LECTURE XXXIX.

DISEASES OF THE RESPIRATORY ORGANS.

The Larynx, Trachea and Bronchial Tubes.

In coming to the disorders of the air-tubes proper, I must say at the outset how much use I shall make of the "Chronic Diseases of the Organs of Respiration," by my late friend, Dr. Meyhoffer. This accomplished physician, born a Switzer, practising in Italy while Nice was Italian, writing almost equally well in French, German, and English, published in 1871, in the last-named language, the first volume of his treatise, containing the diseases of the larynx and the bronchial tubes. It is full of the original work which his capacity, knowledge, and extensive opportunities in Riviera practice enabled him to carry out, and is as practical as it is scientific. It is to our discredit as well as our loss that the second volume, on diseases of the lungs, still remains in MS. for lack of a publisher. The first should be in the library of every homoeopathic practitioner, and will bear repeated perusal.

We begin to-day with the larynx.

Laryngitis is not with us the dreaded disease it is under the old system. We do not say, as Aitken does, if inhalation, leeches, and fomentations fail, "tracheotomy ought not to be delayed." I will refer you to some cases in the Monthly Homeopathic Review for 1866, by Dr. Meyhoffer himself. You will see that we have some capital medicines in specific relation with the larynx and its inflammatory states. Aconite seems indispensable at the commencement, and is sometimes sufficient for the cure. Spongia, kali bichromicum, bromine and hepar sulphuris stand next in order of requirement. The first two have most experience in their favour. Hepar is most suitable when the cough has become loose, but hoarseness remains. Should oedema glottidis supervene, repeated doses of apis would give the best chance of averting tracheotomy.

A more superficial form of laryngitis may be called "laryngeal catarrh." Under this title there is a good article by Dr. Kleinert in the twentieth volume of the British Journal. He seems to have had much experience among professional singers, who indeed in all places are found to resort in preference to

Homœopathic advice. You will profit much by a perusal of his remarks and cases. Causticum, bromine and selenium, with aconite, in recent cases, and carbo vegetabilis in those more chronic, appear to be his especial remedies. The first and last are those which my own experience leads me to commend.

For chronic laryngitis we have the advantage of Dr. Meyhoffer's experience in the shape of a series of chapters in his book. He speaks first of the catarrhal variety, illustrating the effects of kali bichromicum, tartar emetic, kali iodatum, hepar sulphuris, manganum aceticum, carbo vegetabilis and phosphorus. The first is indicated by glutinous, the second by copious and easy expectoration; kali iodatum, manganum and phosphorus, where the larynx is dry and irritable; hepar sulphuris where, while the expectoration is like that of kali bichromicum, the patient's organism is more unhealthy; and carbo "in long-standing catarrhs of elderly people, or in persons whose vitality is reduced to the lowest ebb, by insufficient nourishment rather than by disease, with venous capillary dilatation of the pharyngo-laryngeal parts, and prevailing torpor of all the functions." Dr. Wurmb's experience at the Leopoldstadt Hospital in Vienna is confirmatory of the value of the last-named medicine.* Dr. Meyhoffer adds. causticum and lachesis, the former to restore power, the latter to diminish irritability. He then speaks of a more obstinate form of chronic laryngitis-the follicular; pointing out that this is generally primary, while the catarrhal variety is usually the sequel of a series of acute attacks. Iodine and its compound with potassium are his chief remedies here; and he finds its local application necessary in most cases if a speedy cure is to result. Where the follicular throat is the manifestation of a morbid condition of the general system apt to show itself by cutaneous eruptions (the "herpetic" or "dartrous" diathesis of the French), he finds sulphur of the utmost value-sometimes in the homœopathic attenuations, sometimes in the thermal waters of the Pyrenees. Dr. Meyhoffer next passes to the more profound alterations to which the larynx is liable-hypertrophic laryngitis, inflammation of the vocal cords, and perichondritis laryngea. For all these he deems local treatment indispensable, and homeopathy has little to say to them. It is otherwise, however, with that more serious affection still-tuberculous laryngitis (laryngeal phthisis). Here, although he thinks the conjoined direct and indirect administration of the suitable remedy the best practice, he is satisfied as to the efficacy of the latter even when employed singly. The medicines from which he has derived most benefit are acidum nitricum, argentum See B. J. H., xxii., 347.

*

nitricum, arsenicum, iodium, and seleniate of soda-the first and last suiting more recent cases, the others those of longer standing. Laryngeal syphilis, again, hardly requires local treatment at all. When occurring in connexion with secondary symptoms, mercurius corrosivus and nitric acid are its remedies -the former when ulcers,* the latter when mucous patches and condylomata constitute the lesion. In tertiary syphilis of the larynx he finds mercurius biniodatus and iodide of potassium answer every purpose, and does not think it necessary to give large doses of the latter. When the skin is very eruptive, he often gets the best results from cinnabar-in the third or higher triturations.

I have dwelt thus fully on Dr. Meyhoffer's recommendations because his position gave him unusual opportunities of studying this class of affections, and because of the thoroughly scientific and satisfying character of his communications on the subject. Of our other therapeutists Jousset touches only the tuberculous (or, as he would call it, scrofulous) form; he adds drosera and calcarea to the medicines suitable for it, the former when cough is frequent and violent, the latter when ulceration is present. Bähr's indications for remedies, so far as they go, are mainly the same as Dr. Meyhoffer's, though he attaches more value to manganum. Kafka's only special point is the recommendation of atropia (in drop doses of the first dilution of the sulphate) when the cough sympathetic of laryngeal ulceration is very distressing.

