drooling saliva, or weakness in the lip movement. Compress the lips, smile widely, bare the teeth, and pucker the lips as in whistling position.
Inability to perform these lip actions, may represent facial paralysis, a stroke or possibly complex nerve disease within the body.

Diseases of the lips

Trauma. The lips, in plain sight and the center of much activity during life, usually have suffered bruising, biting, chaf­ing and often a cut or two. Aside from scar formation and pos­sible mild deformity which would result, trauma to the lips heals quickly and is seldom serious. Severe lacerations of the lips ob­viously requires surgical repair.

Cracked and Fissured Lips. Cracking of the lips, with deep fissure formation frequently results from exposure to sunlight and cold, and can be very painful and smile-preventing. It is seldom serious and heals quickly when protected with pomade or skin cream.

Cracking in the corners of the mouth in adult people often indicates ariboflavinosis, a vitamin B deficiency. When the cracking accompanies malnutrition or disease resulting from an inadequate diet, healing of the corners of the mouth usually responds readily to an adequate diet containing sufficient vita­min B.

Leukoplakia. A milky-colored coating, of a slightly thickened nature on the wet inner aspect of the lips, is the appearance of leukoplakia, considered to be a pre-cancerous condition. It can occur in other areas of the mouth, besides the lips, and is often associated with the use of tobacco in any of its forms.

Leukoplakia conditions call for ceasing the use of tobacco and usually the removal of these lesions by surgery or cautery. Mouth cleanliness also becomes a matter of concern, and rou­tine oral hygiene becomes imperative.

Cancer of the lips. Any sore, crack, ulcer or other type of lip lesion that persists for over two weeks, could be a lip cancer. This disease sometimes results from chronic irritations of objects such as nails, hooks or pipes in the mouth, and to excessive ex­posure to sunlight. Cancer of the lip has one characteristic fea­ture about it—it does not heal completely. It is well to remem­ber that lip cancer, like cancer everywhere, is usually small in its beginning, but unfortunately, is often allowed to reach large proportions before medical aid is sought. Good judgement is

Fig. 24. Cancer of the lip begins as a wartlike thickening, followed by an open sore. It is most often seen in men and usually in the lower lip. Thought to be partly caused by biting, irritation, sunlight and pipes moking, it is one of the most common sites for cancer in the body.

over-ridden by the hopeful thought that somehow the lip sore will go away by itself.

Happily, malignancies of the lip can be adequately treated. X-ray therapy and surgical procedures combined, enjoy a marvelously high rate of cure. Only the long-standing and neglected malignancy in the lip grows beyond the point of probable cure.

Lip Paralysis. Inability to move the lip through certain nor­mal functions such as puckering, compressing the lips, smiling or loss of sensation about the lips, usually means some or all of the muscles controlling the lips are paralyzed. Such situations occur in facial paralysis, strokes of short or long-standing, and in several other complex nerve diseases. These difficulties should quickly be brought to the attention of the physician for early diagnosis and proper treatment.

Examination of the Teeth and Gums

Stand before a well lighted mirror and examine the teeth as well as possible with the aid of a small pocket mirror, inserted into the mouth.

1. Examine the teeth for discoloration. Gross discoloration of the teeth often is due to external causes such as tobacco. Darkly, indented lines in teeth crevices often represent decay. Yellowish discoloration in worn-down edges of the teeth, is the appearance of the inner dentine of the tooth.
2. Feel the teeth with tongue and finger for sharp, broken edges or possibly decayed portions of the tooth structure.
3. Determine the firmness of the tooth in its setting. Grasp each tooth and attempt to move the tooth gently in its socket. Very loose teeth, possibly in reddened or retracted gums, may mean pyorrhea.
4. Examine the gums for swelling or soreness about the remaining teeth. Gently press a finger against the gum, both inside and outside and look for any blood or pus discharge, to indicate possible pyorrhea. An accompanying tenderness and swelling, may represent abscess formation.
5. Run the tip of the finger along the gum surfaces for any soreness, ulceration or external sore, possibly indicating cancer or other growth.

Diseases of the teeth and gums

Advancing years exact a heavy toll of the teeth in infection, decay and actual loss. In early years of life, heredity and nutri­tion are most important to the teeth. In later years, especially after fifty, tooth life is in direct proportion to care received.

