The Effects of Dry Atmosphere on Chronic Inflammation of the Larynx and Nares. E. FLETCHER INGALS, A.M., M.D., KY PROFESSOR OF LARYNGOLOGY, RUSH MEDICAL COLLEGE; PROFESSOR OF DISEASES OF THE THROAT AND CHEST, WOMAN’S MEDICAL COLLEGE, ETC. Read before the meeting of the American Climatological Association held in Denver, September 2 to 5, iSgo. Reprinted from “ The Journal of the American Medical Association,” October 11, 1890. CHICAGO : Printed at the Office of the Association. 1890. The Effects of Dry Atmosphere on Chronic Inflammation of the Larynx and Nares, E. FLETCHER INGAES, A.M., M.D., BY PROFESSOR OF LARYNGOLOGY, RUSH MEDICAL COLLEGE; PROFESSOR OF DISEASES OF THE THROAT AND CHEST, WOMAN’S MEDICAL COLLEGE, ETC. Read before the meeting of the American Climatological Association held in Denver, September 2 to 5, 1890. Reprinted from “ The Journal of the American Medical Association,” October 11, 1890. CHICAGO : Printed at the Office of the Association iSqo. THE EFFECTS OF DRY ATMOSPHERE ON CHRONIC INFEAMMATION OF THE EARYNX AND NARES. In this paper it is my object to invite your at- tention to a subject upon which unfortunately we have little precise information, hoping thereby to elicit a discussion in which the observation of others may help to remove the deficiencies which I am obliged to confess. The views which I shall here express are based on the study of a large number of cases, but I shall make no at- tempt to present the histories of these cases in substantiation. Most of my patients live in low altitudes, many of which are damp; though I fre- quently see patients who live in a high and dry atmosphere. In trying to analyze these cases I have been unable to decide satisfactorily what particular phases of the disease are benefited and what in- jured by the dry atmosphere. In the majority, I presume at least four-fifths, dryness of the atmos- phere seems beneficial, but in some it is certainly injurious. At first sight it w7ould seem that cases in which there is excessive secretion would be benefited by residence in a dry atmosphere, whereas those suffering from the opposite condi- tion would be injured, but numerous cases attest that this does not follow in all instances: for ex- ample, in simple chronic rhinitis with excessive discharge, we find a given number of patients im- proved by removal from the shores of large bodies 4 of water inland, but a limited number of cases with the same disease will be benefited by mov- ing from inland districts to the damp climate of the sea shore, or the borders of our great lakes. We find now and then a patient greatly improved by going to a high altitude with a dry atmos- phere, but usually catarrhal cases are injured by this change. The more we see of these diseases, the more we are impressed with the fact that catarrhal inflam- mations are found alike in the damp, chilly at- mosphere of the sea shore, or upon the arid plains of Arizona, in the most favored localities of our southern States, and in the delightful atmosphere of Colorado, though not to the same degree in each section. We may assume that the inflammatory affec- tions of the nares and larynx are essentially of the same character, and that therefore they will be influenced in a like manner, though in differ- ent degrees, by various climatic conditions. These affections we will therefore class together as catarrhal excepting in those instances where we use a qualifying phrase, as for example, tuber- cular laryngitis. Usually these catarrhal affections are less fre- quent in warm climates, therefore, a warm, equable atmosphere would seem best adapted for their prevention or cure. However, in equable climates the air is loaded with moisture, a condi- tion which undoubtedly favors the development and maintenance of certain forms of catarrhal in- flammation. yet the opposite condition of dryness also has its disadvantages, for it favors the forma- tion of dust and allows the air to be laden with various irritating substances which might be ab- sent in the damper atmosphere. As certain im- palpable substances in the atmosphere cause 5 asthma, so in some cases similar substances will excite chronic inflammation of the mucous mem- brane of the upper air passages. The damp, and often chilly atmosphere of the Atlantic sea shore, and the sudden changes along the borders of our great lakes are peculiarly favorable to the devel- opment of this disease. Nevertheless, a consider- able number of the cases that come to those of us who practice in these localities have originated inland. We frequently find that a person hav- ing developed the disease in any given locality will be relieved of it by a change to some other local- ity, though the latter may be either dryer or more moist than the original residence. I know many that are afflicted with the disease upon the shores of Take Michigan, who, upon going but a few miles into the country are at once relieved. I have known those who could not live with com- fort on the sea shore to have but little difficulty upon the shores of our lakes. I have seen those who have attributed their whole trouble to the sudden and severe atmospheric changes on the borders of our great lakes to become much worse by residence in an equable climate. For example, a patient suffering from a moderate degree of hy- pertrophic rhinitis went from Chicago to Southern California in hopes of obtaining relief, but there he was unable to breathe through the nose at all, and he was compelled to return to