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the chorda tympani. It enters the tympanum and passes to what is called the gustatory nerve and accompanies it to the submaxillary gland. Thus the disordered action induced from disease of the nostrils transmits its influence to the various structures of hearing, taste, salivation, etc. If hydrophobia affecting the same nerve-courses, is potent for so much mischief, certainly catarrh cannot be justly regarded as a trifle. It is indeed a very serious affair. It more or less disorders the functions of hearing; it perverts taste and digestion; and all the organs of the voice are more or less impaired.
In the hands of most physicians catarrh has proved intractable. This arises partly from their failure to understand the pathology of the complaint, and partly from the imperfections of the means to combat it. The text-books have been remiss in their instructions. Eminent practitioners considering it as an aggravated cold or disease of debility have contented. themselves with a placebo or some mitigating treatment; and the patient himself, if he imagines himself getting better, is very apt to attempt the letting well enough alone, and neglecting the further care of himself. He charges the fault to his medical adviser for which he is himself to blame.
The treatment should doubtless be largely alterative and corrective of the secretions. The habitual constipation ought to be removed. The clothing should be cool rather than warm; overheating and overdressing being often alone sufficient to produce an aggravating of symptoms. While the lower part. of the body should always be normally warm, the chest, shoulders and head may be with advantage left somewhat cool. The food should be plain, and the amount moderate.. Overeating is to be shunned as a prolific source of mischief.. One-fourth of the food usually taken, and frequently more than that, can be omitted with advantage.
The medicine administered should be given with referenceto neutralising morbid matters and their expulsion from the body; also to attune the nervous system. Tincture of perchloride of iron, tincture of Hydrangea, Baptisia, or Cypripedium can all be used with advantage. The nostrils themselves ought to be regularly and carefully cleansed from their
morbid secretions. These again taken into the system whether by swallowing or reabsorption, are both disgusting and mischievous. Many of our worst neuralgic and eczematous disorders are occasioned in this way. Indigestion or loathing of food are inevitable. Nor does the evil stop here. These are only as pickets and signals to give notice of more dangerous and overwhelming foes. The inhalation of water has been recommended for years, but it has never been satisfactory. If warm, the results are more or less troublesome; if cold, the work is not thorough. The sensation is more or less disagreeable, and we have known painful tic douloureux and erysipelatous inflammation to follow. The inhaling of glycerine is more beneficial, but it is mechanically difficult and often troublesome, so that few would persist in it till results were beneficial. We have been led therefore to use a simple spray apparatus with a medicated water, which would be forcible enough to reach all affected parts and cleanse all about the cells and turbinated bones, but yet so simple as to occasion no unpleasant violence to the tender surfaces. The poisonous matter would thus be neutralised on the spot and removed, and the membranes induced to begin healthy function. It requires diligence, patience and persistence; but the reward, the getting rid of a loathsome and disgusting affection, is an abundant equivalent. The constantly recurring disagreeable accompaniment in society may then be kept more out of sight, and so the blessings of social intercourse become more delightful.
By MASON M. MILES, M. D.
The larynx is a cavity at the the top of the windpipe, formed by the union of cartilages, namely: the thyroid, the cricoid, the two arytenoid, and the epiglottis. These are bound together by ligaments, and muscles move them.
This forms the beautiful and convenient cavity which is
technically called the larynx. Across this enclosure are stretched two cords, called the vocal ligaments. Just above these cords are two cavities which, with the ligaments, act an important part in the formation of the voice. Here is produced the sound which is modified and articulated by the tongue, the lips and the nasal cavities. Hence, the larynx has been called "the seat of the voice."
Laryngitis in an inflammation of the mucous membrane which lines this curious cavity. When disease reaches this organ, and the fluid secreted to lubricate these cords becomes acrid, the voice is rendered hoarse; and when these ligaments become altered in structure by inflammation and ulceration, the voice in many cases suffers a gradual extinction.
The little follicles or glands often become involved in the malady, constituting what may be termed Follicular Laryngitis. The disease is often attended with the secretion of a thick, tough mucus which is expectorated with great difficulty, and if it results in ulceration we may have a large quantity of purulent matter secreted daily.
