complications. They are always paralyses due to compression. The anaesthetic plays a very indirect role in this etiology, merely favoring the involuntary and accidental compression of the nerve trunk or the roots of the brachial plexus.

It is impossible to demonstrate any toxic action of the anæsthetic upon the nervous system. That action remains hypothetical. The treatment recommended is (a) preventive - to avoid during anesthesia forced elevation of the arms, and to see that the arms and legs are not compressed by the weight of the body; (b) curative; the hemiplegic accidents and the hysterical forms need special treatment. The peripheral paralyses should be treated with faradization, if possible, except when there is degenerative atrophy. The reflex paralyses should be treated by reducing the irritability.

OPHTHALMOLOGY

Edited by C. M. Culver, M. D.

Conjunctivitis Folliculosa and Trachoma. In the issue for July, 1889, of the American Archives of Ophthalmology is an article by Dr. O. Walter, of Odessa, on this subject. In recent times the interest in trachoma has increased and many attempts have been made to understand this still ill-defined subject. One writer speaks of follicles, another of granulations, and a third considers the tissue infiltration the essential part; and Axenfelt is right, according to Walter, when he says: 'There can be no chapter in ophthalmology where the number of personal opinions is so large as in that of trachoma. In the absence of certain proof of the parasitic origin of the disease, every one attempts to establish an etiological basis for his opinion, which, however, need be binding on no one else." Unfortunately, such an objective attitude is not universal, and the contention about follicular conjunctivitis has led to a division into two camps, dualists and unitarians, in neither of which is the objectivity always sufficiently observed.

Professor Greef, in his recent Studien ueber epidemische Augenkrankheiten, says: "First of all, the impossible unitarian standpoint must be given up." Again he writes: "If I look through the current literature, the specialists who adhere to the so-called unitarian standpoint, that is to say, a transformation of follicles into trachoma granules, are approaching the vanishing point. Whoever thinks in the modern scientific manner can no longer maintain this principle."

Raehlmann is one of the leaders of the unitarians and Walter, as his pupil, takes that side in this article, declaring that he has never found it necessary to have a disease sui generis in order to dispose of the cases which shall be mild trachoma or severe follicularis. He quotes many of the dualists, showing that they are not in harmony with each other in their tenets, and from this assumes that there is a lack of precision in their definitions, and little agreement on certain points which are essential to the clinical separation of the two diseases. He says that most

of them acknowledge that a differential diagnosis between conjunctivitis folliculosa and trachoma cannot always be made at once. For example, Greef states that in West Prussia, among 3,025 inhabitants, there were 299 with trachoma and 390 cases designated as suspicious. So, concludes the author, Greef could not make a diagnosis in the majority of cases, and Kuhnt's statistics show the same difficulty. With reference to Greef's assertion, that the unitarians are approaching the vanishing point, Walter quotes a formidable number of Russian specialists who, with their large opportunity for the study of trachoma, are of the same opinion as Raehlmann. According to Raehlmann, Pick and Feodorow, the follicles may disappear entirely, leaving no trace, or they may be sclerosed, or, in severe cases, a superficial ulceration leads to an escape of the contents. The writer, then, and those of his faith, do not believe that follicular conjunctivitis becomes trachoma, but that it already is trachoma.

From this standpoint he believes that regions said to be free from trachoma are becoming rare, and that places should be described as having malignant or benign forms of the disease, as one speaks of malarial districts.

Headache and Affections of the Eye.-Dr. RISLEY, of Philadelphia, read a paper before the section on Neurology of the American Medical Association, at its 1899 session, on "The Relation of Headache to Affections of the Eye" (The Philadelphia Medical Journal, 23 September, 1899). The subject is treated in a very dignified way and with no suggestion of hyperenthusiasm; a vast deal of clinical experience is ably interpreted and from it the following conclusions are deduced:

I. That abnormalities of the ocular apparatus are in a large group of patients the sole and sufficient cause of headache.

2. That these abnormalities of vision may be the unsuspected cause, and, therefore, that the absence of symptoms obviously referable to the eyes does not exclude them as an etiologic factor in headache, insomnia, vertigo, petit chorea in children, and certain stomach derangements. 3. That the recent or sudden development of symptoms, e. g., after attack of severe illness, as typhoid fever, the exanthemata, etc.; or in association with more or less acute exacerbation of some general dyscrasia, is not sufficient evidence against ocular participation in causing the symptoms.

4. That the participation of the eyes as an etiologic factor in headache can be positively excluded only in the absence of ocular disease, or after the most painstaking correction of any existing error of refraction or abnormality of binocular balance.

5. That, for the relief of reflex symptoms, accurate corrections are essential, and that these can be secured only by the more or less prolonged use of a strong cycloplegic.

6. That immediate relief by these corrections, in a large group of patients, is not to be expected, since the pain is frequently due to associated pathologic conditions of the fundus oculi, and these require time for cure.

Resection of the Sympathetic in the Treatment of Glaucoma. In No. 18 of the Wiener klinische Wochenschrift for 1899 JONNESCO writes on this subject.

Since his first attempts at the cure of glaucoma by resection of the cervical sympathetic, in September, Jonnesco has operated eight times, the results accruing in which cases he briefly relates at the outset of this paper on the subject. The cases are thus summarized by the author: one of acute glaucoma, one of chronic, irritable glaucoma, three of chronic glaucoma absolutum with irritation, and three of glaucoma simplex. The results following upon operation are thus grouped by him also: (a) in every instance immediate and lasting reduction of the tension of the eye; (b) marked contraction of the pupil, which was also permanent; (c) disappearance of the accompanying headache; (d) cessation of exacerbations; (e) noteworthy and lasting improvement in vision in all tho examples in which retention of light perception or vision indicated that the process had not gone on to atrophy of the optic nerve. This improvement in sight was very remarkable by reason of its immediate occurrence and its constant advance, particularly in one or two of the cases, but it did not occur at all in two of the cases of glaucoma absolutum, nor in that of acute glaucoma.

