BY THE SAME AUTHOR. 
STUDENTS’ MANUAL OF DISEASES OF THE 
NOSE AND THROAT. 
A Digest, Descriptive of the More Commonly Seen Diseases 
of the Upper Air-Tract, with the Methods of Treatment. 
By J. M. W. Kitchen, M.D., Assistant Surgeon to the 
Metropolitan Throat Hospital. Illustrated. Price, $l.OO. 
“ In matters of Diseases of the Nose and Throat this work is a veri- 
table multum in parvo. All unnecessary discussion is eliminated. 
The facts stated are those that are generally accepted by the majority 
of authorities in this branch of medical science. It will be found of 
great value to the hard-worked medical undergraduate, to all begin- 
ners in throat work, and as a quick and reliable handy book of refer- 
ence for the general practitioner. No other work known to us con- 
tains so much plainly stated knowledge on this subject in such small 
space.”—Dr. A. P. Zemansky. Medium cut of the head, showing the Upper Aik Tract in heavy 
outlines, nc. Nasal cavities and turbinated bones; eo, Eustachian 
orifice in the vault of the pharynx ; sp, Soft palate and uvula ; t, Left 
tonsil; p, Lower pharynx ; e, Epiglottis ; vb, Vocal band in the larynx ; 
c, (Esophagus or gullet, the food passage. CATARRH, SORE-THROAT 
AND 
HOARSENESS 
A DESCRIPTION OF THE CONSTRUCTION, ACTION, AND USES 
OF THE NASAL PASSAGES AND THROAT ; CERTAIN 
DISEASES TO WHICH THEY ARE SUBJECT, 
AND THE BEST METHODS FOR THEIR 
PREVENTION AND CURE 
BY 
J. M. W. KITCHEN, M. D. 
Assistant Surgeon to the Metropolitan Throat Hospital; late Instructor 
in Diseases of the Nose and Throat at the New York Post- 
Graduate Medical School; Assistant Physician to the 
Bellevue Chest Class (O. D. Dept.); Author of 
“Students' Manual of Diseases of the ' . 
Nose and Throat” 3 zS1 - * ~ 
G. P. PUTNAM’S SONS 
NEW YORK : 27 & 2Q WEST 2JD STREET 
LONDON t 25 HENRIETTA STREET, COVENT GARDEN 
1884 COPYRIGHT BY 
J. M. W. KITCHEN, M. D. 
IRB4 
Press of 
G. P. PutnamSons 
New York CONTENTS. 
Introductory ........ i 
PAGE 
The Anatomical Construction and Healthy Action of the 
Nasal Passages and Throat ..... 5 
Hygienic Conditions Necessary for the Maintenance of 
Health in the Parts . . . . . .26 
On Certain Diseased Conditions and Processes to which 
the Parts are Subject . . . . . .32 
A Brief Mention of the More Common Diseases Produ- 
cing Catarrh, Sore-Throat, and Hoarseness . . 39 
Certain Symptoms of Nasal and Throat Disorders and 
their Significance . . . . . . -5° 
The Productive Causes of Nasal and Throat Disease . 57 
The Domestic Treatment of Nasal and Throat Disorders, 63 
The Surgical and Medical Professional Treatment of 
Diseases of the Upper Air-Tract , . . . 6g, INTRODUCTORY. 
Catarrh, Sore-Throat, and Hoarse- 
ness are symptoms of disease in the nose, 
pharynx, and larynx, respectively. It is an 
undoubted fact that vast numbers of the 
human race suffer from the disorders pro- 
ducing these symptoms. It is computed 
that, in the United States, five millions of 
the inhabitants are more or less troubled 
with so-called catarrh. That the sufferers 
are multitudinous in number may be in- 
ferred when one takes note of the great 
number of nostrums that are advertised 
from year to year as “ catarrh cures.” 
Each of these preparations is, of course, 
the best and only cure for catarrh. The 
careful reader will often see advertised, cer- 
tificates of cures following the use of these 
quack remedies. The failures to cure are 
not published. The surgeon meets many 
of these uncured cases at the hospital dis- 
pensary and in private practice. It is quite 2 
Introductory. 
possible to formulate a catarrh cure that will 
meet the needs ol a certain number of 
cases ; but that very formula will positively 
injure many other cases, and in any case 
requires intelligent application to be most 
effective. 
It is hoped that a moderate attention to 
the subject-matter contained in the follow- 
ing pages will show the reader that catarrh 
is but a symptom of a variety of different 
diseased conditions, and that each condi- 
tion requires its own peculiar, appropriate 
treatment for its cure. No single case is 
entirely like another, and even the same 
case may require widely varying methods 
of treatment at different stages of the dis- 
ease. It is therefore impossible to devise 
a specific catarrh cure, and, to say the 
least, it is very unwise for a patient to 
experiment upon himself by using the pro- 
prietary remedies so widely advertised. 
Within a comparatively few years there 
has been created in medical science a new 
branch known as Laryngology, and with 
the scientific advancement of positive 
knowledge in this branch has grown up a Introductory. 