In the chronic form of the malady, particularly when attended with ulceration, there is frequently great pain in the larynx, difficulty and pain in swallowing, hoarseness of voice, with violent fits of coughing; the patient expectorating a sanious-looking matter, which has occasionally an offensive
The approach of the disease, however, is often so insidious as hardly to attract notice; sometimes for years giving no other evidence of its presence than the annoyance of something in the throat to be swallowed or hawked up, an increased secretion of mucus, and a loss of power in the throat. At length the throat of the patient becomes sore, its secretions increased and more viscid, the voice grows hoarse, the difficulty of speaking is aggravated, and the case becomes more or less alarming.
The attention of the profession was first called to this malady about fifty years ago. Since that time the cases have increased with great rapidity. The number now can hardly be computed. At first the disease was mostly confined to the
throats of clergymen. Hence the appellation, "Clergymen's Sore Throat." It was soon found, however, to be no respecter of persons. Public speakers, school-teachers and singers are more annoyed with it than most other persons.
☛ Nasal catarrh is one of the most prominent causes of this disorder at the present day. The poisonous secretion drops down from the nasal cavities into the throat and produces irritation, which in time results in a deep-seated inflamation, and frequently in ulceration. The exciting causes of the catarrh are: Taking cold from wet and cold feet, sudden changes in the atmosphere, which often produce obstruction in the pores of the skin, and an unequal circulation and congestion of the throat.
The inhalation of noxious vapors and particles of dust are often to be included, as well as scrofula, erysipelas, diphtheria, public speaking and singing. Excessive mental and physical labor, and a general derangement of the system, producing debility, will aggravate the complaint and are among the primary causes. There are many others, but it is deemed unnecessary to mention them.
Some years ago this malady was considered incurable; but a thorough study of the nature of the disease has given us a clearer knowledge of the causes and proper methods of treatment for it cure.
The late Dr. Horace Green, of New York City, was the first physician in this country to apply remedies locally for the cure of this complaint. He invented the sponge-probang. This he dipped into a solution, prepared from the crystals of nitrate of silver, and dextrously introduced into the laryngeal cavity; thus applying the medicine directly to the diseased part. This was a severe method of administering remedies; yet Dr. Green was generally successful. Sometimes, however, where the larynx was highly inflamed, the introduction of the instrument would cause the parts to contract upon the instrument
and cling to it, and almost cause laceration upon its withdrawal.
I have used the probang more or less, notwithstanding its defect, and usually with marked benefit.
Subsequent to the introduction of Dr. Green's method my old friend, the late Dr. Ira Warren, of Boston, invented what he called a "Laryngeal Shower-Syringe." This was a decided improvement on the probang; it also had its defects.
Many years ago I had an instrument constructed on a new plan, which I called a Laryngeal Silver-Syringe. On the end of this instrument is an elliptical buib pierced with very small holes. I introduce it daily into highly-inflamed throats, usually without giving the patient the least inconvenience. The instrument is charged with a medicated solution; then carried to the proper point, and all sides of the walls of the larynx are instantaneously bathed with a shower of the medicated fluid. It is so quickly and gently done that when the operation is performed the patient scarcely knows it. After he has been treated with this instrument it is difficult to persuade him to have the probang used. I have in this way effected a radical cure in some of the worst cases on record.
The medical solutions which I use with this instrument are prepared largely from the following drugs, viz.: Grindelia robusta, Penthorum sedoides, Polymnia uvedalia, Sticta Pulmonaria, Eucalyptus globulus, Mangifera Indica, Lepigonum medium, Rhus aromatica, Phytolacca decandra, Lobelia, Ipecacuanha, and occasionally argenti nitras, etc. The solutions must be varied in strength to adapt them to the various cases. I use from zj. to zjss. of the fluid extracts to zvij. of distilled water.
In some cases I employ these remedies in the form of medicated vapors by the aid of an inhaler of my own invention. These medicines soothe and subdue the irritation and inflammation and cause the diseased parts to take on a healing process, and ultimately effect a radical cure in all curable cases. Many cases of laryngitis require constitutional treatment in connection with the local. Intelligent physicians, however, will understand this fact, and will be governed accordingly.