Chicago. With these conflicting facts before us, how can we determine what climate to recommend to our catarrhal patients ? We have observed that as a rule they do best in a comparatively dry climate not more than one or two thousand feet above the level of the sea, but there are many excep- tions to this. Occasional cases are greatly bene- fited by a sojourn in high altitudes, and I hope to hear from the physicians of this locality what 6 particular phases of the disease improve in Col- orado. By ascertaining in individual patients the sea- son of the year, and the kind of days when they feel most comfortable, we may often be able to judge of the most suitable climate for them. Yet it frequently happens with these cases, as with asthmatics, that the climate must be tried by each patient for himself in order to determine what atmospheric condition is best suited to his disease. Before sending such cases from home we should try faithfully the methods of treatment which have been found most beneficial by expert laryn- gologists. If these do not succeed we should recommend a dry or moist climate, according to the kind of weather in which the patient feels best—at an altitude of not more than one or two thousand feet above the sea, or even less than this. High altitudes should be tried only inci- dentally, as they are not apt to prove beneficial. My observation, which embraces several thou- sand patients, leads me to the following conclu- sions : A dry atmosphere at a comparatively low alti- tude will generally be found beneficial in the fol- lowing diseases: In rhinitis intumescens, which is characterized by intermittent swelling of the tubernated tissues with obstruction of one or both nares, and the consequent discharges into the throat. In simple chronic rhinitis, with or without ex- cessive secretions; providing there is but little irritation of the mucous membrane. In atropic rhinitis with excessive muco-puru- lent discharge, with but little tendency to drying. In such cases of hypersesthetic rhinitis as im- prove during the dryer portions of the year. 7 However, most cases of hypersesthetic rhinitis will be more benefitted by an equable climate even though the atmosphere be loaded with moisture. A high and dry atmosphere is usually prejudi- cial in rhinitis intumescens and in atrophic and hypertrophic rhinitis, and indeed in all catarrhal affections occurring in patients of nervous tem- perament. These injurious effects may be as- cribed partly to the dryness of the atmosphere, partly to the irritating dust often found in high altitudes, and partly to the effects of the rare at- mosphere upon the nervous system which un- doubtedly has much to do with the etiology of catarrh. A high and dry atmosphere may be expected to prove beneficial in cases where there is exces- sive secretion with little or no nervous irritability; in some cases due to syphilis, and in exceptional cases of atrophic rhinitis with excessive secretion. In inflammatory affections of the larynx we may expect benefit at a low altitude with a dry atmos- phere; in simple chronic laryngitis, and in some cases of tubercular laryngitis. In the latter, how- ever, I prefer an altitude of from 1,500 to 2,500 feet, and there is no objection to the atmosphere being impregnated with the odors of pine and fir which the laity consider of so much importance ; but I doubt whether these are of any benefit. In cases of laryngitis with deficient secretion, or excessive irritability of the mucous membrane, the moist atmosphere of equable climates is gen- erally preferable. A high and dry atmosphere is usually injurious to persons suffering from chronic laryngitis, but it is beneficial in exceptional cases. My observa- tion, however, does not enable me to decide what cases will be improved by this condition. But it 8 seems probable that benefit would be derived in certain cases of simple laryngitis in phlegmatic patients; in some cases due to syphilis in which the mucous membrane requires stimulation, and in exceptional cases of tubercular laryngitis, in which the beneficial effects of the atmosphere upon the constitutional disease more than counter- balance its deleterious influence upon the local affection. The latter are most likely to be found in patients in whom the mucous membrane of the larynx is not very sensitive. In laryngo-pul- monary tuberculosis patients usually do best at an altitude of from 1,500 to 2,500 feet, in a warm and dry atmosphere, but it is often difficult to determine what is best for them because of the beneficial effects of high altitudes on tuberculosis of the lungs and their baneful effects on the same disease affecting the larynx. The injurious effects of such an atmos- phere on the larynx are often attributed to the dust which it contains, but the explanation is unsatisfactory, for in persons who are continually inhaling much more dust, in planing mills or machine shops, the injurious effects are oftener manifested on the lungs than the larynx. It seems probable that the action of this atmos- phere on the mucous membrane of the upper air passages is not very dissimilar to that of the wind and sun upon the skin unused to exposure. Owing to its dryness it causes rapid desiccation and destruction of the superficial epithelial cells with consequent irritation of the subjacent tissues, which in addition to the increased flow of blood to the part, resulting from diminished air pres- sure, necessarily increase the inflammatory action. 70 State Street.