properly perform the offices required of it and to moisten the It is exceedingly important maintained at their normal

air as it is inhaled into the lungs. that these functions should be equilibrium, else the voice suffers.

The healthy mucous membrane, wherever found, has on its surface only that quantity of mucus that will maintain it in a moistened condition; consequently, when there is so much secretion that it flows, it indicates that the membrane is in an irritated condition, thus causing a greater quantity of mucus to be secreted.

*

Almost every person with whom I have spoken on the subject thinks that the mere fact of blowing the nose is no evidence of disease of the nasal passages. But they are very greatly mistaken. Every person in the world that uses a handkerchief for removal of even a very slight flow from the nose is affected with more or less inflammation of these passages. A healthy condition of these passages requires no more relief in this respect than does healthy eyes, or healthy lips, or healthy mouth.

Inflammatory conditions are always the result of irritation, occasioned primarily by colds manifested in the nasal passages, and by tobacco and stimulants. Consequently no person, as already stated, having healthy nasal passages ever blows mucus from his nose, or draws nasal secretion down into his throat, or clears his throat. Every person who performs these acts has a more or less inflamed mucous membrane of these organs, or, to employ a medical term, has a naso-mucositis.

Impeded Nasal Respiration. The nasal passages should have free breathing space sufficient for full and easy respiration on all occasions, except when running or quickly ascending a flight of stairs of about twenty or thirty steps.

If, when lying in bed on one side of the body, the lower nasal passages become closed or partially closed, it indicates a thickening of the mucous membrane. This thickening may be due to

* This condition of the mucous membrane is known as catarrhal, a word that means flowing, or running down." The word "catarrh frequently tends to a misunderstanding of the condition of the diseased parts. For instance, when the inflammation is excessive, the heat of the surface is so great that it evaporates the fluid portion of the secretion, consequently there is no flow, or, to use the other word, no catarrh, which is plainly misleading. Many persons who experience a dry condition of the nasal passages and throat, have no flow of the secretion: this they term dry catarrh, as though one could have a dry flow. If the words naso-mucositic inflammation, or an equivalent term, is employed instead, there will be no confusion. Naso-mucositis is the proper term; this informs one of the location of the disease and of its character.

swellings occasioned by a recent cold, or a permanent enlargement, known as hyperplasia of the turbinate processes, due to a long-continued or chronic inflammation of these parts. This condition is the result of having taken a great many colds, and of allowing them to pass away of themselves," showing the importance of avoiding colds, and of being quickly cured of their effects; for it is only while the colds are gradually passing away that the chronic inflammation always a painless, sensationless disease is slowly but surely forming, producing many sequences that are but slowly removed. The hyperplasias, or enlargements, must be removed by surgical means, or they will aggravate the inflammation that formed them, and result in permanent injury to the voice. It is not at all difficult to see how these enlargements or growths in the nasal passages aggravate the inflammation that formed them.

How Nasal Growths Increase Nasal Disease. The avenue through each nasal passage is just sufficient-no more, no less— in capacity to allow the proper amount of air to enter the lungs during normal exertion or action of the body. When the nasal passages are normal in capacity there is, on taking in the breath, a slight rarefaction of the air in the whole respiratory tract. This is normal, and is required for the purposes of nature. During expiration the air in the whole respiratory tract is in a slighty compressed condition; which again is normal, and is required for the purposes of nature. But if one, or especially if both, of the nasal avenues are reduced in capacity by a growth or growths, the air in passing through the narrowed nasal passages will require greater exertion of the respiratory muscles to draw it in, and greater exertion of their respiratory muscles to expel it. Consequently the indrawn breath will cause a much greater air-exhaustion in the whole of the respiratory tract than is normal. But as the nasal cavities are the only parts affected with chronic inflammation, the air-exhaustion has a very much more bad effect on these parts, and causes a still greater congestion of blood in the mucous membrane lining them, by reason of this air-pump effect of the in-drawn breath. This increase of congestion means an increased blood supply in the inflamed parts, and this extra quantity of blood means increased size of the growth or growths, plainly showing that the inflammation causes the growths, and the growths increase the inflammation.

This is not all the injury done by the nasal growths. On forcing the air from the lungs during expiration, the nasal growths decrease the opportunity for the air to escape, thus causing excess of air compressiou in the whole respiratory tract, which has an injurious effect on all weakened mucous membrane by driving the blood from it. It is thus seen that during the indrawing of the breath the blood is drawn with undue force into the mucous membrane, and during the expelling of the breath the blood is unduly driven away from it. This excessive contrast of the blood-pressure or blood-supply to the inflamed parts maintains disease as long as the nasal growths exist.

