Stclair Thomson

THE OPENING OF PERITONSILLAR ABSCESSES

inflammation. Babies are born with adenoids, and there are emall children, who have never had a touch of acute tonsillitis whose tonsils yet meet in the middle line; neither are they to be called tumours in any strict sense of the word; neither are they evidence of any definite constitutional disease-such as rickets. or syphilis, or the predisposition to tuberculosis. We call them a local hypertrophy, but that name explains nothing. We know that the stores of lymphoid tissue throughout the body are proportionally greater in the child than in the adult; but that is a physiological affair, and enlarged tonsils and adenoids are pathological. Surely it is not unreasonable to suppose that the lympboid structures in the pharynx are under the influence of that natural tendency toward defective development which we see in the teeth and in the upper air passages. Crowded, irregular, and carious teeth; crowded and irregular air passages lined with a mucous membrane which is liable to general atrophy at puberty; crowded stores of lymphoid tissue which is liable to a irregular sort of hypertrophy-surely these three conditions may have a common origin in a gradual change of type. It is certain tbat our teeth in the course of ages are become wesk and ill-developed, and in a word, degenerate, and it may be that this degeneracy is at work also on the neighbouring and allied structures of the nose and the pharynx. For we know that the tonsils, like other organs which are in course of involution, are variable. Many people have no tonsils; that is to say, you can just discover, between the pillars of the fauces, a mere vestige of lymphoid tissue, which is, so far as we know, useless. Others have an excess of lymphoid tissue which is worse than ueeless. Surely this irregularity in size, and this apparent uselessness in function, suggest degeneracy.

OPTIC NEURITIS OF SPHENOIDAL SINUS ORIGIN: OPERATION: CURE

of the maxillary sinuses prevented stagnation in these cavities and its consequent back-pressure and reinfection of the deeper sinuses. The frontal sinuses drained spontaneously and were the first to clear. The drainage from the sphenoidal sinuses was encouraged by daily, or twice daily, introduction of strips of gauze (between the middle turbinal and septum) soaked in equal parts of 5 per cent. cocaine and adrenaline. I was very glad that I had refrained from any operative treatment on these deeper cavities. The traumatism entailed might only-in such an acute infection, and in the narrow and sensitive nose-have resulted in further blockage to the outflow and might possibly have spread infection to other areas through the blood or lymph streams. Pain, insomnia, fever, and other symptoms were treated on general principles. Local warmth (by woollen nightcap and radiant heat) gave relief. I have never seen a fatal case resulting directly from acute sinusitis, diagnosed in good time, and treated on the lines described in this paper. In the two fatal cases of sphenoidal sinusitis which I have referred to, secondary infection of the meninges or cavernouis sinus had developed before the patients came under observation. The care taken of the present case was successful in feniding off all-complications, except the curious acute thyroiditis. This, I imagine, was an infection via the lymphatics, from the pharynx or tonsil, due to the pus descending from the sphenoidal sinuses. The moral I venture to draw from this case is that all cases of acute sinusitis should be regarded with much more consideration than they generally receive. If carefully treated there are very few which would not recover completely. Most of the chronic cases seen in practice and requiring operative treatment commenced originally as acute cases. Had they then been treated carefully, they would not have drifted into the chronic infections which entail so much ill health and often demand prolonged attention and sometimes anxious operative measures. The treatment of acute sinusitis is largely in the hands of the family physician. Except for exploratory puncture and lavage of the maxillary sinuses, operative treatment is rarely called for in an acute case.

Observations on the Cerebro-Spinal Fluid in the Human Subject

One of us (StC. T.) has had under his care for some years a young woman who has suffered from continuous dripping from the nose. The case has not been amenable to any treatment. At first it was thought to be one of nasal hydrorrhœa, but certain characters in the affection convinced the observer that this could not be so, and that the fluid, which dropped from one nostril only, was cerebro-spinal fluid.

Laryngology and Rhinology

it, the alkaloid was difficult to obtain, and was very expensive. But these difficulties were soon overcome, and for many years now cocaine has so far superseded the use of a general, anaesthetic in eye surgery, that for anaesthetic purposes little else is used. Shortly after it began to be generally employed, however, the brilliancy of its effects were somewhat dimmed by sinister reports that surgeons were beginning to have bad results in their cataract cases in consequence of suppuration. These results were attributed to the cocaine, and the conclusion was arrived at that possibly septic matter was conveyed to the eye by means of the special cocaine preparation employed. The rule was, therefore, deduced that cocaine solutions for ophthalmic operations should be freshly prepared, and made up with some appropriate antiseptic. The outcome of the observance of this rule was that the confidence in the drug was at once restored, while as its use increased the value of its advantages became more and more recognised.