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broken up to take a more dorsal course. This Purchase Caduet Online portion, however, re- sumes the characteristic relations in the caudal half of the pons. The deviation corresponds to a gangli- onic intercalation described by Rol- ler, which is reticular, like a trellis- work. It is found at the point where the tegmentum is most re- duced in its dorso-ventral diameter (owing to the exclusion of the teg- menta brachium and the inferior cerebellar peduncles from this field). ' In transverse sections at this level a distinct field is seen, dorsad of and encroaching on the trellis-work ; it extends to the raphe and overlaps the mesal end of the liorizontal lemniscus field ; this is probably the (diverted) dorsal part of the inter- mediate tract. Every specimen in my possession indicates that a large part of this fasciculus becomes lost in the sub- stantia nigra. At the same time a portion continues directly forivard as in the dog. This part has been regarded by Wernicke ° as a bundle from the pes to the lemniscus. It is accurately represented in Figs. XIII., 50, 52, and 53 (/,/'), but there is a curious inconsistency. In Fig. 48 he represents this fasciculus as giving off the most anterior transverse pons fibres, as if it exhausted itself in their formation, while in the level above and be- low this one he has the fasciculus divided transversely and occupying identical situations. He has undoubtedly confounded it with another bundle in this section. This bundle, correctly named by Wernicke, lies on the latero- dorsal aspect of the prepontine fossa, where the pes is free of the pons, it occupies the slope on each side Purchase Caduet of the interpeduncular depression. As Wernicke in Fig. * The projection'system of the brain axis is to the cerebellum of certain tracts from above ' Lehrbuch. r of which has been Caduet Coupon ( Generic For Caduet October i8, 1884.] THE MEDICAL RECORD. 427 XII. (p. 89) terms a bundle occupying a corresponding situation the ansa lenticularis (Linsenkernschlinge), it is possible that through the intervention of this fasciculus ■ Fig. 12.— Section Diagonal to the Sagittal Plane, Deviating Lalerad above, through (X iX-) t. posl-comu : 2, 4, optic radiations of Gratiolet (hemianopsia tract) of caudate nucleus {t:audex corporis striati)\ 6, 9, muscular sense tract voluntary motor tract (the reader must not be misled by its nj>pareitt relati lenticular nucleus, which is not touched in this section and extend: back)!; I r, 12, lenticular nucleus {putamen and middle articulus) ; fields ; 22, direct myeloM:erebellar tract ; 24, dentate nucli 7, geniculatu Monkey's Br; , radiations of lemniscus i (?) : 8, 10, posterior part of :i to the posterior part of the ■oiding this plane, much farther ic chiasm : i8, 20, 25, lemniscus, of cerebellum ; 26, geniculatimi thalamic lamina:. it reaches the higher destination. The optical appear- ance of Buy Caduet the two bundles in their designable course is dif- ferent. (To be continued.) CORYZA VASOMOTORIA PERIODICA ("HAY ASTHMA") IN THE NEGRO. With some Remarks on the Etiology of the Disease.' By JOHN N. MACKENZIE, M.D., SURGBON TO THK HALTIMORE EVE, KAR, AND THROAT CHARITY HOSPITAL. The absence of so-called " hay asthma " in the negro has been brought into prominence by recent writers on the subject, and notably by Beard, as an argument in favor of the imi)ortant role which race is supposed to play in the etiology of the disease. The following case derives its peculiar interest from the fact that, so far as I am aware, it is the first recorded instance of the affection in a race in which the possibility of its occurrence has been denied. J. M , aged thirty-five, unmarried, a tall, well- proportioned, respectable colored man, came, September 6, 1884, to my clinic at the hospital to be treated for " hay asthma." His history may be briefly summed up as follows : He has always been remarkably healthy, with the exception of Caduet Dose a tendency to catch cold upon exposure to the most trivial exciting causes. Ever since his ear- liest recollection, the emanations from hay have invari- ably excited a coryza of great severity, lasting from three to seven days and then subsiding. Handling hay at any season of the year, or even unpacking articles enveloped in straw, Caduet Tablets always bring on sneezing, lachrymation, flushing of the conjunctivre, and obstruction of the nostrils. For the past four years has had an almost constant sensation of " stuffiness '' in the nostrils, with dyspnoea on exertion accompanied by a slight post-nasal discharge, and the attacks of coryza have become much more frequent and have been associated with distressing asthma. The