He quotes Panas and Duvigneaud as saying that only when the nervous mechanism of intra-ocular secretion, that is, the action of the nervous system upon intra-ocular tension, has been elucidated, can the pathology of glaucoma be fully explained, the action of iridectomy understood, and the treatment of the disease—possibly by some different methods from those at present in vogue - be placed upon a thoroughly scientific basis.

Donders regarded the fifth nerve as the probable offender, bringing about an increased secretion; according to him, section of the fifth nerve caused reduction of tension, while section of the sympathetic had no influence; but these opinions have been shown to be incorrect by Wegner, who proved that the fifth nerve has no influence on tension, while section of the cervical sympathetic brings about its reduction. The different opinions of several authors are quoted; Jonnesco says that however stimulation of the sympathetic may bring about the result, clinical evidence shows that such result is dilatation of the pupil, contraction of the small intra-ocular vessels, energetic contraction of the peri-bulbar, unstriped muscular apparatus and probably increased activity of the secreting mechanism for the aqueous humor, thus bringing about increased inflow into the eye at the same time that the means of outflow are diminished — in other words, glaucoma. Where is the original seat of the damage to nerve balance which leads to glaucoma? This author thinks it central, not peripheral; that there is irritation of encephalic or medullary centers from which fibers run to the sympathetic; though removal of the superior cervical ganglion does not eliminate the source of the disease, it does effectually and permanently close the route by which the evil comes; it will be chiefly in those forms of glaucoma in which the nervous element is strongest that most good

will be done by this heroic method of treatment. Simple glaucoma will be most tractable by it, while those in which acute exacerbations are an important feature will be less amenable. Thus Jonnesco's operation will be most serviceable where iridectomy is least so, and vice versâ. The author considers mere division of the sympathetic trunk to be of very small value indeed as a substitute for resection; he finds fifteen minutes sufficient time for the bilateral operation; after it is completed there are observed congestion of the face, eyes and nose, lachrymation, and headache, all which symptoms disappear in about a day's time, but there remain, permanently, contraction of the pupil, sinking of the globe into the orbit, a slight degree of ptosis, and narrowing of the palpebral aperture. As regards the visual condition, there is at once an improvement in the patient's sight, which goes on increasing day by day, and at the same time the circumorbital pains and the headache vanish, after the immediate effect on the cerebral circulation, produced by the loss of the ganglion, has passed away; occasionally there is slight dysphagia. One of Jonnesco's cases was a patient who suffered both from glaucoma and from exophthalmic goitre; both conditions were cured by the one operation.

LARYNGOLOGY AND RHINOLOGY

Edited by C. F. Theisen, M. D.

Blue Nasal Secretion.-At the Congress for 1898 of the French Society of Otology and Laryngology, M. MOLINIE of Marseilles reported the history of a young woman, 25 years old, in whom, after an attack of grippe there occurred a discharge of blue secretion from the nose. Examination of the nasal fossa demonstrated that the source of the secretion was the right middle meatus. Cultures showed the bacillus pyocyaneus.

Two Cases of Foreign Bodies in the Air Passages.-A. E. WIGG, in Internat. Centralbl., etc., Feb., 1899.

Case 1. That of a boy 4 years old, who, while eating, had a sudden attack of suffocation. The child was brought to the hospital in an unconscious condition, where rapid tracheotomy was done. The larynx and trachea were firmly held between the index finger and thumb of the left hand, and trachea cut down upon with a few rapid strokes of the knife; without fixing the trachea, it was opened and held apart with a forceps. A piece of bone was taken out, which had lodged between the vocal cords. The author states that if the operation had not been so rapidly done the boy's life could not have been saved.

Case 2. A woman, 30 years old, had had some teeth extracted under ether. One had slipped from the forceps and disappeared. Since that time patient had coughed after any attempt to move or talk. A tracheotomy was done, but the foreign body was not coughed out. Patient died, and at the autopsy a left sided empyema was found, and a bicuspid was discovered wedged in a small bronchus of the left lung.

ALBANY

MEDICAL ANNALS

Original Communications

PRESIDENT'S ADDRESS:*

REMARKS ON RETROPHARYNGEAL ABSCESS AND PULSATING EMPYEMA, WITH REPORT

OF CASES

By J. L. ARCHAMBAULT, M. D.,

Cohoes, N. Y.

Mr. Vice-President, Gentlemen:

A few moments more and this session will be a thing of the past. Before bringing it to a close I desire to thank you again for the honor conferred upon me when, a year ago, the Society elected me to its highest office. In this position, which I have held through the kindness of men much better than myself, I am very happy not to have lost sight of the motive which prompted them to call me from the rank and file to this exalted station; they had in mind to be partial to the "Cohoes Profession." I would now give a very imperfect expression to my sense of gratitude should I fail to refer to those whose representative I happened to be, the whole merit of the honor I received on that occasion.

As I look back, my gratification would be unsurpassed could I only retire with the conviction that your expectations were not disappointed and that I have served my term with both assiduity and competency. As anticipated, very few have been the meetings at which I have presided, and about *Delivered before the Albany County Medical Society, May 9, 1899.