Decay. Tooth decay slows down considerably in adult years as compared with the formative years of childhood. It can, how­ever, start at any age and often continues until the tooth is lost. Prevention of tooth decay means proper and regular cleaning of the teeth, along with routine dental inspection and hygiene.

Abscess (Infected) Teeth. An abscessed tooth, with an accumulation of pus in and about a root, often develops from cracked or decayed teeth. Sometimes the abscess is very small, but fre­quently reaches the size of a walnut with terrific pain, high fever and a greatly swollen jaw and neck.

Because of its many consequences, besides the pain involved, abscessed teeth must be treated as early as possible. The very val-

Fig. 25. Abscessed teeth are fre­quently the cause of other ailments in the body such as arthritis, skin difficulties, etc. They are almost im­possible to cure and should be re­moved.

uable x-ray can easily locate the abscess and even picks out small abscesses before they cause discomfort.

Dental treatment may require removal of the abscessed tooth, although at times treatment which allows the tooth to remain is successful in curing the abscess.

Cracked Teeth. A tooth broken from trauma or any other cause may not be painful or diseased itself, but jagged, sharp edges of the teeth are often points of chronic irritation for the gums, cheeks and tongue. Continued irritation becomes serious eventually, as a possible cause of cancer and other disease within the mouth. Broken, cracked teeth, therefore, are always a matter of concern for the dentist, in the prevention of further disease.

Pyorrhea. Pyorrhea is responsible for the greatest proportion of teeth lost during the adult years. The tooth itself is not in­volved but the surrounding gum is infected and discharges pus as it recedes farther and farther. It is difficult to check and seeks to destroy the tooth socket in the bone. Pyorrhea is most often due to a slackening in routine dental care in later years, accom­panied by a foregone conclusion that the teeth will become lost eventually, no matter what care is given them. After the teeth are lost, the gums overcome the infection and the Pyorrhea is ended.

False Teeth. After the loss of permanent teeth, the wearing of dentures and plates is dictated more by custom of society rather than by absolute necessity. Adjustment to the wearing of artifi­cial teeth may be quite difficult at times, but such problems are usually solved with patience, especially when under the care and guidance of a good dentist.

Cancer and Similar Growths of the Gums. Cancer involving the gums usually extends from cancer growing in the floor of the mouth or side of the tongue. It appears as an ulcerating, irregu­lar sore similar to a large canker sore, and it bleeds easily. There are several other growths of the gums which are difficult to iden­tify or distinguish from cancer. Accurate diagnosis then requires an exact medical investigation, including x-ray study and micro­scopic identification.

The treatment of cancer of the gum as well as other similar growths, is usually a matter of surgery or x-ray treatment. Be­cause such treatments are markedly successful in early stages but sadly unsuccessful in later stages, continual soreness anywhere on the gums as well as other regions of the mouth should be brought with haste to proper medical authorities.

Examination of the Tongue

The tongue is examined mainly in natural light, and at least partially with forced extension. Grasp the tip of the extended tongue between the thumb and forefinger, (wrapped in a hand-derchief) and pull the tongue forcibly forward and downward for complete exposure.

1. Examine the tongue for any unusual discoloration. Note any irregular  "map-like"  gray coating,  yellowish-brown discoloration, bluish discoloration area, or extreme fiery redness to the entire tongue. Discolorations of the tongue may have definite meanings, some of great significance.
2. Examine the tongue for any white, leathery, and possibly stiffened areas. Such whitened regions are often leukoplakia.
3. Observe closely in the forcibly extended tongue, any sore, ulcer, bleeding or unusual growths visible or touchable.articularly examine the side, under-surface and back of the tongue as far as possible. Finding of any sore or lesion of the tongue of this nature may mean cancer.
4. Observe the tongue's ability to move to all regions in all directions. Paralysis in any direction is important.

Diseases of the tongue

The tongue, like the rest of the inner surface of the mouth, may have several diseases common to the inner mouth cavity. However, its refinements in touching and tasting bring it in con­tact with all substances entering the mouth and expose it to more irritation than the rest of the oral cavity.