3 
set of practitioners who make a special study 
and practice of diseases of the nose and 
throat. Every practitioner of medicine 
should have taken a special course of 
instruction in diseases of the nose and 
throat, and should be able to treat any 
of the ordinary forms of disease that 
are met with in those organs ; but 
there are many cases that require the at- 
tention of the expert surgeon, who of 
necessity has to give years of study to, and 
to keep in constant active practice in, this 
special branch, to be able to afford satisfac- 
tory results in treatment. Intelligent and 
competent medical men, who have made a 
special study of these disorders, are now 
located in nearly all our large cities, and 
each year witnesses new acquisitions to the 
ranks of these specialists. 
Probably in no other branch of medical 
science has such advance been made dur- 
ing the last few years in improved methods 
of treatment. It is therefore evident that 
sufferers from disease in these special or- 
gans need not, for their alleviation or cure, 
put their trust in the claims and promises 4 
Introductory. 
of advertising charlatans, as their troubles 
can receive the intelligent attention of 
trained specialists either in private prac- 
tice or, if poverty prevents, in the dispen- 
sary practice of the throat departments now 
established in connection with almost all 
hospitals and dispensaries. It may be ad- 
mitted that the ideas of the average layman 
as to the nature of the disorders treated of 
in this little book are decidedly misty. It 
shall be the object of the writer in the fol- 
lowing pages to endeavor to throw a little 
light into this obscurity. THE ANATOMICAL CONSTRUCTION AND 
HEALTHY ACTION OF THE NASAL PAS- 
SAGES AND THROAT. 
IN order that the reader may gain any in- 
telligent grasp of the subject, it is nec- 
essary that he should know something of 
the Anatomy and Physiology of the parts 
where the morbid processes under discus- 
sion occur. These parts are the Nasal 
Passages, Pharynx, and Larynx, a part of 
the human body often known as the Upper 
Air-Tract, the lower continuation of which, 
connecting with the larynx, is composed of 
the trachea, bronchial tubes, and the final 
air-cells in the lung substance. (See fig. 
i.) 
All these parts form a continuous air-con- 
duit from the external atmosphere to the 
net-work of minute blood-vessels surround- 
ing the exceedingly thin membrane lining 
the air-cells. Through this thin lining the 
oxygen of the air is absorbed into the 
5 6 
Catarrh, Sore-Throat, and Hoarseness. 
blood, and the surplus of carbonic-acid gas 
in the blood is given out to the air in the 
air-cells, and is from thence expired into 
the outer atmosphere by way of this same 
air-tract above mentioned. 
Representation of the larynx, trachea, bronchial tubes, and 
lungs in their relative positions in the body. 
Fig. i. 
In the frontispiece the heavy dark lines 
indicate the outline of the upper air-tract, 
and the various parts important to our sub- 
ject are named. From the number of Catarrh, Throat, and Hoarseness. 
7 
these named parts it may be rightly in- 
ferred that this part of the human body is 
not simply an air-tube, but that it is a 
rather complex machine, and has complex 
functions to fulfil. 
What are these functions, and how are 
the organs formed for the fulfilling of their 
purpose? 
I. The Nose is not only an air-pas- 
sage, but it is arranged so as to detain on 
its sinuous surfaces, and by means of the 
hairs found inside the nostrils, a great deal 
of atmospheric dust and other impurities 
that would be likely to injure the delicate 
structure of the air-tract farther along. Its 
surfaces warm the passing air about two 
degrees F, and moisten it very considera- 
bly. The nose is also the organ of smell, 
and takes part in the formation and modi- 
fication of articulate speech and song. 
The nasal passages are two irregularly tri- 
angular-shaped cavities, opening to the 
outer air by the two nostrils, and into the 
upper part of the pharynx by two oval- 
shaped openings known as the posterior 
nares. The walls of these cavities are of 8 
Catarrh, Sore- Throat and Hoarseness. 
bone at the back part, but the parts in 
front of the plane of the face are mostly of 
elastic cartilage, a provision very desirable 
and convenient. Imagine the inconven- 
<D 
ience of blowing or cleaning the nose if 
o o 
the end of that organ was rigidly stiff, and 
also consider the effect of the many bumps 
and blows that seem a part of every child’s 
experience, upon so prominent a projec- 
tion, if it was non-elastic. This elasticity 
allows of considerable dilatation of the 
nostrils, which movement is the result of 
contraction in the neighboring small 
muscles during the act of inspiration. The 
two nasal passages are separated by a 
partition known as the septum; this is 
usually not quite straight, and when very 
greatly bent the deviation is a cause of 
disease. The outer surfaces of the bony 
walls are much expanded in extent by their 
structure. Three convolutions of bone ex- 
tend out into the passages, and in the 
mucous membrane covering these expand- 
ed surfaces are embedded the end filaments 
of the special nerve of smell. These pro- 
jections (see B. 8., fig, 2.) are called the Catarrh, Sore- Throat, and Hoarseness. 
turbinated bones, and they fill about all of 
the space in the nasal passages that is not 
needed for the passage of air. 
