WITH THE COMPLIMENTS OF THE AUTHOR. DISEASES OF THE MAXILLARY SINUS —BY— EDWARD BORCK, M. D„ \/ ♦c . j MEMBER OP THE MEDICAL AND CHIRURG1CAL FACULTY OF MARYLAND AND BALTIMORE MEDICAL ASSOCIATION; 8T. LOUIS MEDICAL SOCIETY : MISSOURI STATE MED. A8S.; TRI-STATE MED. SOCIETY ; FORMERLY ASsT SURGEON TO WEST BUILDING HOSPITAL, BALTIMORE, MD., AND LATE SURG. U. S. VOLS., ETC. OIF" ST. 3L.OTTXS, ILvdIO. REPRINT FROM INDIANA MEDICAL REPORTER, EVANSVILLE, INDIANA. i860. PROSPECTUS THE INDIANA MEDICAL REPORTER A MONTHLY JOURNAL OF MEDICINE AND SURGERY, Is published at Evansville, Indiana, about the 10th of each month, by the Editors, A. .VI. Owen, M. D., J. E. Harper, M. D., Benj. F. McCoy, M.D. Each Number contains forty-eight extra large octavo pages of the best and lat- est Medical Literature, printed on fine rose-tinted paper. 1 he Editors have made arrangements with some of the best men in the Profes- sion, both in this country and in Europe, who will contribute original articles, and able correspondents will f urnish the latest experience in the large hospitals of London, Paris, Vienna, New York, Philadelphia, and our Western cities. Special attention will be green to Articles on Medicine and Surgery, as practiced in the Ohio and Mis- issippi Valleys. The aim of the Editors in adding another to the already extensive list of Medical Journals is, to supply to the Profession in the West and South at a moderate cost, a thoroughly reliable, first-class Journal, fully up to the requirements of the present ad- vanced stage of Medical Science. OPINIONS OF OUR COTEMPORARIES. The Indiana Medical Reporter is the title of a sprightly new journal hailing from Evansville. *** The city of Evansville has a population of about 50,000, and is the center of a rich community and reason- ably there should be enough < rofessional material and pride to give a healthy support to this new enterprise (Obxtetric Gazette ] We have received the first number of The Indiana Medical Reporter ** It is an octavo, 48 pages, printed on tinted paper, and presents a very creditable appearance. We wish prosperity to the new enter- prise.—(Toledo Med. and Surg. JournalJ * * * It has all the appearances of push and success.—(Virginia Medical Monthly.) The Indiana Medical Reporter will compare favorably with 'he oldest and best monthlies We hope the Reporter’s expectations may be fully realized (Medical Herald, Louisville, Ky.) * * May The Indiana Medical Reporter live long and prosper.—(fjruUwillc Medical Newx.) >j <• <• May it prosper and be very useful.-(SI. IjOuIh Courier of Medicine It presents a very creditab e appearance, "*nd bids fair to succeed in the rich and populous district of which the thriving city of Evansville is the center —(SI. houis Clinical Record.) It is very neatly gotten up on tinted paper.—(Ohio Medical Recorder.) A personal knowledge of the superior professional and literary attainments of the editors, leads us to predict for The Reporter a career, of great usefulness to the medical profession in its territory [Cin- cinnati Lancet and Clinic.] * Subscription Two Dollars per annum in advance. ADDRESS: INDIANA MEDICAL REPORTER, 501 Upper First Street, EVANSVILLE, IND. 13 DISEASES OF THE MAXILLARY SINUS. BY EDWARD BORCK, M. D., ETC., ST. LOUIS, MO. 702 Olive Street. fljr he Antrum Highmorianum, was named after Nathaniel Highmore, a sur- II i geon of Oxford, because he wrote on the surgical diseases of this cavity i and published many useful hints, especially on fistula in 1651. The cavity however was well known by anatomists long before him, and under- stood of course at present; nevertheless, it is always well to recall to our memory the anatomy of any part, before studying the diseases thereof. I shall not take up time and space with its study, the reader is referred to any good anatomical work, but would say that the branches of the nerves and bloodvessels supplying, and the membrane lining this sinus deserve some attention, the latter on account of its secretion and susceptibility to congestion. A mucous discharge from any artificial opening from this cavity may be mistaken for pus and the patient subjected to unnec- essary treatment; and again, some of the natural openings may be closed, and thereby a collection of mucous retained in this sinus, which may also be mistaken for an accumulation of pus, or an enlargement pro- duced by such cause, for a more serious trouble. Diseases of the antrum are more frequent, than is generally sup- posed, the most common is inflammation followed by suppuration; the causes of inflammation are various, it may be idiopathic in the first place, then develope and be succeeded by destruction of the surrounding parts, again it may be traumatic, as for instance : a penetrating or gunshot wound, which produces destruction and then inflammation, or it may be caused by a carious tooth, (the most frequent source of disease of the maxillary sinus), or by a fall or blow, or by necrosis of the alveolar pro- cess, etc., etc. The early symptoms of a simple idiopathic inflammation of the maxillary sinus is somewhat obscure and difficult to recognize before any external changes have taken place, though the symptoms are the same as in all other inflammations, hence the surgeon should be on his guard, and