VOLUME XXVII

JULY, 1907

NUMBER I

THE RELATION BETWEEN THE MOUTH AND THE EYES AND EAR.*

By MELVILLE BLACK, M.D.,

Denver, Colo.

Professor Ophthalmology, Denver and Gross College of Medicine, Etc.

Mr. Chairman and Gentlemen: When your secretary asked me to prepare a paper on this subject, I was reminded of how dentistry and ophthalmology are in a manner related, in that each has its field of work in the head and that each is a specialty so distinct in medicine that few in general medicine attempt to encroach upon our domains. You see, I do not put the dentist outside the medical circle, for your claims to the use of drugs are as well founded as those of the ophthalmologist. It is a matter for regret that a separate degree should have been created for the dental graduate. It is unfortunate that dentistry is not a part of the general medical curriculum. A better knowledge of the teeth would not come amiss to most physicians, and a more comprehensive knowledge of general medicine would be of much value to the dentist.

I shall not quote from the reports of others, showing the relation between the teeth and the eye and the ear. I shall simply endeavor to give you my own views.

I cannot help prefacing my remarks by the statement that as important as is the relation of the teeth to the eye and the ear, much more important is the relation of the teeth to the general system through the alimentary tract. I might say also that the eye and ear take second place to the nose in relation to the teeth. The high-arched palate so encroaches upon the nasal chambers that insufficient room in the nose is the result. The septum is bent and deformed, the nasal passages are narrowed and the accessory sinuses are badly drained. All this favors a catarrhal condition of the nasal mucous membrane and the formation of naso-pharyngeal adenoids. This abnormal nasal state in my opinion is most frequently responsible for eye and ear symptoms. I do not believe to any extent m the reflex relationship between diseased teeth and diseases of the eye or of the ear. It is much easier for me to understand how a maxillary sinus diseased from a tooth can produce eye and ear disease. I am not inclined to look upon teething

*Read before the Denver Dental Association, April 11, 1907.

in babies as an important factor in the production of ocular disease, and without some concomitant etiological factor I question the relationship of coexistent symptoms. To the high-arched palate, however, I believe we must look for this relationship. I believe the orthodontists will agree with me that this is true. How easy it is for the developing nose of the baby to be formed into a cramped, crooked cavity from gradual, slow, upward displacement of the palatine arch. Once nasal respiration is interfered with and the child becomes a mouth-breather, there remains nothing to hinder the continuance of the elevation of the palatine arch.

When we remember that this anatomical change causes a general narrowing of the face, it is easy to understand how the bony orbits are relatively acted upon, and as they contain the visual organ with its intricate muscle balance, how easily it may be disturbed. I am quite positive that among children who are mouth-breathers we find a larger proportion of refractive errors and errors of ocular muscle balance.

It is a well recognized fact that among adults who were mouth-breathers during childhood, and especially among those in whom the habit continues, we find exaggerated catarrhal conditions of the nose and throat. We find in these subjects a larger proportion of accessory sinus disease. These abnormal nasal conditions are direct and indirect causes of ocular and aural diseases. Most of our lachrymal diseases are dependent upon such nasal etiology.

It is not at all uncommon for a suppurating ethmoidal or frontal sinus to burst into the orbit, and there form an abscess. It is not so very unusual to find that a choroidal disease or a retinal disease or an optic nerve disease is dependent upon a nasal lesion for its etiology. The same may be said of some of the corneal diseases of the chronic interstitial type. Let me reiterate that except for the intervention of the nose with its accessory cavities, I do not believe there is much relationship between diseases of the eyes and the teeth.

We do not need to take up much time with the relationship between the teeth and the ear. Here again we must fall back upon the nose as the go-between, the same high-arched palate being the contributing factor in causation. I do not know if you gentlemen have decided whether the high-arched palate is the cause of adenoids or whether the adenoids are the cause of the high-arched palate. I do know, however, that the orthodonist insists that all adenoids shall be removed before the work of correcting the deformity is commenced. It is a well known fact that diseases of the ear are largely dependent upon closure of the eustachian tube from adenoids. It is

also a recognized fact that catarrhal conditions of the nose contribute extensively to catarrhal conditions of the eustachian tube and middle ear. Acute inflammatory conditions of the middle ear and mastoid are also dependent upon extension from the nose and naso-pharynx. Circulatory diseases of the labyrinthian portion of the ear are frequently dependent upon the state of the nose. Therefore, any condition of the mouth which tends to upset the normal relation of the nose stands. out boldly as a relation between the ear and the nose.

For fear that I may not have made my position clear in regard to the reflex relationship of the teeth to the eye and ear, I desire to say that I am perfectly aware that pain from the teeth is frequently referred to the regions of the eye and ear. Patients frequently complain of pain in the ear for which no local cause can be found. Many of these cases are at once relieved by appropriate treatment of a molar tooth. It is not so common to have pain from the teeth referred to the eye as it is to the ear. During the passage of the so-called wisdom teeth through the gum it is quite common to have pain referred to the ear. In this paper I have dealt with the relationship from the standpoint of disease and not of reflex pain. Personally I have never seen a case of eye or ear disease which was caused by the teeth through reflex nerve influence.

ALARMING HEMORRHAGE IN QUINSY.

By ROBERT LEVY, M.D.,

Denver, Colo.

It is generally believed that quinsy, although extremely painful, is an affection unattended by danger or serious complications. This as a rule is true. There are, however, rare and serious complications, which must always be considered in determining the prognosis of this affection. Among these complications one of the most dangerous, though fortunately of very rare occurrence, is that of severe hemorrhage. This may be due to a variety of causes. Excluding hemorrhagic diathesis and other dyscrasiae, such as albuminuria, arterial sclerosis, and such local affections as gangrene of the tonsil, we find that alarming and violent hemorrhage results from burrowing of pus and the subsequent erosion of one of the blood vessels supplying the peritonsillar region.

According to Deaver (Surgical Anatomy, page 238), we find the pharynx supplied by the ascending pharyngeal branch of the external carotid, the tonsillar, the ascending palatine