Part 1

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VOL. XII. JULY, 1900. PART 3. THE JOURNAL OF OPHTHALMOLOGY, OTOLOGY AND LARYNGOLOGY.

EDITOR, CHARLES DEADY, M. D.

ASSOCIATE EDITOR, A. W. PALMER, M. D.

NASAL OBSTRUCTION AS A CAUSE OF HAY FEVER OR ASTHMA.

BY WM. WOODBURN, M. D., DES MOINES, IA.

I do not propose to treat this subject technically or theoretically, further than to simply say, I consider the first a mild form of the second, and both a reflex neurosis. I shall relate my experience and treatment of some half dozen cases illustrating my subject.

CASE I.—Mrs. H., a farmer’s wife, æt. thirty-five, had been troubled for a number of years with hay fever from harvest time until frost came in the fall. Inspection of the nose in June, 1899, showed the lower right and both middle turbinated bodies greatly hypertrophied. Removal of the anterior and lower half of the middle and cauterization of the lower, gave complete immunity for the entire season. This patient could not, at any time, sweep the floor or ride behind horses against the wind, without violent paroxysms of sneezing, but since the operation has had no further trouble on this score.

CASE II.—Mr. D., æt. about thirty-five, a traveling man, the patient of our secretary, consulted me on August 28 last, in the midst of his annual attack of hay fever. Examination showed the entire nasal mucous membrane greatly engorged, as it always is during an attack. On the right side of the septum, near the floor, was a sharp septal spur, projecting at right angles about three-eighths of an inch, prodding the tumefied lower turbinated body. The removal of this spur under cocaine anæsthesia greatly modified the symptoms immediately, but a grateful frost, following in a few days, prevented an exact estimate of the benefit to be ascribed to the removal of this offending appendage.

This year, however, will furnish opportunity to determine how permanent the effect will be.

CASE III.—Wm. S., æt. four years, a great sufferer from asthma, at times when having a slight cold, to which he was very prone, to such an extent that he could not lie down for several days and nights. Relief had been sought in the higher altitudes of the Rockies and a residence of one year at Denver, but none came. I was consulted on November 25, 1899. An examination showed the post-nasal space almost occluded with adenoid vegetations. Of course I advised their removal, which advice was accepted, and their thorough removal, under the local application of cocaine, accomplished the purpose. This was the child of a brother practitioner, and in April this year I had a letter from the doctor, in which was the very gratifying sentence, “William has not had the asthma since you removed his adenoids, and is much better in every way.” This was especially pleasing since his suffering had always been more severe and constant during his previous winters.

CASE IV.—Male, æt. forty-five, Swede; occupation, bridge-builder. Had suffered annually for fifteen years with, first, hay fever, and, later in the season, asthma. In the summer of 1899 he anticipated his attack by a trip to the mountains of Colorado, where he found exemption and remained until the first frosts had appeared here, and then ventured to return. Immediately on arriving at Omaha on his return, his old antagonist met him and the battle again raged with even renewed vigor. He consulted me a few days after his arrival home, in a frame of mind ready to accept any suggestion which promised him relief. I examined the nasal passages. The right lower turbinated was greatly hypertrophied, and on the application of cocaine, 3 per cent. solution, the tumefaction largely disappeared and great immediate, but of course, temporary, relief was experienced. On the left side an immense septal spur on the osseous portion was found and removed. After the temporary swelling incident to the operation had subsided, his relief was, and remains, complete. I subsequently cauterized the enlarged right turbinated, since which time, he informs me, he has breathed more freely than he has done for fifteen years.

CASE V.—Lady, æt. about twenty-eight, married, had consulted all the physicians in her home town, except the one she should have at first consulted. Finally, in desperation she went to a young up-to-date homeopathic physician, who looked into her nose and assured her he knew what caused her trouble. He made an application of a solution of cocaine, and in a few minutes her respiration became nasal and normal. “Oh, what a relief! That is the first good breath I have had for weeks,” was her exclamation. Both lower turbinated bodies were immensely hypertrophied, and the doctor wisely advised their removal and referred her to me to do the work. When I first saw the patient she was a frail, pale, wan little woman, thoroughly exhausted. I saw her about six weeks subsequently, in a remarkably improved condition. Had gained about twenty pounds in weight and was plump, rosy-cheeked, and had entirely lost her distressed appearance.

The last two cases both occurred in the practice of my good friend, Dr. C. M. Harrington of Knoxville, Ia., and are all the more valuable because he is here to corroborate the fair statement of the cases I have made, and emphasize the beneficial results in a discussion of my paper.