Mouth Breathing. - Breathing through the mouth is an acquired habit, and it is always the result of a limitation of breathing space in the nasal passages, caused by a swelling of the mucous membrane lining them, or by a growth. The effect of mouth breathing is injurious to the throat, larynx, lungs, and the nasal passages themselves, as the latter require air to pass through them to maintain them in a healthy condition. If the nostrils were closed, and maintained so for a month, I am sure that every portion of both passages would soon become in a highlyinflamed condition; and this inflammation would soon extend, by continuity of structure, to the Eustachian tubes and middle Some authors say that mouth breathing has an injurious effect on the mentality of the sufferer. This is an erroneous way of stating it. If they said that the disease that caused the mouth breathing injured the sufferer mentally, then they would have the statement correctly made. The mental injury is due to the nasal inflammation extending to the brain by way of the bloodvessels and nerves of the anterior and posterior ethmoidal cells, the frontal sinuses and the sphenoidal cavities.

ears.

Unlike any other part of the body, the nasal passages and these cells and sinuses opening into them are supplied by bloodvessels from the brain. These blood-vessels, after coming from the brain to be distributed to the nasal passages and the cells connected with them, send branches up into the brain cavity to the meninges, and branches from these again leave the brain cavity and again descend into the nasal passages. It is seen that the nasal passages and these cells and sinuses are fastened, as it were, to the meninges of the brain by these blood-vessels. This is one of the reasons why a mere cold in the head will affect one mentally.

Pruritic Rhinitis (Hay-Fever). - Many persons are slightly afflicted with this disease; that is, they suffer from a slight itching of the nasal passages, followed by a few sneezes; the sneezing soon causes a full or stuffed sensation of the passages. The sooner this complaint is treated the better for the voice.

THE PHARYNGO-NASAL CAVITY.

Dropping in the Throat. If one is conscious of the least dropping or flow of mucus from the posterior portion of the nasal cavities into the throat, it indicates the existence of a chronic inflammation of these parts of sufficient gravity to require the aid of a physician, as nothing the sufferer can do for himself is likely to result in anything but positive injury, causing him to be more susceptible to colds.

Inflammation that Affects Phonation and Vocalization.

If

a singer or speaker is in the habit of forcibly and suddenly drawing in his breath up through his nostrils with his lips closed, making a sound in the back part of his throat while doing so, thus drawing the post-nasal and pharyngeo-nasal secretion down into his throat; or if he, with mouth closed, sends a gust of air from his lungs up behind the soft palate out through the nasal passages, thus throwing the excess of secretion that is lodged behind the soft palate up higher into the posterior nares, these acts plainly prove the existence of chronic naso-mucositic inflammation that will be certain to weaken the voice if allowed to remain; and not only this, but to affect the stomach also, for a sufficient quantity of this partially-decomposed secretion is involuntarily and unconsciously swallowed both day and night, much to the detriment of the whole digestive system.

Adenoid Growths. These are most frequently seen in persons under twenty-five years of age. They are a source of a continued flow of secretion down the back of the throat, and ultimately lead to a serious debility of voice, especially in singing, and frequently cause a hacking cough that debilitates the voice in both singing and speaking.

Fibroid Growths.-These are far more serious in consequences than adenoid growths.

Follicular Pharyngitis.

THE PHARYNX.

The posterior surface of the pharynx, as seen when the mouth is opened wide and the tongue de

pressed, should not be more heightened in color than the anterior surface of the soft palate. If the surface is rough, because of the presence of small, round elevations, called "follicular pharyngitis," it indicates a chronic pharyngo-nasal and nasal inflammation. If this condition is allowed to remain, the voice will ultimately become injuriously affected. No applications of iodine, nitrate of silver, nitric acid, or any other caustic, should be applied to these small elevations, as no remedies, and certainly none of the above irritants, applied to them will cause their disappearance. No one is conscious of the presence of these elevations. They produce no injurious effect on respiration or deglutition. They are perfectly painless, and can only be made to disappear by treating the originating inflammation that exists in the posterior nares. If they are larger than twice the diameter. of a pin-head they may have to be removed by mechanical means. They are growths quite similar to adenoid growths on the upper posterior wall of the pharyngo-nasal cavity.

A Gagging Cough. If a singer or speaker has had a gagging cough for several months, he usually has a follicular pharyngitis also. The pharyngitis is a sequence of the irritation occasioned by the lodgment of muco-purulent secretion on the posterior wall of the pharyngo-nasal cavity, and the presence of this secretion is the occasion of the gagging congh. In this condition he will notice that the cough and the roughness in the back part of his throat are frequently greatly increased when his stomach is "out of order;" and his stomach will very frequently be "out of order" at such times as the muco-purulent secretion flows from the posterior nares into his throat, thence into the stomach, showing the very close relation between the stomach and these air passages. Very frequently when the stomach is in good condition his cough and the appearance of his throat will be improved, but the abnormal conditions of the pharyngo-nasal cavity and throat will not permanently recover under stomach treatment alone. Local applications will be required to relieve the local inflammation behind and above the soft palate, for this is the primary location of the irritation that causes the cough; this inflammation in turn being caused by naso-mucositis.

[TO BE CONTINUED.]