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classed together in one group, and in the main cumlental space would be an encroachment show symptoms in common, yet it is not defi- upon the ciliary body by the lens, obstruction nitely demonstrated that they are the expres- of its circulation, and a crowding forward of sion of one and the same pathological process. its anterior part against the base of the iris. The principal symptoms they show in com- The iris would move forward and obstruct the mon are increased intra-ocular tension, and filtration angle. Again, the obliterated cirmore or less gradual deterioration in the func- cumlental space would prevent the forward tions of the retina.
escape of the fluids of the vitreous, which by After recognizing increase of tension as one being blocked up would press the lens, ciliary of the main factors in glaucoma, the next body and iris forward, and cause the shallow question that suggests itself is, whether that aqueous chamber, which is so often present. tension is due to hypersecretion or obstructed The circumlental space, he says, may be desecretion of the intra-ocular fluids ?
stroyed in several ways: The secretion of fluids to the interior of the By the advancing bulk of the lens, in eye has been very clearly shown to take place advancing age. from the ciliary portion of the uveal tract and 2. The subnormal size of the globe, or to escape from the eye, principally at the ciliary zone. angle of the anterior chamber, and a much
3. The excessive size and prominence of smaller portion escaping from the papilla at the ciliary processes. the posterior part of the ball.
For exciting causes of glaucoma, he says Leplat's experiments on the circulation of we must look to the conditions which overintra-ocular fluids, led to an estimation of the fill the uveal tract with blood. ratio of amounts escaping by the papilla and In regard to the inflammatory nature of the anterior chamber as being i to 50. Ac- acute glaucoma, Mr. Smith says: “To my cording to Leplat, the amount of fluid which mind, acute glaucoma is as much an inflamleaves the anterior chamber of a rabbit's eye matory disease as strangulated hernia, and no is about 20 to 25 m. grms. in five minutes.
more." The theory of Harris that tension was in all
Mr. Smith gives some interesting conclucases due to retention of secretions, by a pri- sions as to the part played by a small cornea mary obliteration of Fontana's spaces at the as an etiological factor in glaucoma, based on angle of the anterior chamber, was for a time the measurements of a large number of glausatisfactory, as this obliteration had always comatous and nonglaucomatous eyes. been present in the cases of glaucoma which In consideration of the facts, that the corhe had examined, and almost always found in nea increases little if any after the fifth year, the examinations of others. But subsequent and that the lens, so long as it remains healthy, investigations by Pagenstecher, Baily and increases in weight and volume throughout others, developed the fact that obliteration the whole of life, the idea suggested itself to of these spaces was not essential to the pro- him that the small mature cornea might indiduction of glaucoma, as cases were met with cate a small globe, which at some stage of wherein this closure did not exist.
lens development, would be found too small Priestly Smith, to whom ophthalmologists for the advancing bulk of the lens, and yet reare indebted for much accurate knowledge of tain sufficient circumlental space. the pathology of glaucoma, advances the hy- In order to test the accuracy of the theory pothesis that the primary or predisposing of the association of glaucoma and a small cause is due to “deficient circumlental space, cornea, he resorted to a measurement of 1,000 and that obstruction of the filtration angle is cases of healthy eyes and 69 cases of glaucodue to mechanical causes, and mostly a result' matous eyes. A report of these measurements of the former; but that tension does not rise, was made to the ophthalmological society of or the glaucoma process actually begin until the United Kingdom last October, and pubthe occurrence of the latter.
lished in the British Medical Journal, and reHe says the effect of deficiency of the cir- sults as follows:
The analysis of the 1,000 cases, including all arch of the atlas being often recognized at ages, gave a general average of 1.6 millimetres, about the point where the vertex of the size variable in individual cases, but not often palatal arch, in contraction, impinges upon the greater than 12. millimetres, nor less than 11. posterior wall. From this point upwards the millimetres, number greater than 12. milli- wall curves forward. metres 34, number less than 11. millimetres 17.