CASE VI.—An old-school physician, æt. about thirty-five, had for a number of years been troubled during the late summer months and early fall with hay fever. Had sought relief from a number of specialists in his own school of medicine as well as prominent general practitioners. By chance he was directed to me, not knowing my school of practice, in the midst of attack in 1899. No satisfactory examination could be made until a 4 per cent. solution of cocaine had been applied and caused a lessening of the engorgement. There was plainly visible a large well-organized simple polypus hanging by a distinct pedicle from the right middle turbinated body. Its removal with the cold wire snare gave prompt and permanent relief and made a lasting and loyal friend of my old-school confrère.

In none of these cases do I mention any medication. None was used except to cleanse the mucous membrane of the viscid secretion always present in such conditions, and following such operations. All of the cases reported were mechanical obstructions, and demanded mechanical treatment, and no line of medicinal treatment would have done more than temporary good.

DETACHMENT OF THE RETINA—A CASE.

BY JAS. A. CAMPBELL, M. D., ST. LOUIS.

In May, 1885, Geo. H., age thirty-seven, came to me from Indiana, with the following history: He had been very nearsighted all his life, but had never worn glasses. His eyes had never troubled him in any other way, until a few days before he came. He then noticed a few floating white spots before his left eye. This gradually increased, and the vision of this eye, by degrees, grew less and less until after four days the sight of the left eye was gone. There was no pain in either eye.

Examination showed vision of the right eye was 4/200; with a — 13 Ds. glass, 15/200. With the left eye he could just distinguish light in the outer upper field of vision. With the ophthalmoscope only the lower fundus of the left eye could be made out, where the retinal vessels were seen up to the lower edge of the optic disk. The disk itself could not be made out, but above it a bulging, detached retina was prominent, with a hemorrhagic spot at its inner margin. In the upper outer fundus another separate bulging detachment of the retina could be plainly seen.

The right eye was highly myopic, with a myopic arching around the disk, and the entire fundus was mottled with small choroidal pigmentation spots, clearly of long standing.

The nature of his trouble was explained to him. He was kept quiet, and all forms of tobacco and stimulants were forbidden. He was placed on kali hyd. 3d, three times daily. In one week’s time a remarkable change for the better had taken place. The detachment was much reduced. The wavy retinal vessels were seen climbing over its edges. The optic disk was visible. In two days more he could count fingers with the left eye at two feet. The improvement continued. On June 24 vision of the left eye was 15/200; right eye, 15/100. He then went home for a few days; the kali hyd. being kept up. July 13 he returned, saying that the improvement had gone on by slow degrees, until, suddenly, the vision of the left eye was again lost, on July 12. He was then placed on 5‒grain doses of kali iod. 3d, three times daily, which was followed by very slow improvement, so that in three weeks he could again count fingers with the left eye at two feet, and the detachment, which had resumed its former dimensions, was somewhat reduced. I then went back to kali hyd. 3d, three times daily, which was again followed by improvement for some months after his return home. This, with some intercurrent medication, was kept up from time to time for a year, gradual improvement being reported until the sight of both eyes seemed about as it was in former years.

May 3, 1899, fourteen years after his first visit, he again came to me, reporting that his eyes had gotten along very well, with no particular trouble until in 1897, when he took a severe cold, which settled in his left eye, which became badly inflamed. He went to St. Louis, but did not find me, as it was during my summer vacation. Returning home, he consulted Dr. Knapp of Vincennes, Ind., who advised the removal of the left eye, as it seemed hopelessly involved by that time. This was done, and he progressed nicely, the vision of the right eye remaining about the same, though occasionally its vision seemed not quite so clear.

This was the situation until two weeks before his visit, when the sight of the eye began to grow dimmer. There was no pain present at any time, but vision gradually grew worse and worse.

Examination: V. R. = 8/200; where it had before been 15/100. Ophthalmoscope revealed some increase of the old choroidal atrophic mottling, with a red blurry optic disk.

He was placed on gels. θ, three times daily, for a few days, with evident improvement of the optic nerve congestion. He was then given kali hyd. 3d, four times daily. He returned home in a week, keeping up the same remedy. In three weeks he returned to me again, when examination showed decided improvement; with — 13 Ds., V. = 15/100 once more; still keeping up the kali hyd. 3d.; thus having been brought back to the condition which followed the treatment in 1885, and which had remained in _statu quo_ for fourteen years.

