The fat-tissue in the orbits should be yellowish-white; from it the
red muscles and the white nerves should be easily distinguishable. On
section of the eye-ball the vitreous normally is clear and the retina
uniformly grayish-black and smooth. The most common and important
conditions to be looked for are phlegmonous inflammations, purulent
panophthalmitis, orbital hemorrhage, thrombosis of ophthalmic vein
and sinus cavernosus leading to pachy- and leptomeningitis, neoplasms
of orbit, wall of orbit, eye-ball or lachrymal gland (melanosarcoma,
glioma, gliosarcoma, neuroepithelioma, various forms of sarcoma,
angioma, lipoma, adenoma, carcinoma), affections of individual
muscles (myositis, atrophy), atrophy of optic nerve, choked disk,
retinitis, choroiditis, iritis, glaucoma, etc.
4. POINTS TO BE NOTED IN EXAMINATION OF EAR.
Note condition of scalp (hyperæmia, œdema, hemorrhage) about ear,
condition of external canal (dry, moist, character of contents),
condition of periosteum, particularly over the mastoid process
(normally grayish-red), condition of bone after removal of periosteum
(normally smooth). Inflammatory œdema, purulent infiltrations in the
soft parts, collections of pus beneath the periosteum, roughness
of bone beneath elevated periosteum, presence of pus or blood in
external auditory canal, perforations of drum, etc., should be noted.
Normally the drum should be grayish-white and shining. Note contents
of middle ear, Eustachian tube, condition of ossicles, mastoid cells
and bone. Lining of middle ear should be grayish-red and smooth; the
cut edges of bone should be uniformly grayish-red. When infiltrated
with pus they are brown or greenish. The mucous membrane is deep-red
or greenish in purulent inflammation; yellow, creamy pus, often of
very offensive odor, may be found in middle ear, Eustachian tube or
external canal. Note character of perforations; old ones have smooth
and thickened edges. The most important pathologic conditions are:
otitis media purulenta, inflammation of mastoid cells, caries of
mastoid process, sinus-thrombosis (leading to meningitis or pyæmia),
otitis media tuberculosa, granulomatous polypi, cholesteatoma,
sclerosis, congenital anomalies, foreign bodies, parasites, neoplasms
(chiefly of external ear).
5. POINTS TO BE NOTED IN EXAMINATION OF NOSE.
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