The anterior boundary is formed by the In the 69 cases of glaucoma the general average two oval openings of the posterior nares, and was 11.27 millimetres, maximum 12. milli- the posterior border of the vomer or septum. metres, minimum 10. millimetres. The num- Each lateral wall of this space is marked by ber less than 11. millimetres in the glaucoma the funnel-shaped orifice of the Eustachian list of 69 was 34, or 26 per cent. The number tube with its surrounding cartilaginous ridge, less than ii. millimetres in the 1,000 cases and by the folds formed by the reflection of was 17. millimetres, or 4 per cent. In the the mucous membrane over the anterior and 1,000 cases there was not one cornea so small posterior borders of this cartilaginous emias 10. millimetres, while there were 9 such in nence, termed respectively plica-salpingo palathe much smaller glaucoma group.
tinæ and plica-slapingo pharyngæ. The cavity Brugsch, in Knapp's Archives for 1889, gives of the upper pharynx differs greatly in differas his opinion that small eyes are much more ent individuals. Its approximate measurepredisposed to glaucoma than larger ones. ment, however, would be in the vertical and He thinks the predisposition of Egyptians to antero-posterior lines three-fourths of one inch, glaucoma (being 4 per cent., whereas in and in width about one and three-eighths Europe it is i per cent.) is due to their small inches. Attached to the basilar process and eyes, particularly marked in the cornea.
petrous portion of the temporal bone is a According to Priestly Smith, then, the order thick aponeurosis of fibrous basement memof occurrence is, first, the choking of the cir- brane, beneath which lie certain muscular cumlental space, obliteration of passage for structures involved in the movements and vitreous fluids forward, pressure upon and a support of the head. The mucous membrane crowding forward of the anterior part of the lining it does not differ particularly from that ciliary body against the base of the iris, and a of the respiratory tract. It is richly endowed secondary blocking of the filtration angle. with both the tubular and racemose varieties (Concluded in September Number.)
of mucous glands, and its epithelial surface is
covered with columnar ciliated epithelium. Rhino-Pharyngeal Disease and Some of its Situated in the upper and central portion Reflexes.
of the cavity, we find an aggregation of glands
known as the pharyngeal tonsil, or Luschka's Read before the Academy of Medicine and Sur-tonsil, and it is this which gives to this part gery, Topeka, Kansas, May 20, 1890. of the pharynx an especial interest for us. As
described by Luschka it is a soft mass of tisBY W. E. M'VEY, M. D., TOPEKA, KANSAS.
sue of about a quarter of an inch in thickness,
spread over the roof and posterior wall of the In the recent works on diseases of the nose naso-pharynx, covering the whole extent of and throat, I find some points in anatomical the basilar process of the occipital bone, and description which I think it well to present. extends the whole width of the pharynx. That cavity lying immediately behind the pos- The most constant appearance of this body terior nares, and limited above by the basilar is that in which the mass is traversed, longiprocess of the occipital bone and the posterior tudinaliy, by a series of fissures or indentapart of the body of the spenhoid, which forms tions of about a quarter of an inch in depth, its roof, and extending downwards as far as with a slight disposition to branch, giving rise the border of the palate has been called the to a sort of crow's foot appearance. The gross naso-pharynx. The posterior wall is formed appearance of this mass of glands varies someby the spinal column, the prominence of the what, however, and presents occasionally a soft cushion-like outline covered with small causes of this disease are advanced by the rounded elevations, or is traversed by fissures various writers. Bosworth thinks that in in various directions. Luschka describes an many cases it can be attributed to an hyperopening about as large as a pin head in the trophied pharyngeal tonsil acquired during lower portion of the tonsil which leads into a childhood, as the result of some exanthemasmall sac, to which he gave the name bursa-tous diseases, but considers disease of the napharyngæ.
sal passages proper as the most potent of all There is much difference of opinion as to causes. the existence of such an anatomical structure
Beverly Robinson finds in the diathesis of in the normal state, and is probably better ex- syphilis, scrofula and tuberculosis, and in a plained by Ganghofner as the adventitious re- general constitutional tendency to catarrhal sult of certain morbid conditions of the glands disease which he has termed the catarrhal diin this region.
athesis, the most prominent factors in producThe nerve supply of the pharynx is derived ing naso-pharyngeal troubles. From our own principally from the second division of the experience we would be unable to say that fifth pair, together with branches from the either Bos:vorth or Robinson were exclusively, glosso-pharyngeal and vagus. We find the
correct, but should rather think that somepharyngeal branches of the glosso-pharyngeal thing of 'each were true. We undoubtedly do forming a plexus, supplemented by filiments find such a condition as that termed by Robderived from the pneumogastric, spinal acces- inson a catarrhal diathesis and in these persory, external laryngeal and sympathetic.