Detachment of the retina is always a serious condition. It is not an unfrequent complication in high degrees of myopia. In three hundred cases collected in Horner’s clinic, 48 per cent. were in myopic eyes. Its progress is generally unfavorable. It is usually treated by perfect quiet, rest of patients, after confining them to bed for some weeks, giving infusions of jaborandi and hypodermics of pilocarpin mur. Puncture through the sclera at the points of detachment, allowing escape of the fluid, has been advocated and performed by various well-known authorities, but has not been successful enough to ensure its general adoption. In rare cases spontaneous recovery has been observed, but I cannot think that the case here presented belongs to this class, for the original attack was in 1885, and was of such a degree that the vision of the left eye was reduced to mere perception of light in the outer upper field of vision. Under kali hyd. 3d, remarkable changes and rapid improvement took place. A relapse followed on his return home, after a couple of weeks. This again yielded to the same treatment, the vision of the left eye regained what it had lost, and remained in this condition for twelve years, when a severe general inflammation of the left eye necessitated its removal. Then, in a couple of years, the vision of the right eye became suddenly involved. Rapid improvement again followed the same remedy, and it was restored to its original condition. Hence, I cannot regard the improvement as either spontaneous or a coincidence, but think I am justified in attributing it to the direct result of the remedy given.

In the old school iodide of potash, in large and repeated doses, is a very common remedy in all intraocular diseases, and the more obscure the case, the more frequently and persistently it is used. Some cases are benefited by it, others not. The points I wish to make are, first to demonstrate the homeopathic possibilities of treatment in this serious disease; that when you have a homeopathic kali hydriodicum case, kali hyd. will probably help it, whether you give it in the third trituration or in more appreciable doses. In the case here reported kali hyd. 3d was certainly more potent than the 5‒grain doses used for one week and then changed to the 3d trituration again.

CLINICAL CASES.

BY C. GURNEE FELLOWS, M. D., CHICAGO.

CASE I.—Early in 1899, Mrs. H. B., age forty-nine, presented herself for an opinion as to her condition. She had been hoarse for three or four weeks, and had a little inconvenience in swallowing, with no cough, but she complained of ordinary sore throat such as would follow an everyday cold. The main symptom was an excessive amount of mucus from the nose, nasopharynx, and pharynx.

Examination revealed a large pharyngeal ulcer on the left side, with enlarged cervical glands on the same side, and my suspicions were aroused as to its malignancy. Upon expressing such a fear the patient admitted that she had been examined by a surgeon who likewise had suspected carcinoma and advised its removal. She absolutely refused to think of operation at anybody’s hands, and insisted upon my giving it the best treatment possible.

I cleansed it with the usual antiseptic solutions, and applied orthoform and other well-known and everyday methods for a week or two with a fair amount of relief, but the ulcer continuing, I applied specific treatment in the hope of clearing up the diagnosis, and, much to my delight as well as to the patient’s comfort, the ulcer healed, the induration disappeared and the patient was, to all intents and purposes, well. After a number of weeks the external glands even diminished in size, so that I rather felt that the diagnosis of cancer was wrong and that it must be specific in character.

The patient ceased her visits, but returned in a few more weeks with a condition as at first, but upon the opposite side of the pharynx. Same treatment and everything else I could suggest did absolutely nothing for her relief, and I felt that the diagnosis this time must be carcinoma, but she refused even to have a small section taken for the purpose of diagnosis. Consultation agreed with me as to the malignancy of the growth, but operation was refused. She died in another month, practically from starvation.

I report this case after having read the article by A. Worrall Palmer upon cancer of the larynx, in the January number of this journal, because in the prelude, this method of diagnosis, and the application of this specific mixed treatment is advised, and because in this case it was followed by apparently successful results with what seemed to be an entire cure of the case, and therefore a clearing up of the diagnosis, but which, on the other hand, was followed by a return of the same condition, but upon the other side of the throat. The second point in the case is the great relief of all symptoms following the iodide of potash and merc. administered internally, and the administration of kali bi. and arsen., which most certainly had in the early part of the disease a very satisfactory effect. I believe that this case was cancer from the first, but that, contrary to expectations, it yielded beautifully to internal treatment.

CASE II.—Mrs. M. E. C, age fifty-six, presented herself with a sensation of swelling in the throat accompanied by stinging pain, and with a history of from one to a dozen attacks of suffocation each twenty-four hours, much worse at night; otherwise no soreness of the throat or special sickness preceding these attacks, but they have been fairly constant for a year. She had become suspicious of the trouble being cancer, and, after having had some months of treatment from her family physician, she was more impressed with the fact than ever.

