3 The Anaemia, Neurasthenia, Bronchitis, Influenza, Pulmonary Tuberculosis, and during Convalescence after exhausting diseases employ Survival Fellows' Syrup £3£ of £353 The Fittest محمدی of Hypophosphites Contains-Hypophosphites of Iron, Quinine, Strychnine, Lime, Manganese, Potash. Each fluid drachm contains the equivalent of 1-64th grain of pure strychnine. Special Note.-Fellows' Hypophosphites is Never Sold in Bulk. Medical letters may be addressed to Purulent ophthalmia due to gonorrhoeal infection generally develops on or before the fourth day. There are cases of purulent ophthalmia neonatorum without gonococci in the discharge from the eye or from the mother's vagina and with no history of gonorrhoea. The best way to apply cold to the eye is with a small Leiter coil attached to a douche bag that contains ice water; it does not devitalize the cornea as does ice.. In purulent ophthalmia keep the lids from sticking together by smearing their edges with vaselin from a collapsible tube, or, better, with fine lard that has been washed thoroughly with 1:3000 formalin it is not absorbed so quickly. The Crede instillation of 2 per cent. nitrate of silver has caused a persistent and troublesome conjunctivitis. Argyrol 10 per cent. is efficacious and less irritating. A solution intended for the eye, urethra, or any sensitive tissue, should be made from the fused nitrate of silver, not from the granular nor the crystalline form, because ordinary nitrate of silver contains a free acid. Examine pus from the middle ear immediately after paracentesis, to guard against organisms from without. The smegma bacillus is often confounded with the tubercle bacillus, which it clearly resembles; the former is rarely if ever found singly, the latter very rarely occurs in middle-ear suppuration. If there be streptococcus infection, instead of trying to abort the mastoiditis open the mastoid promptly, unless the case is improving. The other ear may become inflamed and show streptococci within two or three hours. Potassium iodide (in collyria, lotions, etc., 2.5 per cent.) readily enters the aqueous and vitreous, but penetrates the lens capsule with difficulty. Paralytic myosis follows a lesion of the pupil-dilating fibers and is characterized by slight contraction and reduction of reaction to light or convergence. In spastic myosis the reaction to light or accommodation is unusually slow. Mydriasis paralytica is characterized by medium dilatation and total absence of reaction to light. In spastic mydriasis the pupil reactions remain, but they are sluggish. In two cases of senile cataract upon which absorption treatment" had been used the cornea, upon operation, collapsed; the lens was adherent to the iris, although no synechiae could be observed before extraction. The spoon had to be resorted to.-Lee Wallace Dean. Recent corneal opacities may be differentiated from old ones by fluorescin, which stains green the former and not the latter. It is claimed that the normal consistency of the cornea is greatly weakened and the liquefaction of the vitreous is not unusual in cases taking the "absorption" or "resolvent" treatment; this coincides with my own experience. Walter L. Pyle. Before local cauterization, curettage, etc., of the cornea define the limits of the lesion by staining with fluorescin. Undiluted tincture of arnica flowers is very apt to cause an irritative inflammation-particularly of the eye-probably owing to the presence in the flowers of a minute insect which haunts them. For local use a dram of tr. arnica to six or eight ounces of water is sufficiently strong. Arnica is the remedy for bruises; externally and internally. For acute phlegmonous dacryocystitis, in fact for acute cellulitis almost anywhere, put six drops of compound tincture of iodin into a well-stoppered bottle with six ounces of water, and give a teaspoonful (or an equivalent swallow) every hour in severe cases; lengthen the interval between doses as improvement is manifested.-Journal of Ophthalmology Otology and Laryngology. The trouble with the average physician is that he belittles ophthalmology because he sees so many non-medical people practicing it, and he assumes falsely that there cannot be much in it, which is a species of intolerable egotism totally inconsistent with the pretences of the profession in the matter of advancement, and I regret to say that many who know better continue to dole out drugs, where they are absolutely unnecessary. Let us emulate the lawyer and charge for our opinions, not for drugs or glasses. When a prospective comes to me saying he does not believe, I reply "it is not a matter of belief, but will you follow my instructions for a stated time?" If the answer is doubtful I refuse to touch the case. I cannot afford to deal with such people, they would ruin the reputation of god or devil. Let the doctor who is in general practice know more, let him break away from the code of ethics which teaches that everyone who disagrees with its balderdash is inconsistent, and he will soon find he has an individuality of his own, resources of his own, development peculiar to himself and capacity to show them effectively.-Suggestion. Nose, Throat, Heart and Lungs. CONDUCTED BY DR. J. MARTINE KERSHAW, ST. LOUIS. FACIAL NEURALGIA, (6) SIX CASES, DUE TO DISEASES IN THE NOSE AND ANTRUM, WITH COMMENTS. A CASE OF IMMEDIATE TRACHEOTOMY FOR FOREIGN BODY.