Tongue Discoloration. A gray tongue discoloration, coated on the tongue with a map-like appearance, is often called "geo­graphic tongue" and is of little significance. This condition is known to persist at times for years without any disease being

Fig. 26. Geographic tongue—a clearly demarcated discoloration of the tongue surface arriving and departing without an exactly known cause. It is sometimes thought due to body metabolism and sometimes to ex­ternal pigmentation as from excessive smoking.

present. It ordinarily disappears in a short time without any treatment and may well represent a temporary gastric upset.

Brownish-yellow Tongue Discoloration has two usual mean­ings. The first is the over-use of tobacco in which the tongue is stained with nicotine and tar to produce brownish stain on its surface. The stain will disappear shortly after the use of to­bacco is stopped.

The second possible meaning of a brownish-yellow tongue may mean pernicious anemia. When the possibility of tobacco staining is not present, and the patient is fifty years of age or over, the lemon-yellow tongue may have serious meaning, and should be seen by the physician.

Bluish Discoloration on the tongue is usually a type of birth­mark. It is usually painless, does not bleed and is not sore, is

Fig. 27. Blood vessel tumors (angiomas) usually exist since birth as birthmarks. Soft bluish masses, they are usually painless and rarely cancerous.

slightly elevated and occasionally covered with small amounts of hair. They have great nuisance value but little actual danger. They, of course, exist from childhood.

Fiery Red Coloration of the tongue, usually means glossitis, or an irritated tongue. Glossitis can be quite painful and ap­pears to have no apparent cause. It is however, frequently due to a deficiency of vitamins, particularly vitamin B12, and frequently improves when this vitamin is given. The condition is thought by some physicians to be a pre-cancerous condition and worthy of careful observation.

Leukoplakia. A whitish discoloration, as a soft wet crusting on the tongue surface and occasionally on the inner surface of the cheek, is termed leukoplakia. It is the result of chronic irritation, such as over-indulgence in the use of tobacco, but is also thought at times to be related to syphilis or some other systemic diseases. Leukoplakia definitely is a pre-cancerous condition and neces­sitates immediate expert medical care.

Fig. 28. Leukoplakia on the tongue is a white eathery sometimes sore formation resulting from chronic irritation. Often caused by smoking it is considered potentially cancerous and should not be ignored.

Cancer of the Tongue. Any ulcer or recent sore irregularity on the tongue might be the beginning of cancer. Three percent of all bodily cancer, and found much more in the male sex, it is often associated with jagged and broken teeth, or other irrita­tions such as leukoplakia, glossitis or syphilis. It is definitely a disease of later years; it was formerly associated with syphilis about fifty percent of the time. Now, however, coincidence with syphilis is very low, and association with heavy smoking is be­coming higher and higher.

Any sore on the tongue over two weeks in duration demands a physician's early attention.

Paralysis of the Tongue. The tongue normally has great agility to move in any direction including straight out. When it loses the ability to move, especially to one side, difficulties such as strokes are quickly suspected. Paralysis of the tongue, whether in whole or part, almost always represents difficulty with nerves which bring motion ability to the tongue muscle and the physi­cian's examination alone can uncover the basic difficulty.

Enlarged Tongue. An enormously enlarged tongue (macro-glossia) sometimes is found in unusual diseases of the body tissues, along with accompanying enlargements of other soft tissue areas of the body, such as the lips, nose and facial features. Diag­nosis and treatment for these difficulties becomes considerably involved and the physician's advice is without equal.

Examination of the Pharynx

The pharynx can be seen partially by forceful traction on the tongue, by the fingers wrapped in a handkerchief. It begins in back of the one-half inch uvula, which hangs down freely from the posterior rim of the palate.

1. Observe the sides of the pharynx where the tongue appears to originate, and note the irregular flesh colored tonsils on each side. When removed, a small cavity remains in their

Fig. 29. The pharynx is the re­gion of the tonsils, back part of the nose and swallowing area. It is probably the most examined of all body regions, and reflects many diseases.

site. Adult tonsils may be atrophied to a pea size or if irri­tated and infected, be as large as grapes and flecked with pus.

2. With a flashlight, examine the back of the pharynx while attempting to yawn. An all-over redness, with noticeable soreness, usually means pharyngitis as in colds, sore throats, etc.