Examination revealed nothing in the way of foreign growth, but very much enlarged varicose veins at the base of the tongue, with a granular pharynx. Prognosis was favorable and the treatment as follows:

Glycerole of iodine to the pharynx and base of tongue, following cleansing and antiseptic solutions; galvano-cautery destroying the largest of the blood vessels, and moschus 3x internally. A complete cure resulted in less than thirty days; complete cessation of all attacks, which, of course, proved the diagnosis to be other than any malignant trouble, and, although the local treatment was probably efficacious, I believe that much of the trouble was of a neurotic type, incident to the climacteric, and that moschus deserves a good deal of credit for the result.

THREE KALI CARBONICUM CASES.

BY THOMAS M. STEWART, M. D., CINCINNATI, OHIO.

CASE I.—Patient, a tall thin woman; dark hair and eyes. Badly nourished as a result of mal-assimilation of food. Troubled with frequent attacks of styes on the upper right eyelid. Patient anæmic. Complained of frequent chilliness; chilly on least exposure. Physically and mentally patient was exhausted.

Some improvement was secured by correcting an eye trouble with glasses. Nux vomica, psorinum, and hepar of course acted indifferently. On a later visit the case was cleared up by the mention of the chilly sensation and the exhaustion. Kali carbonicum began an improvement and carried the case on to a point where diet did the rest.

The woman’s means were limited, but she was able to carry out the diet direction, because her principal articles of diet had been meat and eggs. She was getting too much nitrogen. A generous supply of the carbo-hydrates; a direction to drink plenty of water, but not at meal times; and more exercise in the open air changed the conditions to healthful ones.

CASE II.—A young woman, well nourished, but not muscularly strong. Catches cold easily and is readily exhausted by muscular exertion. Sensation of a lump in the throat, with stitching sensation at each cold. With each cold has some cough, due largely to an elongated uvula. With each cold must “hawk” a great deal in the mornings to “clear the throat.” The patient was a vocalist and suffered frequently from these acute colds and hoarseness.

The case had been prescribed for by several physicians. A study of the case brought out the kali carbonicum picture of “coryza with hoarseness; catches cold at least exposure to fresh air, and with each cold there is a stitching pain in the pharynx,” and kali carbonicum 6x trituration cured the case, including the relaxed uvula. The patient has frequently presented this picture and each time kali carb. did the work.

Some additional benefit, in lessening the liability to these attacks, has been secured by the cold sponge bath each morning. Deep inhalation of fresh air three times a day, to aid in the oxidation of the food stuffs; and by inculcating the habit of daily attending to Nature’s demands, whether there is any desire or urging in that direction or not.

CASE III.—Patient a nervous woman. Suffering from mixed astigmatism and pronounced insufficiency of the internal recti muscles, which we oculists denominate an exophoria. Patient suffered terribly from headaches, almost daily in their occurrence, frequently with nausea. The muscular trouble was cured by the use of prisms, the mixed astigmatism corrected by a glass, and there remained a severe backache. It was located in the small of the back as if there were a heavy weight pressing there; worse during menses, with bearing-down pain; patient was obliged to sit down frequently, on account of the ache. Her physician had prescribed sepia, cimicifuga, and natrum muriaticum—and in response to a question, “Could the eye treatment have had anything to do with apparently aggravating the backache?” I replied, “No; I think the relief of the headache has simply allowed the attention to be drawn to the backache.” I asked for other symptoms and one day received a little line stating that the “backache was worse after eating, and the patient could not walk much on account of the backache, was obliged to sit down frequently,” and kali carbonicum was advised. It cured the case.

ATROPHIC RHINITIS.

BY C. R. ARMSTRONG, M. D., THORNTOWN, IND.

Atrophic rhinitis is that chronic disease in which there is a wasting away of more or less of the mucous membrane, glands, and turbinated bones, and is generally accompanied by some abnormal conditions of pharynx and all the sinuses connected with the nasal cavities.

This is no new disease, but one physicians have had to deal with these many years; one we meet in practice every little while, and one which we cannot study too carefully, because the treatment for the disease in many cases ends in failure to cure.

I do not know that I will be able to say anything new of this morbid condition of nose, but will state a few things as I see them in practice day by day. There is always a favorable point about having a patient with this disease, along with the unfavorable ones. That is—the physician always has plenty of time to study his case and see every minute change in the recovery ere the patient is pronounced cured. This is more commonly known as ozena, or fetid catarrh, from the odor which accompanies the trouble. However, there is a form of the disease in which the atrophy is present, but has no fetor accompanying it. The latter is a much drier form with no secretions at all.