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tral irritation or paresis. This characteristic irritability may pass away with the subsidence of the attack, or may be more or less constantly present in the interregnum, ac- cording, presumably, to the amount of structural injury which the nerve-centers have undergone. This secondary hyperaesthesia may be brought about, then, if my view be accepted, either by a direct impression made upon the ter- minal nerve filaments in the respiratory mucous membrane, or by an indirect influence conveyed or reflected through the vaso-motor centers from a distant organ ; or, finally, Order Ditropan from an excitation starting in the centers themselves. The hyperaesthesia met with in these conditions may be general, or localized in individual segments of the respira- tory tract. In either case, while all portions of the tract as Oxybutynin Online a whole or in part Cheap Ditropan may share in the general hyperaesthesia, there are certain areas in which the latter is usually more pronounced, in which a greater susceptibility to the impres- sions by which reflex Generic Ditropan acts Buy Cheap Ditropan are produced is discoverable, and in which may be most conveniently and satisfactorily studied the vaso-motor manifestations of this special class of neuroses. These are : In the nasal passages, the area covered by erectile tissue, and chiefly that portion found in the lower and posterior portions of the nostril (posterior end of inferior turbinated Order Oxybutynin Online body and erectile tissue in the septum immediately opposite — reflex sensitive area) ; in the pharynx, the vault and posterior wall ; in the larynx, the inter-arytenoid commissure; and, in the trachea, certain areas along its posterior wall. It is worthy of notice that, roughly speaking, it is the lower and posterior portions of the individual segments of the respiratory apparatus where these sensitive Purchase Ditropan areas have been shown to exist. According to Buy Oxybutynin my belief, then, these affections are inti- mately related to some disturbance of the sympathetic nerve, and probably a deranged condition of the vaso-motor centers themselves.* The neurasthenic phenomena, what- ever the condition may be upon which they depend, may, as has been pointed out above, be due entirely to a primary irritation or well-defined disease in the nostril or in other parts of the respiratory tract, but until this condition is produced the Buy Oxybutynin Online case is simply one of ordinary nasal inflam- mation, and does not become true vasomotor coryza unti the nervous apparatus is markedly involved. Generic Oxybutynin In other words, in considering this affection we Buy Cheap Oxybutynin are dealing with a neurosis, or, at least, with an affection in which the neurotic element plays the essential and most conspicuous part. In addition to the arguments already advanced in favor of this view, I desire Purchase Ditropan Online to call attention to the existence of a hitherto undescribed neurosis of the aural apparatus closeh T allied or analogous in aetiology, mechanism, etc., to vaso-motor coryza, of which I have seen one case, which will be published in due time. Suffice it to say here that in this affection we have to deal with, if we may thus ex- press it, a sort of hay-fever of the ear. When to this we add the receut observation of Dr. Order Ditropan Online Gradle f concerning a periodical affection of the conjunctiva closely analogous to hay-fever, we have, it seems to me, additional evidence in favor of the sympathetic origin of the affectiou under re- * For nn elaboration of this point, see especially " Am. Journal of the Med. Sci.," Oct., 1885, he. cit. f "Am. Jour, of the Med. Sei.," April, 1886. Feb. 26, 1887.1 MACKENZIE: RESPIRATORY VASO-MOTOR NEUROSES. 233 view. In vasomotor coryza the area over which the reflex vms. '-motor disturbances are manifested is chiefly the terri- tory which receives its vaso-motor nerve-supply from the sphenopalatine Buy Ditropan ganglion ; in the Order Oxybutynin aural neurosis, the phe- nomena are localized or Purchase Oxybutynin Online more pronounced in the area pre- sided over by the otic; in Dr. Gradle's cases of recurring conjunctivitis the parts involved are supplied by the oph- thalmic, and so on. I would also refer to two additional observations which I have made, and which are of especial interest in view of the probable vaso-motor or sympathetic nature of the affec- tion — viz., the occasional marked swelling of the thyreoid gland, and to an enormously swollen and congested condi- tion of the auricles analogous to that of the rabbit's ear in the famous experiment of Claude Bernard upon the cervical sympathetic. I have said Purchase Oxybutynin above that the two areas most frequently and notably concerned in these respiratory vaso-motor dis- turbances are the nasal passages and bronchial tubes. This leads me to refer briefly to the question of asthma and its relation to nasal disease. To Voltolini is universally and erroneously attributed the credit of pointing out this inter- esting relationship. That the asthmatic paroxysm is not infrequently associated with or terminated by a discharge of mucus or serum from the nasal passages, is a fact which was familiar in ancient times. Tints, among others, Coelius Aurelianus,* in speaking of the diagnostic value of an excess of mucus in connection with the so-called "convulsive asth- ma," after commenting on its various symptoms, proceeds to say : " At si gravior impetus superpositionis fuerit, ora Ditropan Online cegro- tantium livescunt, et quidem excluso per nares humore m/ici- lento, rclavuiitur, atque prcefocationis carent metu, quod non aliter cedit, etiamsi per oculos lacrimarum fuerit Jtuor," He also gives a cold in the bead (gravedo) as a symptom of asthma. It was not, however, until centuries afterward that Zecchiusf described an asthma whose cause he as- cribed solely to a catarrh of the betid, Buy Ditropan Online whose premonitory symptoms were a pain in the head, a distillation from the nose, and a small cough, and whose treatment consisted in the use of the ordinary remedies directed against catarrh of the head. I have called attention, too, clsew here,J to the "suffocative catarrh "' of Schneider, and the "anniversary asthma" of Floyer, as bearing upon this relationship. I may add that the association of asthma, whooping-cough, and sneezing was also observed by Josef Frank.*

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