sons there is usually a nervous irritability, a The glosso-pharyngeal receiving communi- tendency to the development of a variety of cations from the facial, pneumogastric and neuroses. This catarrhal neurotic tendency sympathetic, becomes a compound nerve, is sometimes manifested by transitory erupcomposed of both motor and sensory fili- tions upon the skin, the result of the injestion ments. The pneumogastric, which is also a of some irritating or indigestible substance. mixed nerve, supplies branches to the phar. In naso-pharyngeal disease we sometimes find ynx and also to the larynx, the pharyngeal the mucous membrane of the vault of the branch given off from the ganglion of the pharynx in a state of congestion, the contrunk, divides into branches and unites with gested masses looking red and angry. In the the filiments of the glosso-pharyngeal to form passive stages of the disease, when not excited the pharyngeal plexus.
by recent exposure to cold or contact with irWith a nerve supply derived from the fa- ritating substances, we will find more often cial, glosso-pharyngeal and pneumogastric the thickened masses presenting a greyish, with numerous communicating branches from soggy appearance, with the fissures consideraeach of these and from the sympathetic, the bly deepened and filled with a muco-purulent pharynx becomes of the utmost importance discharge, which exudes upon the surface of to us in our study of the reflex element of the membrane, adding much to its greyish apdisease.
pearance. The profuse discharg?, mucous or In the disease known as naso-pharyngeal muco-purulent in character, either from lack catarrh, or, as I think, more properly named of the usual watery exudation or from its abby Robinson, “ Follicular disease of the naso- sorption by the inspired air, becomes thick pharynx,” we may have either of two quite and tenacious, adhering tightly to the mucous distinct morbid conditions. We may have a membrane. This adherent mass of muco-pus chronic inflammatory process of the glandu- acting as a foreign body, excites the patient to lar structure with active cell proliferation, and frequent and violent efforts for its removal ; as a resulting condition a true hypertrophy. this being accomplished, the membrane is left On the other hand we may have an extreme in a congested and irritable condition for recell proliferation, many of the cells being ceiving the next accumulation. This process thrown off, forming with the excessive mucous being frequently repeated, the membrane besecretion a muco-purulent discharge. Many comes hypersensitive, and the presence of mu
cous, dust or even air is a source of irritation of the thick secretion which had accumulated not only to the mucous membrane of the naso- and was very tenacious in character, requiring pharynx but by reflex sensibility to the lower the use of a brush. Thinking the nasal pharynx, to the larynx and respiratory tract. trouble of primary importance I began the We often find in these cases a spasmodic, irri- treatment there, using cocaine to reduce the tative cough, excited by the slightest contact irritability and to see what effect it might with an atmosphere containing any irritating have upon the cough. There was no apparent properties, so distinct in its character that you benefit as far as the cough was concerned. would at once recognize its nervous element. My attention had already been called to the
The usual involvement of the larynx and feeling of something in the larynx which was respiratory tract in naso-pharyngeal disease found only slightly reddened upon examinahas been recognized by most writers on this tion. Still believing the cough to be due to subject but has been attributed to various reflex irritation, I began to investigate the in
fluence of the naso-pharyngeal trouble. After Bosworth, in carrying out his idea of the cleansing the membrane as well as possible nasal cavities being the primary source of with a spray, I introduced a camel's hair trouble, attributes it to the habitual mouth brush for the purpose of removing some adbreathing of the comparatively dry air. But herent mucous and immediately she was as we find the same irritation where mouth seized with a violent fit of coughing and combreathing is not habitual, we are hardly in- plained at my putting the brush down into clined to accept his explanation. By many it her throat.
her throat. After a thorough cleansing, we is stated that the secretions passing down the applied with the brush, tincture iodine. This pharynx and into the larynx sets up a low treatment was repeated several times at intergrade of inflammatory trouble there. It
vals of one or two days, with the satisfaction seems very improbable to us that this occurs.
of seeing a constant and marked improveThe secretions passing down are either in- ment. The treatment was suddenly intervoluntarily swallowed or pass into the æso
rupted, but I afterwards learned that for two phagus. The catarrhal diathesis may
weeks after this treatment there was entire plain the existence of a mild catarrh in the relief from the cough, when from exposure, a upper air passages in some cases, but we be- severe cold was contracted and the trouble lieve a more prominent factor in its develop- renewed. I am inclined to think that this ment, is the frequent spasmodic cough caused feeling of something in the throat is not a reby reflex irritation, keeping the larynx 'in a sult of a direct irritation of the larynx but is state of excessive activity and consequent
a reflex sensation from the presence of the congestion. I have frequently had patients adherent mass of muco-pus upon the irritable complain of something accumulating and and hypersensitive membrane of the nasosticking in the larynx, at which they were pharynx. That there are other reflex troubles constantly hacking in their efforts for its re-growing out of this disease, we have strong moval, but with no apparent success.
