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Maps, plataa, charts, ate, may ba filmad at diffarant reduction ratios. Thoaa too larga to ba antiraiy included in ona axpoaura ara filmad baginning in tha uppar laft hand cornar, laft to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartea, planches, tableaux, etc., peuvent Atre filmte A dee taux da reduction diff Arents. Lorsque le document est trop grand pour Atre reproduit en un seul clichA. il est filmA A partir da Tangle aupAriaur gauche, de gauche A droite, et de haut en baa, an prenant la nombra d'imagea nAcaaaaira. Las diagrammes suivants illustrant la mAthode. 1 2 3 1 2 3 4 5 6 Uf hi ;;i ^it . i'-^'i ^ ^''4 14 Hi:::i:r;i:msi:iiiiiis^^^^ is There a Rampoldi's Sign? CASEY A. WOOD, M.D. RBPRINTIID PROM MEDICINE. QEO. S. DAVIS, Publisher. Januaify, 1896. mm > [HRPKINTBD prom MKIiICINK, JANUARY, 1896.] IS THERE A RAHPOLDrS SIGN? BY CASKY A. WOOD, M.D. In looking up the literature of a subject in which I happened to be interested, I ran across the first pnper by Rampoldi * in which he invited the attention of the profession to the proposition that a transitory but recurrent (and unequal) dilatation of the pupils is an early and almost constant sign of the ordinary form of pulmonary phthisis, and that this pupillary anomaly results from an irritation transmitted by way of the sympathetic to the nerves supplying the iris. I was induced by the article in question to make some observa- tions on my own account, but as these were neither sufficiently numerous nor extensive to enable me to arrive at any rational conclusion, I said nothing about them. In the la.st number of the Atmali, however, Rampoldi has again referred to the matter in a way that makes one feel that a proper investigation of the subject is worth while. If it be true that unequally dilated pupils are to be seen in the very early stages of phthisis pulmonalis, how important it is that we should be on the lookout for such an easily recognized sign ! In the articlet last referred to, Rampoldi reviews the opinions of several writers on this subject, and publishes his later experiences. At the last International Medical Congress, Destree read a paper % in which he claimed that in 97 per cent, of ca,ses of tubercular phthi- sis he had observed an unequal dilatation of the pupils dependent upon irritation of the sympathetic plexus at the hilus of the lung from disease in the bronchial glands. This sign, he claims, often precedes the invasion of the lung tissue, and is an unfailing indica- tion of tuberculosis of the bronchial glands. Cardarelli draws atten- tion to the fact that the tubercular character of the swelling in the peribronchial glands has been recognized for a very long time, and that these glands, like the mesenteric, may retain the bacillus tuber- culosis in a state of latency. Destree has elsewhere and later affirmed that after long-con- tinued and daily study of these cases he was able to state positively that the pupillary condition is the result of swelling of the peri- * A nnali di O/lalmologia, anno xiv, f asc. 4. f'Ancora Sulle Variazioni Pupillari dipendenti da Malattie Polmonari di Natura Tubercolare," Annali di Ottalmologia, anno xxiii, fasc. 6. X " Un Segno Prenionitorio della Tubercolosis Polmonare," Riforma Medica, anno x. No. 79. a AV THERE A RAMPOLDPS SIGN? bronchial glands which, pressing upon the filaments of the sympa- thetic, brings about the mydriasis referred to, and that he had confirmed the fact of pressure upon the nerve by many autopsies. Moreover, recent researches have proved that the peribronchial glands are usually infected very early in pulmonary tuberculosis — are probably tlje first tissue invaded — and if we could be put into possession of a sign that would indicate that invasion, it is easily understood how important it would be from the standpoint both of diagnosis and treatment. Rampoldi shows that he was the first (in 1885) to draw atten- tion to this sign of pulmonary disease. Later, in 1886, le published a case which seemed to confirm the experience of Oelil ' ' that it is possible to transmit a primary excitaiion of the vagus to the pupil by way of that sympathetic branch that runs from the superior cer- vical ganglion to the vagus itself. ' ' In addition to this sign, the author believes the following history furnishes evidence of further implication of the ocular nerve-supply by tubercular disease of the lungs; R. A , domestic, aged 16, appeared to be in good health, but had suffered for three years with a slight cough, thought to be bron- chitic. She visited the clinic on accoiuit of the drooping of the right upper lid, which had been noticed the previous fortnight. A careful examination of the eyes was made, and it was found tha the patient had a decided ptosis on the right side, accompanied T: a marked contraction of the corresponding pupil, which was, at th. jame time, sluggish to light and accommodation. In other words, she had a ptosis with an unequal dilatation of the two pupils. There was no trace of posterior synechiae, and no refractive error. Vision was normal both for distance and near. Chiefly on account of the irregular innervation of the iris and levator palpebrae superioris — not otherwise explained — Rampoldi suspected pulmonary disease and sent the patient to the medical clinic. She was found to have tuberculosis of the right apex. 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