PHTHISIS OF THE LARYNX.

By D. E. SMITH, M. D., Brooklyn, New York.

Laryngeal Consumption is an insiduous disease and usually begins with a slight inflammation or rather catarrhal irritation of the mucous membrane of the larynx, producing hoarseness and a husky cough. Generally, however, the cough, so far as it depends upon laryngeal trouble, is insignificant. The expectoration is at first of a frothy character. These symptoms may continue for several weeks or months without any serious apprehension on the part of the patient. The complaint is so insidious in its invasion that it is often far advanced before the patient manifests any anxiety.

The next feature observable is a slight difficulty in swallowing. An increased defect in the voice is also noticeable upon speaking loudly, or when varying the tone. The voice becomes more and more of a cracked character till its healthy tone is lost. It is sometimes a dry squeaking or whispering, and complete aphonia often ensues. The expectoration is at first scanty, but as the disease advances it becomes of a mucopurulent character; shreds of blood are sometimes attached to it, and at times it is even fetid. Ulceration and disorganisation of the parts presently occur. Dead or ossified portions of the cricoid cartilages with calcareous substances are found in the larynx and are sometimes expectorated; but more rarely they fall into the trachea and pass into the bronchi causing inflammation and ulceration of the parts where they lodge. When the epiglottis is complicated, as is often the case, swallowing becomes exceedingly difficult and spasms of the glottis with suffocation frequently occur in the act of deglutition.

CAUSES.

Exposure to cold, wet or currents of air, swallowing acrid or corrosive fluids; drinking very hot water; inhaling pungent vapors, as the fumes of sulphuric acid, strong aqua ammonia, or chlorine gas. It sometimes takes place from repeated

attacks of sore throat, and not unfrequently follows as a sequence to diphtheria, laryngitis, catarrh, or suppressed eruptions. Statistics show that males are more subject to this affection than females in the proportion of two to one.

PROGNOSIS.

The prognosis of phthisis of the larynx is, taking all things into consideration, unfavorable. The prudent physician will always be careful how by the use of words he expresses a favorable opinion as to the issue in this disease, as it is often complicated with tuberculosis of the lungs. As a general thing more die than recover; yet under judicious and careful treatment a large proportion may get well.

TREATMENT.

Formerly blood-letting was the sheet-anchor, especially in acute laryngitis, and to show the extent to which this treatment has been carried, I will refer to the case of Dr. John W. Francis, of New York, as reported by Dr. J. B. Buck, in the twelfth number of the New York Medical and Physical Fournal: "Dr. F. had complained for three days of soreness of the fauces and when he was attacked with pain, difficulty of breathing and swallowing and a sense of strangulation for which 153 ounces of blood were abstracted as follows: On the 17th of November, zxi., evening, 3xxx.; 18th of November, zxvi., evening, 3xvi.; 19th of November, zvi., evening, 3xvi.; 20th of November, zxvi. ; 22d of November, 3xii. For three or four days after Dr. F. was still in a precarious condition and required a repetition of the blood-letting."

Who will say after this quotation of the treatment of inflammation of the larynx by Old-School practitioners, that the innovation of the Eclectic practice was not a necessity and imperatively demanded?

The treatment resorted to by Eclectics (the innovators of medicine as we are sometimes called) consists of both local and constitutional means. In order to give in as brief a manner as possible our method in phthisis of the larynx, I will re

port a case. I will here state that the treatment of the patient to which I am about to refer may not coincide with the views of all Eclectics, and also that all my cases do not terminate so favorably. If a physician saves two-thirds of his patients who have phthisis of the larynx I think he is doing very well.

About twenty years ago the Rev. Mr. G-, a clergyman connected with the Methodist Episcopal church, called at my office to consult me with reference to a throat-affection which had troubled him for the past year. He was unable to preach and it was with the greatest difficulty that he could even speak aloud, having at times complete aphonia. He had a hoarse, peculiar cough; the expectoration which was at first of a frothy, mucous character, was now muco-purulent with small streaks of blood; the appetite, too, was poor; he had a haggard look with great emaciation; and in fact he had about given up all hope of ever preaching again. The mucous membrane of the larynx was evidently in an ulcerated condition and his symptoms were of a dangerous character. I would like to write out the history of this case in full, but will at once proceed with the treatment and the result. I ordered his diet to be of the most nourishing character and taken at regular intervals, and no drink allowed at time of eating. This was with the view of having the food well masticated and insalivated in order that it might be easily assimilated after digestion, and thus impart strength and vitality to the system, which are of the utmost importance in this disease.

For the aphonia, R. Tincture Drosera, five drops in half a tumbler of water; a teaspoonful once in three hours. This soon restored the voice. Expectorants were given, combined with alteratives; of the latter the principal one being the Syrup of Iodide of Iron.

In addition to the above treatment, counter-irritation was produced over the larynx in the most thorough manner with Croton oil. In four weeks he was restored to health and sent to the mountains for two months to recuperate, with positive orders not to attempt to preach. In six months after I first

began this treatment, he resumed preaching and has continued to do so for the past eighteen years. He has never since been troubled with his throat. I attribute the cure largely to the severe counter-irritation without which the other treatment would have failed.

PAPER READ BY TITLE BUT NOT RECEIVED.

The Use of Antiseptics in the Treatment of the Respiratory Organs, by J. R. BORLAND, M. D.

(E) DERMATOLOGY.

V. A. BAKER, Chairman. J. W. PRUITT, M. D., Secretary.

DISEASES OF THE SKIN.

Address by the Chairman.

The relation of the Cutaneous exhalants to the physical economy, and the serious and often fatal results of maladies which affect the surface of our bodies, are well known. A want of knowledge on this subject led in a former century to the gilding of the body of a child with gold foil, for purposes of public exhibition. The coating was impervious to air and moisture, and arrested the functions of the skin almost immediately. Congestion of the lungs and brain ensued, terminating speedily in death. The physicians did not even suspect the cause of dissolution.

Even now, however, the pathology of skin-diseases is imperfectly comprehended. The text-books are numerous enough, but they are in many respects an impediment to the practitioner. The various authors, in their anxiety to exhibit themselves as original observers and discoverers, have devised a swarm of names, classifications and subdivisions, too numerous to be remembered, and not always distinctions with any important difference. A simpler mode of investigation will be found to be more suitable and satisfactory. The physiology of the skin should be carefully studied, and its conditions in health. The influences that operate to disorder it are to be carefully noted. Very often a faulty digestion will be found to be at the bottom of the abnormality. The condition of stomach known as pyrosis, or water brash, will often be attended by a peculiar affection of the skin. True, it is only evanescent, and soon disappears; nevertheless it affords a valuable suggestion.

Eczema rubrum of the lower extremities often assumes an