3. Examine the wall of the pharynx on all sides and the back of the tongue, if possible, for any one particular sore, ulcer or bleeding point, which may mean cancer.

Diseases of the pharynx-larynx region

Pharyngitis—A general redness like that of raw hamburger, covered with many small blood vessels, is the appearance of the irritated pharynx—called pharyngitis. Pharyngitis frequently ac­companies upper respiratory infections, bronchitis, sinus disease, virus infection and various types of sore throat. If hoarseness is present, it means that the vocal cords, which cannot be seen easily, are also irritated along with the rest of the pharynx and larynx. Treatment of pharyngitis varies usually with the disease which it accompanies. As a difficulty by itself, it frequently re-responds to gargling with plain water or salt water solution.

Tonsilitis—Infection and inflammation of the tonsils is most frequent in childhood during the formative years. It is not un­common however, for tonsils to become infected in the senior years of life, or harbor infection through the years, to bring about other bodily disturbances in adult life. Tonsils which might appear to be innocent, may actually harbor and distribute bacteria organisms, sometimes responsible for other diseases such as arthritis, kidney disease and sore throats, among others.

Removal of the tonsils in later years is frequently done. It is slightly more difficult than in childhood, but is often followed by relief from arthritis pains and a host of other diseases, which have been kept alive by long-infected tonsils.

Cancer of the Pharynx. Malignant growth, especially cancer, often occurs in the pharynx, base of the tongue and the vocal cords. Unfortunately this area cannot be seen without the aid of special mirrors and lighting arrangements.

The features arousing suspicions of such difficulties are hoarse­ness of a constant nature, pain, and bleeding, which may occur together or separately and in variable degrees. After fifty years of age, coughing of blood and a soreness in the throat, of more than ten days' duration, should arouse suspicion. Hoarseness is a very common difficulty at all ages and is no cause for alarm following brief periods of sore throat or upper respiratory infection. How­ever, a persistent hoarseness of several weeks or more in a person of fifty years or older, should prompt suspicion of serious vocal cord disease, including cancer.

There are other growths in this region, such as polyps, cysts and plain irritations, all of which are easily treated by the physi­cian, but the possibility of cancerous disease in the pharynx region, demands early diagnosis, if effective cure is to be ex­pected.

Halitosis (Bad Breath). This difficulty concerns everyone, and can be very offensive and embarrassing. The problem is exag­gerated by widely publicized advertising, but nevertheless, hali­tosis is a very real problem everywhere.

Prevention of offensive breath is mostly a matter of effective oral hygiene. This includes cleaning the mouth and teeth after each meal, at least to the point of rinsing the mouth well. Un­usually persistent cases, however, warrant a physician's help in determining the cause. Investigation may uncover disease pos­sibilities within the mouth, nose or sinus region, as well as lungs or bronchial tubes.

Coughing. A cough is usually due to irritation of the larynx or vocal cords by colds or infections in this area. The irritation may be described as a tickling, or as a rasping soreness. It may be temporary and respond to various gargles and rest, or the cough may persist for long periods.
When copious amounts of sputum are produced with cough­ing, the most probable site of difficulty is in the lungs, whereas, the cough originating in the larynx is usually described as a dry and hacking cough.

THE NECK

The neck, the support and connection for the head to the body, is also the location of the thyroid gland and many human ills as well.

Examination of the Neck

The neck is examined in a well-lighted position before a close-up wall mirror for clear observation.

 Note flexibility of the neck. Bend the head slowly front­ward and backward, from side to side, and rotate to the right and left. Stiffness or soreness noted in these actions may denote arthritis, irritation of the neck muscles and ligaments, or an infection in the neck.

Fig. 30. The neck contains the body's important connections for the head and senses. There are many great blood vessels glands nerves breathing tubes muscles and other structures in this small space. It also may figure prominently as a thing of beauty.

2.  Feel for enlarged neck glands. Bend the head back and feel along the sides of the neck muscles, stretching from the breastbone to the mastoid bone. Enlarged glands in this region can be rolled under the fingers, and usually are painful to touch.

3.  Feel the region of the thyroid gland. With the thumb and forefinger, press gently on the sides of the windpipe just above the collarbone. Swallow and feel the thyroid gland rise and fall along with the windpipe.