attack is ushered in sometimes by a tickling or itching sensation in the upper and back portion of the throat and nose, sometimes by violent sternutation. The ■ Read before ihe Clinical Society of Maryland, October 3, 1884. nostrils become suddenly obstructed, a' profuse watery discharge is excited, the eyes become red, swollen, and painful, and the lids Caduet 10 Mg slightly puflTed. There is always in- creased lachrymation. Cough is some- times present, but forms an unimpor- tant feature of the paroxysm. In a short while, generally in the course of an hour, the asthmatic symptoms supervene. The extreme dyspncea thereby produced ren- ders him perfectly helpless. The asthma is worse at night, so that during the pe- riod of his attack he gets very little sleep, the dyspncea often amounting to or- thopnoea. The latter is relieved after an hour or more by violent sneezing, fol- fi lowed by a copious watery discharge from the nose. After this he falls asleep, to be awakened in a short while by another attack of asthma, which is in turn re- lieved by sternutation. He sleeps ha- bitually on his right side, with the head elevated. This state of affairs lasts from the second week in August to late in September, when the coryza and asth- ma disappear, leaving him in a state of nervous prostration and with a slight nasal discharge. During the period of ., " cold " the apex and sides of the nose freiiuently become excessively vascular, and the skin is cast off as the disease subsides. During the past four years, the paro.xysms have been increasing in severity, the present attack having com- pelled him to give up his position as a waiter in one of the hotels of the city. The disease may come on at any season of the year, if he is exposed to Caduet Price its exciting causes, but he rarely suffers between Caduet Dosing April ist and the second week in August. At the latter period he never escapes. Among the exciting causes in his case, apart from the emanations from hay, are exposure to sudden atmospheric Caduet Mg changes, coal dust, the use of tobacco, the inhalation of tobacco smoke, and Caduet Cost the greasy smell of the kitchen. The dust from cleaning various articles, dusting carpets, door-mats, etc., invariably provokes coryza. The odor or presence of flowers, light, and diet have no efiect at any season of the year. He has never had any symptoms referable to a disordered nervous system before the appearance of the asthmatic feature of his disease. Since then has become restless and irritable and is subject to attacks Caduet Generic of nervous Caduet Online debility. The only relief he has ever gotten, apart from the natural termination of the paroxysm by sternutation, has been What Is Caduet from the inhalation through the nostrils of the fumes of some proprietary pastils. Physical examination. — No disease of lower respiratory apparatus. Simple congestion Order Caduet of nasal and lower phar- ynx. Posterior Caduet 5 Mg extremities of the lower turbinated bones engorged, swollen, bright red, and covered with a translucent film of mucus. Posterior nares symmetrical. Hypertrophic enlargement of the erectile tissue of the posterior part of septum on right side. Anterior extremi- ties of inferior turbinated bodies slightly swollen, bright red, and present the appearance of two little rounded prominences jutting out from the outer half of the nasal floor. Tlic interval between them and the middle is considerable, and the latter are remarkably i)rominent, running in an oblique direction from behiml, upward and forward. Septum straight, face symmetrical. The mucous membrane covering the anterior end of the middle turbinated body especially swollen, but the swell- ing can be readily reduced with the probe, the action awakening no reflex. Systematic exploration of all accessible portions of the nasal chambers with the probe gave rise to no re- flex except at one spot, .\long the inner edge of the left inferior turbinated body, about one and one-fourth 428 THE MEDICAL RECORD. [October i8, 1884. inch by measurement within the nostril, the most ex- quisite paroxysm of Caduet Dosage asthma followed the simple contact of the exploring probe. The sonorous and sibilant rales were loud enough to be heard in the adjoining room. The conjunctiva became flushed, painful, and covered with tears, and a thin watery discharge Buy Cheap Caduet accumulated in the nostrils. These symptoms lasted for a few moments and passed away, leaving the condition as described above.' My views in regard to the predisposing and exciting causes of the disease popularly known as "hay asthma," have been given in a condensed form elsewhere," and

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