forget to examine the upper air passages and see if there might not be found sufficient trouble to cause it. An irritation of almost any part of the body, except the nasal cavities, has been said by good authority to produce it; and if so, why not an irritation of cavities so closely connected to the great center of the nervous system? I have examined the upper air passages of several persons, who had had epileptic seizures for several years, and in all of them found an inflamed condition of the membranes lining the nasal cavities. I do not wish to be understood that I think every case of epilepsy has for its cause nasal catarrh, but I think it should hold a prominent position among the causes. June 1st, 1882, D. C., æt. twenty-five, called on me, wishing to consult me in regard to his upper lip, which had been sore about one year. He said he had tried everything he could hear of, and several doctors beside, and nothing did him any good. On examination of the nasal cavities, I found a thin fluid leaking down upon the upper lip. I told him that it was this that caused the soreness, and that treating his nose would cure his lip. He said he would take treatment, but had spasms several times a week, and consequently could not come regularly. I told him. we would do the best we could, under the circumstances. During the first week, I applied a spray of vaseline anteriorly and posteriorly in the nose; and the second week applied, with Nos. 4 and 5 of Dr. Rumbold's spray producers, the following solution: B. Acid Tannic......... Glycerine (Price's). Aqua........... Mix. gr. ij. .3 ij. .3 ij. After making a thorough application of this, I coated the nasal membrane completely over with vaseline. I made these applications three times a week the first month, second month twice a week, third month once a week. After the first month, he did not have so many seizures as before; at the end of the second month still less in number; at the end of the third month, or during the last week, no spasms, the discharge from the nose stopped and the lip well. I heard from him six months afterwards; he had had no return. The only internal treatment given was iodide of potassium in the usual dose. V. B., æt. twenty-nine, Fort Wayne, Ind., runner for a wholesale paper house, called on me Sept. 8, 1882, stating that he had become unable to attend to business, on account of a sensation of falling forward; that he would often have to lie down, or would fall and become unconscious for a short time. Consequently he had to quit business several times. During the three years he had these attacks, he had taken treatment of several physicians, but all to no purpose. He thought he was gradually growing worse, and the attacks more frequent and severe. After making an examination, I found the membrane lining the pharynx and post-nasal cavities red, dry and glistening. Gave treatment of vaseline and pinus canadensis comp., making applications during the first month, three times a week, second month twice a week, and third month once a week, since which time he has been perfectly well, only he thinks he cannot stand a great amount of business as well as before having these attacks. I gave no internal treatment, whatever, except occasionally some quinine. Miss M., æt. 12, of Fort Wayne, Ind., was brought to me by her father, June last, stating she had had catarrh ever since she was three years old, and also had spasms, but did not expect help for them, as his physician told him they could not be cured. I made an examination and found she had ozona. I could not completely cleanse the nasal cavities for several treatments. After cleansing, I used fluid cosmoline, mixing with it one grain of carbolic acid to the ounce. I treated her every day for one month, every third day the second month. At the end of the first month, she began to improve. During the second month there was a decided improvement, seemingly in every respect, and no spasms; but, unfortunately, at this time my patient was attacked with typho-malarial fever. During the course of the fever she had no spasm. She is now convalescing and will soon be able to come for treatment again, which will be necessary, a her catarrh is worse and the spasms will likely return unless she takes treatment. as ARTICLE III. PHLEBITIS.* By H. C. FAIRBROTHER, M. D., of East St. Louis, Ill. Phlebitis, as the name implies, is an inflammation of the veins. The disease may be limited to a small section of one vein, or the entire trunk of the vessel, with many of its tributaries, may be involved. Some authors speak of phlebitis as an inflammation of the internal coat of the vein, but there is nothing to be gained from this fine distinction. The most frequent site of this disorder is the veins of the posterior part of the leg, although those of the uterus and various other parts of the body are sometimes subject to its ravages. In the majority of cases phlebitis is of traumatic origin, and it is maintained by some that it is always so, although the wound from which it arises may escape our notice, as in the phlebitis known as phlegmasia dolens, which proceeds primarily from traumatic uterine phlebitis. In this respect, phlebitis resembles very closely erysipelas. It may be either idiopathic or traumatic, and the manner of its origin has an influence upon its course and termination. Phlebitis from a wound is generally easily detected, more given to suppuration and less likely to assume the chronic form, while the idiopathic form of the disease is often obscure in its symptoms, rarely ever suppurative, and always chronic in character. This idiopathic phlebitis, although scarcely touched upon in the text books, has many interesting