I would add two cases more recently put on record. One, from Dr. Bartus Trew, was diagnosed tubercular by its former old-school attendants, but got well in his hands under causticum 6 and calcarea 30. The other is reported by Dr. Speirs Alexander, and the laryngoscopic evidence given. It practically recovered under arsenicum iodatum 3x and causticum 30.† Besides the laryngeal troubles of childhood, of which I shall speak in their proper place, I have yet to mention two other morbid states incident to the part, which may or may not be connected with its inflammations. These are oedema glottidis and aphonia.

Edema Glottidis.-I think that the best advice I can give you as to the treatment of this dangerous condition, under whatever circumstances it may occur, is to trust to apis,-which, if necessary, may be given subcutaneously as in a striking case

* Mr. Dudley Wright sent to the Monthly Homœopathic Review of April, 1894, a case of ulceration, presumably tubercular, which recovered under kreasote 1x. Subsequently he found that the subject was a syphilitic one (J. B. H. S., viii., 227).

† J. B. H. S., vii., 90; viii., 223.

recorded in the North American Journal of Homeopathy for June, 1896. Since this remedy has cured it even in its most fatal form, viz., that which occurs in children after drinking from the spout of a tea-kettle, it will probably be competent to deal with all other forms of the malady. Should it ever fail you, however, you may (before thinking of surgical measures) consider the claims of sanguinaria, as illustrated by the excellent case of Dr. Thomas Nichol's, which you may read in the second part of the fourth edition of Dr. Hale's "New Remedies."

Aphonia, when dependent upon substantial changes in the organ of voice, has obviously no therapeutics of its own. When, however, in simple laryngeal catarrh, acute or chronic, the weakness of vocalisation is out of the usual proportion, causticum is nearly always a helpful remedy. For hysterical aphonia I know no medicinal means which can compete with localised galvanism, though Jousset speaks well of nux moschata, platina and ignatia. Dr. Meyhoffer agrees with me here. In paralytic aphonia which is not of this character, and which is not traceable to compression of the recurrent nerve by tumours or aneurisms, phosphorus would seem the most hopeful remedy, but silica has actually proved curative.*

Gelsemium has cured weakness of voice coming on at each menstrual period,† and antimonium crudum is said to be beneficial when it occurs every time the patient is exposed to heat.‡

A lesser degree of aphonia is hoarseness, and this may generally be dispelled by one of the remedies already mentioned-causticum, manganum, or carbo vegetabilis, to which may be added kali bichromicum and hepar sulphuris. An old-school physician is cited in L'Art Médical for October, 1897, as calling attention to erysimum (he does not say which species of the genus so named, probably the officinale). Its efficacy has given it the title of "herbe aux chantres," and this Dr. Herbary says he has been surprised by the rapidity of its action in the cases in which he has tried it.

I come now to the bronchial tubes, and take up the large subject of

Bronchitis. A paper on this disease, which I read before the British Homeopathic Society, will be found (with the dis

*See N. A. J. H., Dec., 1895, App., p. 96.

† See Meyhofter, loc. cit., p. 230.

Dr. Pearsall reports to the North American Journal of Homœopathy of June, 1893, two cases of aphonia, with flabby relaxed condition of the laryngeal mucous membrane and imperfect approximation of the vocal cords during phonation. Arsenicum iodatum, given in one case in the 30th, in the other in the 2x, proved curative.

cussion following it) in the fifth volume of its Annals. Of that paper my present remarks will contain the substance, though in a somewhat different arrangement.

I shall speak here of simple acute bronchitis, of capillary bronchitis, of toxæmic bronchitis and of chronic bronchitis.

1. For simple acute bronchitis in the fairly healthy adult, it is rare that any medicine but aconite is required, if the case be taken in time. It must be remembered, however, that this medicine attacks inflammation through the blood-vessels, and not-like a specific irritant of the part-by influencing the inflamed tissue itself. It is only because in a catarrh like this the tissue is so lightly affected that I believe aconite capable of breaking up the disease. Should the inflammation have thoroughly established itself, we cannot expect aconite alone to cure it. But even here it is a most useful auxiliary; and a few introductory or alternating doses will greatly help the specific irritant of the tissue to effect a cure.

Of the medicines falling under the latter category I shall speak of bryonia, kali bichromicum and ipecacuanha.

In our domestic treatises, bryonia generally heads the list of bronchitic medicines. I think, however, that too extensive claims are made for it. It unquestionably produces inflammatory irritation of the trachea and largest bronchi, but there is no evidence that its influence goes farther than these. I have argued this point in my paper, and you will see from the discussion that my colleagues share in my dissatisfaction with its action in most cases of bronchitis. Good for the common "cold on the chest "-i.e., where the catarrh invades only the trachea and largest bronchi-it is of little use beyond.

In animals poisoned by kali bichromicum it is noted that the bronchiæ were inflamed as far as their ramifications could be traced; and symptoms of the disease are manifest both in the provers and in chrome-workers. My own experience with it is that in most cases of simple bronchitis, if, after aconite has expended its action, any other medicine is required to modify the condition of the inflamed tissue, kali bichromicum will do it. It is also very effectual in the bronchitis of influenza. We have here a general condition which demands, not aconite and cold water, but arsenicum and champagne. When the influenzal catarrh runs down into the bronchial tubes, arsenic will not follow it; and here kali bichromicum comes in most usefully. There is one symptom often present in these cases, which is especially characteristic of the remedy now under notice. This is a thickly coated tongue, which, with loathing of food, indicates that the catarrh has involved the alimentary passages.

Every now and then a case will occur whose symptoms