learn to diagnose and treat it early to prevent complica- tions. If a patient presents himself with all the symptoms of acute inflam* mation, but no external abnormalties, how are we to discriminate? An increase of all these symptoms and some externally developed manifesta- tion may call our attention to the direct trouble at once. On the other hand, if the symptoms have already been lessened by treatment, or the acute stage has subsided spontaneously, when we first see the patient, and he is complaining of dull permanent pain in the region of the sinus, which 4 extend up to the eye, when pus is escaping from the nostrils, when the head is bent on the opposite side to that affected, as sometimes met with when blowing the nose mucous escapes, then it is not so difficult to know what is the matter. If in addition to this, the cheek be swol- len, we should at once distinguish, whether the soft parts only are affected, or whether the maxillary bone is arched or swollen out, whether the inflammation is only external to the sinus or within its cavity. In the first the pain is exclusively external, in the second inter- nal, and the touch is the best guide: external swelling is always more or less moveable, the tumefaction not so hard, while the swelling of the bone is always hard and not moveable. Again we may see a case with a swell- ing of the upper jaw like a tumor, this swelling may be fluid only, and communicate with the sinus; if decayed teeth are present, extract them at once, the fluid may escape and the tumor disappear, and thereby avoid giving an incorrect opinion. The anterior walls of the sinus are very thin, therefore abscesses and fistulae are easily produced and frequently met with; we also meet from time to time with patients who have had for years a fistulous opening upon the cheek, or below the eye, or in the roof of the mouth that com- municates with the antrum, which may be cured by a counter opening into the sinus, after having resisted all other treatment. In regard to the treatment it must be conducted upon general prin- ciples, both constitutional and local: first of all subdue the inflammation; second, if there is an accummulation of fluid or pus, establish an opening for its free evacuation. To do this we may select a point of necessity, that is a fistula, or any carious part of the maxillary bone, or by the extraction of any decayed teeth. ‘ ‘ Let me here call attention to the precept of warming the forceps before using them to pull a tooth, by doing so, we will save the patient much pain and the disagreeable feeling of cold steel.” Or, we may be obliged to elect a point, for instance, where all the teeth and bone are sound, then the last molar should always be extracted and the perforation made there. However the crowns of the teeth may all appear sound, and notwithstanding the one or the other may be dis- eased on the point of their roots, this we may be able to know, by strik- ing the teeth with a steel instrument, the diseased one will make itself known at once, by the sharp pain produced, then that one should be removed, and we often find pus following at once, caries having already destroyed the thin layer of bone over the root of the tooth. Sometimes the roots of all the molar teeth enter the cavity naturally and are only covered by the pituitary membrane; sometimes the roots of one only enter, generally the second molar. I had a specimen in my possession where all the roots of the molars and second bicuspid entered the sinus, and occasionally we may find the first bicuspid to do the same, and also 5 the canine tooth, if the roots are very oblique, but it is very rarely met with. But if the teeth are all sound and the patient objects to loosing one, an opening has to be made through the alveolar, and the best and easiest point to elect is a perpendicular line with the second molar, between its two anterior roots, making a transverse incision through the gum and periosteum as high up as the points of the roots, an opening here is very easy and quickly made with a dental drill and engine, if not at hand, any other method may do, the opening may be enlarged at pleasure. We may also meet with a case where but one decayed tooth has been extracted and the opening cannot be enlarged there, and there is not room enough for the complete evacuation, and the purulent discharge may persist, and we may be obliged to resort in addition to a side opening. In the memoir of Mons. Lamerier, a case is recorded where he was obliged to resort to this, the opening left by the tooth permitted air into the sinus, and the patient spoke like one whose palate was open, particles of food found their way into the cavity, and it took a long time to heal. This evil may now be remedied by plugging the hole temporarily with carbolized cat- gut and thereby save the patient that annoyance. To produce a cure after such an operation, injections of iodine, carbolic acid or other medicated fluids may be employed according to indications. I generally use a simple solution of luke-warm salt water. Injections into the antrum may also be attempted by the natural openings, but it is very difficult to accomp- lish. It is also advisable never to perforate through an old alveole where the teeth have been removed a long