features, and, on account of the insiduous character of its early stages, its existence is often overlooked, and treatment rendered for various other maladies. Upon its first appearance, when there is little else but the pain to attract attention, this disease may be mistaken for rheumatism, for inflammation of the sheaths of the tendons and muscles (teno-synovitis), for neuralgia, for sciatica, or for syphilitic ostitis. In its later stages it may be mistaken for calcarious degeneration of the arteries. From the usual forms of rheumatism, affecting the joints only, phlebitis may be distinguished by * Read before the Tri-State Medical Society, Indianapolis, 1883. a consideration of the parts affected; but from muscular rheumatism, which it more closely resembles, it can only be separated by careful attention to the character of the pain. The pain in phlebitis is sharp and steady in position and without intermission; it is aching and sometimes throbbing; in short, it is the pain of inflammation. The pain of rheumatism is shooting, not so fixed in position and always intermittent, and there is often a rheumatic diathesis that assists in the diagnosis." From sciatica and other forms of neuralgia, this disease may be differentiated by attention to the anatomy of the parts and the kind of pain. In neuralgia the pain is cutting, shooting, and never so persistent as the pain of phlebitis, except in sciatica, and this disease may be known by the position of the nerve; also in neuralgia the pain. is not increased by motion and rather relieved, than otherwise, by pressure. In syphilitic ostitis, the pain is greatest at night and usually exists at night only, and is subject to iodide of potassium. Phlebitis may be distinguished from calcification of the arteries, remembering the anatomy of the parts, by attention to the early history of the disease, and by the fact that calcarious degeneration of the arteries rarely occurs except in old age. According to standard authority, this chalky formation in the arteries is peculiar to old age; but in a heart I had occasion to examine a short time ago, in a woman thirty years old, chalky deposits were found, and chalky degeneration of the arterial wall, near the entrance of the pulmonary artery. Phlebitis may be known from the inflammation of the sheaths of the muscles and tendons, (teno-synovitis) by the fact that in this disease, which is almost peculiar to the hand and forearm, the usual symptoms of inflammation are more prominent. There is heat, redness, swelling and tenderness on pressure, all of which are usually absent in phlebitis. The causes of idiopathic phlebitis are often exceedingly obscure. In most cases no cause can be assigned, except some influence having a depressing effect upon the nervous centres, by which their power for resisting disease is lessened. But this is also true of other diseases. Indeed, it may safely be said that debility is the parent of all disease; not muscular debility alone, because the muscular frame may be in vigorous health, while other forms of weakness exist, much more concerned in the introduction of disease. Excesses of various kinds, such as the intemperate use of alcohol, or the venereal indulgence, will expose the system to diseases that would otherwise never reach it; and the same may be said of certain mental emotions, such as sudden shock, grief, melancholy, disappointments, and especially the disappointments and anxieties in connection with the passion of love. Even contagious and epidemic diseases seem to follow this rule and attack the system only when at a disadvantage. I have often had occasion to observe a young man strike the city in the full flush and bloom of vigorous health, and for days and weeks continue to sound all the shoals and depths of the lowest forms of disease, and come out without a scratch. The system must undergo some sort of preparation, before disease of any kind can get a foothold, and this is especially true of idiopathic phlebitis. The following is a typical case of this disease*. On the 12th of March last, V. B., a ticket agent, married, thirtytwo years of age, somewhat irregular in all of his habits, was attacked by a fever in which the temperature ran exceedingly high for a period of three or four days, without the slightest intermission. Some pains were complained of about the extremities, but these were looked upon as the ordinary pains of pyrexia. Upon the subsidence of the fever, however, a severe pain was felt in the left popliteal space. There was no symptom nor sign of disorder but the pain. The ordinary local applications for the relief of pain were made, but without effect. The pain continued, with varying degrees of severity, for a period of two weeks, and gradually extended along up the inner side of the thigh. At this time, the corded and knotty condition of the internal saphenous vein was easily discernable. The severity and persistence of the pain were now over, but occasionally a sharp pain, lasting for a few hours or a day, would appear a little off the line of the original disease, and upon examination, it would be found that a tributary of the saphenous was involved, and its thread-like character could readily be followed up to the main vessel. These symptoms gradually disappeared, the patient improved, and now, at the present time, seven months after the first attack, the only effects of the disease remaining are some knotty protuberances along the vein, a little oedema of the foot and leg, and inability to walk but a short distance. The entire circulation and nutrition of the leg were damaged by the disease, *This was reported in the St. Louis Medical Society at the time of its occurrence. |