Billeder på siden
PDF
ePub
[ocr errors]

dition of the cornea may be. One eye being affected, its fellow seldom escapes, though an interval of a day or two may elapse before the second suffers.

The plan that has seemed to give the best results is the frequent use of a weak lotion so as to remove the discharge before it collects in any quantity, and thus to assure the lotion coming into direct contact with the inflamed conjunctiva. Place the point of a syringe-making sure that it is quite smooth-just within the inner commissure of the lids, and the lotion will be discharged over the entire inflamed surface. The mother or other attendant must be strongly impressed with the idea that the preservation of the child's sight depends in large measure on her regular and faithful use of the wash, and she must be cautioned not to chill the child by wetting its clothes; the wash not being intended for a general bath. Local measures stand first, but there are others of the utmost importance in severe cases, the first often proving of no avail unless the child be well nourished. The health of the mother and her ability to suckle the child effectually become weighty matters for consideration. As I have repeatedly said, the danger lies not in the profuse discharge, as the uninformed would suppose, but in the liability of the cornea to undergo extensive ulceration or to slough. In such cases it first becomes dull and hazy, loses its lustre and looks "steamy," just as does a window-glass covered with condensed steam; then it gets opaque at its centre with softening of its tissue, and finally an ulcer, perforating the whole thickness of the cornea, forms; the iris prolapses and perhaps the lens and vitreous humor escape, the eye ultimately shrinking to a mere nodule. Much depends, no doubt, on the severity of the disease, but as much, or more, on the general vital power, whether the affection shall prove only a troublesome complaint, or greatly impair or absolutely obliterate sight. During that early period of life during which the disease manifests itself-commonly three or four days or at most within a week, after birth-the interchange of material in the system is so active and there is such a power of forming new tissues, that if this power be ably sustained by suitable measures it is often surprising to see how

rapidly a large ulcer of the cornea will heal up, leaving but a slight amount of opacity. In such a case a faint pink tint may be seen around the margin of the cornea caused by the vessels that are carrying blood to repair the breach. Minute doses of quinia (they should be minute), given in milk, seem of service to weakly infants, while blisters or leeches may destroy the last chance of staying the progress of corneal ulceration, and to attempt to bring such a child "up by hand" is to doom the eye to certain destruction.

CATARRH AND ITS SEQUENTS.

By JAMES E. BRIGGS, M. D., 126 West 11th street, New York.

Perhaps very few complaints have been more neglected, and more subjected to empirical treatment than catarrhal affections. What makes this the more remarkable is that they are so general, a very numerous portion of the community being sufferers. The medical text-books are meagre in their treatment of the subject; one would almost imagine that their authors had never heard of it. Very many physicians, if asked by a sufferer what to do, will give some brief, halfintelligible direction, and then hurry to change the subject. They abandon the field to the experimenters, the quack and the empiric, virtually confessing that they are themselves unable to cope with it. Indeed, the number of medical men who have catarrh and do not know what to do about it, is in equal proportion to the rest of the community who have tried many things and received no benefit. They seem to regard it as about as hopeless as cancer, with the one redeeming feature that it does not kill so quickly. It is passed over cursorily, skipped as soon as may be, and may as well be classed with the opprobia medicorum. Few Professors of Theory and Practice of Medicine seem to know much about it, judging by their lectures.

"It is a cold, or the result of a cold," is the usual explanation. This would seem to be very plain, but it is far from that.

What is a cold? One will discourse about damp weather, chilly rooms, and the like; another will be very explicit about sudden transition from a heated room to a cold atmosphere; and we have a round of explanations. But then, a person seldom is unpleasantly affected by passing quickly from a hot to a cold atmosphere. In Norway, Russia and other cold cli mates it is the practice to keep the houses at a very high temperature as a protection against the severe weather outside. Damp weather is encountered almost constantly in island countries, with very general impunity. Indeed, it is almost safe to say that climate has little to do with the matter. The complaint is about as common and certainly as aggravated in summer as in winter, in dry as in moist countries. The causes must be sought from other sources.