time, the bone is there too dense. What other diseases do we meet with in this cavity ? Polyps and fungous excrescences, the lining membrane of the maxillary sinus may give origin to, the same as in the nostrils. Hemorrhages may also occur into this cavity. Cystic, fibrous, cartilaginous tumors. Sarcomatous, car- cinomatous tumors, atrophy and hypertrophy which involve more or less the whole maxillary bone. Another complaint that deserves mentioning is neuralgia. Every prac- titioner meets with this no doubt, it occurs chiefly in old indentulous per- sons, it is caused by compression of some nerve in the atrophied alveolar process, and extends often into the sinus. Dr. Sami. D. Gross, I believe, first called attention to it. If general treatment fails, excision of the bone has to be resorted to. Most of the so-called neuralgic pains depend upon congestion of the lining membrane of the antrum, produced by some irritation. In conclusion I will say, if the people could only apprehend the mis- chief a decayed tooth or root is capable of producing and the conse- quences that may follow, they certainly would not suffer and bear the pain as long as they do and thereby injure their health. Volumes might be written on this subject, but may these few remarks be sufficient, with the hopes, that they may benefit some one. JgtMfj*! fttUtgt of g§*$t*$*t|fe<. Member ol the Association of American Medical Colleges. CLINICAL ADVANTAGES. THE COLLEGE DISPENSARY—Under the immediate control of the Faculty, being sup- ported by the city, is an invaluable adjunct to the College, and of great practical value to the student It furnishes an extensive field of observation, enabling the student to acquire proficiency in the art of examining, diagnosing and prescribing for patients, and becoming familiar with bandaging and other manipulations connected with minor Sur- gery. Advanced students, in addition to cases of obstetrics, will have patients in other branches entrusted to their management, under the supervision of the Professors. About 5,000 patients are treated annually at the Dispensary Clinics are held here every day at from 1 to ‘2$ P. M. ST. MARY'S HOSPITAL—This is an admirably arranged and commodious charity, con- structed at a cost, originally, of over one hundred thousand dollars, as a United States hospital It belongs to the Sisters of Charity, who superintend its management The Medical Staff, being members of the College Faculty & U. S Marine Service hold clinics free to the medical class every Wednesday and Saturday It is believed that the opport- unity for bedside observations at this charity affords advantages in Diagnosis and Thera- peutics unsurpassed as aids to medical studies by any other institution of the kind, espec- ially to those who expect to practice their profession in the West or Southwest The var- ious operations performed here furnish examples in every department of Surgery. The marines under treatment at this port, together with a large number of other patients, keep the one hundred and ten beds in the hospital generally occupied. COUNTY ALMSHOUSE AND HOSPITAL—This large county charity is the recepticle of a great variety of acute and chronic cases. These cases embrace the diseases generally pe- culiar to this climate, together with the various forms of chronic diseases found here and elsewhere The institution has always been subservient to the College, and students are admitted without charge. Under existing circumstances and such facilities for instruction, we are convinced that our advantages will meet the reasonable demands of the student and challenge the in- vestigation of an enlightened Profession ; and hence the Institution claims that its Di- ploma shall be ample evidence of true professional merit, of the possession by its pos- sessor of genuine knowledge of medical science, embracing the various branches which fill the requirements that constitute Medical Education GEO. B. WALKER, M. D., Professor of Principles and Practice of Obstetrics. H. G. JONES, M. D., Professor of Principles and Practice of Medicine and Clinical Medicine. JOHN W. COMPTON, M. D., Professor of Materia Medica and Therapeutics. A. M. OWEN, M. D., Professor of Principles and Practice of Surgery and Clinical Surgery. F. W. ACHILLES, M. D., Professor of Chemistry and Toxicology. M. J. BRAY, M. D., Professor of Military and Clinical Surgery. MEDICAL FACULTY. EDWIN WALKER, M. D., Professor of Anatomy and Diseases of the Nervoit* System. C. P. BACON, M. D. Professor of Diseses of Women. W. R. DAVIDSON, M. D., Professor of Physiology and Pathology. J. E. HARPER, M. D., Professor of Diseases of the Eye, Ear and Throat E. LINTHICUM, M. D., Professor of Genito-Urinary and Venereal Diseases and Clinical Snrgery.. W. A. WHEELER, M. D. Professor of General and Surgical Anatomy. ISAIAH HAAS, D. S., Lecturer on Dentistry and Dental Surgery. The Fee for Admission to the entire Course of Lectures is $50 00 Matriculation Fee 5 00 Demonstrator’s Fee 5 00 Graduation Fee < 25 00 Admittance to the Hospital free. The Fees are payable at the commencement of the Lecture Term The Graduation Fee during the first week of February. For An- nouncement or other information, address, G. B. WALKER, M. I)., Dean, 502 Upper First Street, Evansville, Ind.