reasons to believe. amination reveals the larynx considerably red
There is little doubt that in many cases of dened, but no accumulation or extensive mor- asthma, naso-pharyngeal disease is a promibid condition.
nent factor, if not a causative element. Some months ago a patient came to me with There is some difficulty both in the diagnoa cough of about two year's standing, with sis and treatment of this disease, and is conseperiods of comparative relief and exacerba- quently often neglected. The reflected light tion. Upon examination I found considera- and throat mirror will usually reveal its pre: ble deviation of the septum nasi to the right ence, but if such an examination cannot be with some hypertrophy of the turbinates on made, the finger introduced into the pharynboth sides and in the vault of the pharynx a geal vault may find the trouble. lobular looking mass of a greyish appearance For treatment-cleansing applications and at first, but of a deep red color upon removal | the use of astringents with spray or brush
but probably better than these is the applica- Some Uses of Acetanilid and Antipyrin. tion two or three times a week of tincture of iodine, followed by mild washes or sprays Read before the Central Branch Medical Assoof vaseline. If there be much hypertrophy,
ciation, June 5, 1890, at Greenleaf, Kas. removal with the forceps or galvano-cautery should be accomplished and followed by such BY H. REDING, M. D., OF VERMILLION. after treatment as the condition would indicate. By the use of cocaine, surgical opera
If we can always keep ourselves and our tions in this region are much simplified. It patients cool and comfortable, life will be may be applied with a spray or brush, or, if worth living, and our success as practitioners immediate and certain anesthesia is desired, assured. may be introduced by means of a hypodermic Modern chemistry, that indefatigable forager needle mounted on a curved shank so that in the fields of nature, has added much to our the part can be easily reached.
Armamentum Medicatum. Where the patient can not be seen 'regularly,
Among the multitude of gifts for which we a cleansing solution of
have to thank her, means for combating fever R. Sodii bicarbonatis...
. 3 ss.
and pain claim our warmest appreciation. Sodii Boratis..
. 3 ss.
Specifics do not abound, and much of our Listerine.
treatment is yet, and must be symptomatic. Glycerine...
Among new remedies, designed to meet Aquæ.....
..ad. 3 iv.
symptomatic indications, antipyrin and acetanthrown into the pharyngeal vault by means ilid have for some time—the former about five of an atomizer will often, by keeping the years, the latter a shorter period-received membrane clean, afford much relief from the much attention from the profession. I do not troublesome symptoms.
apply to acetanilid the trade-marked name Another solution which is antiseptic and as- "antefebrin,” under which it was introduced, tringent in properties, and one from which I and I am inclined to apologize for speaking have obtained excellent results, is that of G. of antipyrin, but I can find no other name M. Lefferts, and is composed of
suiting me better. The clinical name phenylR Iodini cryst...
dimethyl-pyrazolon according to professor Potass. iodid..
Sadtler, or dimethyl-oxyquinizine after other Zinci iodid...
authorities, is calculated to produce luxation Zinci sulpho-carbolatis...
of the maxilla in one unversed in chemical Listerine
lore. “Methozni,” an unwarranted contracAquæ....
.....ad. 3 iv.
tion of its chemical name, and "analgesine" This may be used in an ordinary atomizer, under which it is manufactured and sold in but should, I think, usually be somewhat di- France, are not supported by sufficient authorluted.
ity to warrant their adoption. When it is possible to have it so, a regular
I wish to protest against the burden which and systematic course of treatment will be is laid upon us by the patentee of antipyrin, much more satisfactory to yourself and pa- and urge my brethren to do all in their power tient. Having your patient come to you two by agitation and influence with our legislators or three times a week, carefully cleansing the to lift this and like burdens from our shoulders membrane each time before applying your and pocket-books; and also, as far as may be remedies and carefully adjusting these to suit done with satisfaction, to substitute for it in the requirements of each individual case, you prescribing, cheaper, unpatented remedies. will find you are able to do much for the re
Antipyrin and antifebrin stand on different lief of this class of sufferers.
bases relative to their protection by patent.
The patentees of the former have secured to In the past fourteen months typhoid fever themselves complete protection by covering has cost Chicago $2,143,800.
not only the name, but also the product itself