Annoying as the complaint is, there is much connected with it that is really laughable. The New England people have contracted a peculiar nasal tone of voice, which is regarded as specifically Yankee, but is more truly a result of catarrh of the posterior nares. Probably nobody hears his own voice. correctly; and hence few are aware of any improper intonation. Yet it gives a queer impression to hear the peculiar a, u and ow, which are sharp enough to cut. Perhaps the absurd pronunciation is a modern distortion of utterance, but it evidently originated in the obstruction of the breath, and has become classic in Eastern estimation. It serves to distinguish the culture of Boston and New England from the broad enunciation of the Knickerbockers and other outside barbarians of the United States.

The causes of catarrh and the various seats of the disorder are numerous. We are safe in assigning the origin to debility. It is usual to attribute it to taking cold, yet no person who is not already debilitated is liable to contract a cold. Indigestion and fatigue are the principal causes of taking cold. Dr. Franklin used to say, that he would any time by overeating. Samuel Thomson observed that the great body of disorders which he was asked to treat were attributed to a cold. Bad air, insufficient exercise, improper food, exhaustion by fatigue or other cause, will be very likely to occasion

catarrh. Sexual excesses come within the category. Whatever cause enfeebles the patient, reducing health below the normal standard is likely to result in disorder; and the peculiar epidemic or untoward climatic influence gives form to the disorder thus indicated.

When merely a "cold" has been contracted the matter is simple enough. The pores of the skin are obstructed and the effete and noxious material which should pass off by the insensible perspiration is retained in the body. The lining membranes are called into requisition to perform the duty of the skin. Coryza appears among other symptoms, and the patient is annoyed by a feeling of obstruction in the nostrils, dull heavy pain in the head, and a stupid feeling. After a day or two there is copious excretion, accompanied by arrested secretions, dryness of the skin and constipation. It is generally supposed that this form of complaint wears off after a few days or weeks. It may be that the patient omits to notice it, but the wearing commonly lasts on a good while. The disorder of the nostrils becomes a permanent disease, characterised by ulcers in the posterior nares, inflamed fauces, and other continuations of the affection. Sometimes the uvula is lengthened and becomes a serious annoyance; the Eustachian tube is liable to obstruction, which results in deafness; and presently the affection of the diseased parts becomes more or less malignant, and extends itself toward the more vital structures, with more serious results. The various disorders of the membranes of the trachea, larynx, and bronchi supervene; the parenchyma itself is often involved, resulting in consumption, besides other disorders more or less common in this climate.

It is perhaps to be doubted whether coryza alone, simple cold, would of itself make progress to such a final culumination. The numerous array of blood-poisons, however, can generally be found at hand to be set agoing with this provocation. There is scrofula at every turn, manifest or obscure. Various ill-cured disorders, eczemas, exanthemata and others are lurking about in most constitutions; and even the vaccine poison, thought often apparently harmless, is an active

element in accelerating the progress of the various other maladies. The blood having been once set in ferment by it, nobody knows when it stops or is ever likely to stop. Where there is the most vaccination there is the most catarrh as well as consumption. The complications are among the most serious that physicians encounter.

The ozena is the common form of catarrh among us. The lining membrane of the nose has become permanently disordered and is reluctant to take on healthy action. The affection often extends clear to the frontal sinuses and even to the ethmoid and sphenoid cells. This is characterised by tenderness over the eyes and heat over the forehead. The eyes themselves are often impaired, as well as the hearing, while the taste and smell are chiefly abolished. Sometimes the bone itself is affected and becomes carious. The patient is usually characterised by a quick whistling breath; but now a most offensive odor is superadded, disgusting to every one and most sad and distressing to the sufferer. This state of things continues a longer or shorter period, till all the functions of the physical economy are exhausted, and death takes place.

The membranes of the nostrils are in direct connection with branches of the Vidian nerve. This fact accounts for the close relations of catarrhal affections of the mouth and nostrils with disorders of the throat. There are three branches of nerve extending from the spheno-palatine ganglion. This ganglion with its branches is the organic nervestructure affected in hydrophobia, and the poison in venomous animals is here secreted. It is situated on the external side of the nasal plate of the palate-bone. It gives off three branches : the palatine nerves, which supply the membranes of the mouth, the second, which supply the soft palate and uvula, and the back parts of the nose, and the Vidian or petrosal nerve. This last nerve is the most generally distributed of them all. One of its branches constitutes a part of the plexus of the superior cervical ganglion existing round the carotid artery. The other runs between the dura mater and the Casserian gangloin and joins the facial nerve, which it accompanies to the back part of the tympanum; where it becomes

« ForrigeFortsæt »