Diseases of the neck

Sore-Stiff Neck. Stiffness in the neck is the usual result of irri­tation in the muscles, bones and ligaments that make up the spine in the neck region. Sudden soreness or stiffness, of a tem­porary nature, is often due to the strain of unusual neck-bending activities, such as gardening work and ordinarily a day of rest relieves painful situations as these. Stiffness, or pain in the neck of a recurrent nature, is usually caused by continuing difficulties from sprains, fractures and arthritis or possibly an infection else­where in the body, such as, teeth.

The treatment of neck stiffness and soreness depends upon its cause. X-rays may reveal local difficulties in the neck, while ex­amination of the entire body may reveal an infection causing general arthritis or other systemic disease. The only treatment a person should attempt for himself in such matters, is regulation of elimination, diet, proper rest and avoidance of exceptional exercise in the neck region. Continuing soreness and pain in the neck should be investigated by the physician for possible serious underlying disease.

Enlarged Glands in the Neck. Enlarged neck glands com­monly follow an infection in the mouth, possibly of the teeth,

Fig. 31. Neck growths and en­largements, present since childhood, often are the result of abnormal de­velopment. Fast-growing enlarge­ment at any age is most likely due to infectious processes, but may mean cancerous disease. Goiter moves up and down with the swal­lowing act and is most often close to the midline.

tongue or pharynx. These enlarged glands, can be felt just be­low the angle of the jaw, extending straight downward. They are frequently tender to the touch, and if infected, can be pain­ful without being touched at all.

In addition to infection, enlarged neck glands can result from tumor growths in the oral cavity, of the lip, tongue, gum, jaw or tonsil. They may also indicate a cyst within the neck, enlarge­ment of the thyroid gland or systemic lymphoid diseases, such as Hodgkin's Disease.

Any neck enlargement lasting more than a week, may repre­sent serious disease, and the physician should be consulted with­out delay.

The Thyroid Gland and Its Diseases. Thyroid disease is sel­dom seen today, but thirty years ago it was a common sight to

see large neck goitres. Medical research found that iodine was lacking in the soil in regions where thyroid disease was preva­lent and the addition of iodine to table salt in these regions, re­sulted in a sharp drop in disease of this gland.

Few people realize the importance of the commonplace box of iodized table salt, but this discovery has benefited thousands of people. The diseases of the thyroid encountered today are most frequently seen in the over-fifty age group.

Enlargement of the Thyroid Gland {Goitre). Any enlarge­ment of the thyroid gland is significant because this gland em braces the windpipe and is firmly attached to it. The enlarge­ment may compress the windpipe to create difficulty in breathing and sometimes in swallowing.

A smooth balloon-like enlargement, usually in young women in otherwise perfect health, is the "colloid" goitre, which results from insufficient iodine in the diet. Medical treatment, in the form of iodine therapy, is usually followed by a reduction in the size of the thyroid gland.

A bumpy, nodular grape-like enlargement is a goitre, possibly of the over-functioning type. These thyroids are very likely to create considerable systemic difficulty in the present or future, and therefore, are candidates for medical or surgical treatment.

Cancer of the thyroid gland, usually felt as a single bump or nodule, is not common, but any solitary lump felt in the thyroid region, demands the examination and diagnosis of a doctor skilled in this field, as treatment may be necessary quickly.

Over-Active Thyroid (hyperthyroidism). Thyroid over-activity is often the cause of nervousness and weight loss. The gland is not necessarily enlarged but it produces definite symptoms of over-activity, such as, loss of weight, extreme nervousness, tremors of the fingers, excessive perspiration and palpitation of the heart.

Over-activity of the thyroid may be treated either by medica­tion, surgery, or x-ray. It is only after adequate examination that the course of best treatment can be known.

Under-Active Thyroid (hypothyroidism). A thyroid gland with too feeble a function is soon reflected throughout the body in several ways. There is a weight gain without any apparent over-eating, long sleep with persistent fatigue and often a dry skin with dull unmanageable hair.

The thyroid gland is the fire-and-ambition gland of the body, and without it nearly all drive is lost. Treatment of an under-active thyroid is simple. It is thyroid hormone, taken orally, under the guidance of the physician for the cure of this health and ambition stealing disease.

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