* BY W. PEYRE-PORCHER, M. D., Charleston, S. C. Vice-President of The American Laryngological Association; Ex-President of the S. C. Medical Association: Vice-President of the Charleston Medical Society, etc. In looking up the history of facial neuralgia, trigeminal neuralgia, ticdouloureaux, I have found but seven [7] cases reported in the Surgeon General's office in Washington, which were attributed alone to disease in the nose and antrum. When we consider the endless number of cases in which stretching, resection or total removal of the various nerves and ganglia have been done for the relief of this condition we are impressed with the fact that the true etiology of this disease must have been overlooked in the great majority of cases. It is beyond question that as a rule rather than the exception, the disease is a reflex neurosis or pressure symptom from inflammation in the nose and antrum, and that in any event, it is far more rational to seek for and remove the cause of the neuritis rather than to remove the nerves or ganglia themselves. Owing to the fact that orbital neuralgia, etc., are so often due to errors of refraction and inflammatory conditions in the eye it has come to be considered that tic-douloureaux, or facial neuralgia is mainly if not entirely due to the same cause. So general is this belief that practically speaking we may say every case heretofore has been treated by a surgical operation on one or the other of the nerves in the face. I shall endeavor to show in this paper that the most frequent cause of severe facial neuralgia is a localized inflammation in the nose, antrum or teeth since in the last six cases which have been treated by me the chief and only cause of the trouble was found in these organs. As may be supposed many of the severest cases of trigeminal neuralgia come under the observation of the dentist, and two of the cases which I shall report were referred to me by a very observant dentist, who suspected disease in the antrum on account of the intractable nature of the pain and because he did not detect sufficient disease in the teeth to account for it. Of course if resection or removal of the gasserian ganglion, the spheno-palatine or the infraorbital nerve is performed the pain must temporarily be abated, but that does not at all prove that the orginal cause of the neuritis or the inflammation in nose, antrum or teeth has been removed. Of the seven cases reported in the Index Medicus, the first one was published by Elsberg in the Archives of Laryngology in 1883, entitled "Reflex and other Phenomena due to Nasal Disease." A second case was published in the same year by E. M. Gillian, in the N. Y. Medical Journal, *Read at the Annual Meeting of the American Laryngological Association, Washington, D. C., Mas 14, 1903. entitled, "Tic Douloureaux, Resulting from an Exostosis of the Septum Narium." E. S. Peck also in 1890, published an article on "Reflex Occular and Facial Symptoms of Nasal Disease." International Journal of Dentistry, New York and Philadelphia; also Transactions of the New York Odontological Society for the same year. Two cases of "Inveterate TicDouloureaux of Nasal Origin" were published in 1892, in the Virginia SemiMonthly by John Dunn, of Richmond, in which the paroxysms of pain were entirely relieved. In the London Lancet only two cases are reported entitled "Two Cases of Severe Trigeminal Neuralgia Due to Nasal Disease," by treatment directed to the nose and antrum by M. P. Coyler, M. D., in 1895. In all the cases which I have attended most of whom had undergone considerable treatment at the hands of other men, repeated surgical operations, etc., before coming to me, no examination whatever had been made of the nose, nor had their attention been called in any manner to the fact that the seat of the trouble might be found in those organs. All specialists are aware that patients may have numerous abnormalities in the nose without being in the least degree aware of their presence. Therefore, it is not surprising that the patients should not have known of the disease in the nose or antrum. So many instances of this have occurred that I have felt impelled to put the following cases on record. I will refrain from quoting any of the innumerable cases where almost all the nerves of the face have been either removed or resected for the relief of facial neuralgia. It is not rational to assume that the results obtained from the removal of pressure symptoms in the nose and antrum were only psychical in character because there were no other causes to which the inflammation could be attributed, and besides when the septum had been mashed almost flat upon itself no notice had been taken of it even after the patients had been subjected to many surgical operations on other portions of the face without obtaining more than temporary relief. Without further comment here, I will as briefly as possible report the following cases: Facial Neuralgia from Pressure of Hypertrophied Turbinates. A lady, aged about 65, nervous, hysterical, almost weak minded, said that she had suffered intolerable pain in the face for many years with periods of temporary relief and exacerbation. She had been attended by many physicians and every kind of local application had been made. She had been saturated with iodide of potash and other drugs. I was inclined at first to think that she was a hypochondriac and, therefore, I would pinch her nose and face when her attention was distracted to see if her ailment was imaginary or real. I very soon discovered that it was by no means all assumed but I was at a loss to discover the cause of the reflex pain. Her turbinates were hypertrophied, but there was no other derangement that I could find. I therefore determined to reduce them as much as possible with the electric cautery and also ordered an anodyne liniment of aconite, arnica and laudanum to be applied on the face. This treatment proved to be very effective |