Transverse representation of the bony walls of the nose. 
B. 8., Turbinated bones. S., Septum of the nose. Through 
the open mouth are seen the soft palate, S. P. The uvula, U. 
The right tonsil, T. The upper edge of the epiglottis, E. 
The tongue, R. The lower pharynx is at the back between 
the soft palate and the tongue. 
Fig. 2. 
Odoriferous particles are deposited on  Catarrh, Sore- Throat, and Hoarseness. 
these surfaces as air is drawn through the 
passages, and these produce that peculiar 
effect on the nerve filaments, which, being 
conveyed to the brain, gives to the individ- 
ual the sensation known as smell. Men- 
tion must be made of several passages and 
cavities contiguous to and communicating 
with the nasal passages. These are, the 
lachrymal or tear-duct, which conveys the 
tears from the eye to the nose ; the frontal, 
maxillary, sphenoid, and ethmoid sinuses, 
which are located in the bones that com- 
pose the walls of the passages. They are 
apt to become diseased in conjunction with 
the nasal tract, and present difficult prob- 
lems in the way of curative treatment on 
account of the difficulty in reaching the 
seat of trouble. These nasal passages and 
contiguous cavities have the further func- 
tion of acting as resounding chambers in 
producing certain modifications and changes 
in the sounds of the voice, as will be ex- 
plained further along. 
11. The Pharynx acts as an air-passage, 
a resounding cavity for the voice, and the 
lower part of it as a food conveyer. It Catarrh, Sore-Throat, and Hoarseness. 
will be noticed by glancing at the fron- 
tispiece that in the lower part of the 
pharynx the air-tract and the food-tract 
cross each other, the food starting at the 
lips and being carried to the stomach by 
way of the mouth, lower pharynx, and the 
oesophagus or gullet. The mouth is also 
an accessory air-tract brought into use dur- 
ing unusual exertion and consequent need 
of an increased air supply, but the normal 
healthy method of breathing is through the 
nose with the mouth shut. The pharynx 
extends from the base of the brain to, and 
is continuous with, the oesophagus. The 
soft palate is a flexible curtain, which is the 
continuation backward and downward of 
the hard roof of the mouth. It has mucous 
membrane on both of its sides, enclosing 
muscles that will contract and draw it up- 
ward and backward. 
When these muscles are relaxed, the 
soft palate hangs downward, and in the 
middle line of its lower edge will be seen a 
short dependent projection known as the 
uvula (see U. fig. 2). In this state of re- 
laxation there is a free passage for air from  Catarrh, Sore-Throat, and Hoarseness. 
12 
the mouth to the nasal passages, and all 
parts of the pharynx constitute one con- 
tinuous tract; but when the soft palate is 
contracted and raised upward and back- 
ward, it divides the pharynx into two parts, 
which may be called the vault of the 
pharynx, and the lower pharynx. The lat- 
ter opens into the mouth, and is the part 
seen when looking directly backward 
through the open mouth. The posterior 
apertures of the nasal passages open direct- 
ly into the vault of the pharynx, and this 
latter place should properly be considered 
as a part of the nasal passages. It is a sort 
of retired corner in the air-tract, and dust 
and the secretions of its mucous membrane 
are apt to become lodged there, acting as 
an irritant to the parts. 
The lower pharynx has the advantage 
over the vault, in that its surfaces are 
swept, and thus cleansed, by every mouth- 
ful of food swallowed. The unclean condi- 
tion of the pharyngeal vault acts as a cause 
in bringing about and keeping up the dis- 
ease known as post-nasal catarrh, the most 
common disease of this part of the body Catarrh, Sore- Throat, and Hoarseness. 
13 
that falls to the care of the medical prac- 
titioner. In the sides of this vault are lo- 
cated the orifices of the Eustachian tubes, 
two passages that convey air into the mid- 
dle ears. Inflammation of this part of the 
air-tract is apt to extend along these tubes, 
producing ear-troubles. Indeed, simple 
stoppage of the orifices of these tubes from 
an excess of mucus secreted in the back 
part of the nose or upper part of the 
pharynx may more or less interfere with 
the function of hearing. In examining the 
lower pharynx, we find at the base of the 
tongue, leading forward and downward 
from the pharynx, the opening into the 
larynx or beginning of the windpipe prop- 
er, which latter tube runs perpendicularly 
down the neck in front of the oesophagus. 
The oesophagus is always relaxed and flat- 
tened out, except when food is passing 
through it, while the windpipe is always 
kept open by stiff, cartilaginous, nearly 
complete rings which fulfil that purpose. 
Leading from the soft palate on each side, 
downward to the tongue, are two folds of 
mucous membrane known as the pillars of 14 
Catarrh, Sore-Throat, and Hoarseness. 
the fauces, and between them are the 
organs known as the tonsils. These glands 
are much subject to inflammation and to in- 
flammatory changes. They are two almond- 
shaped bodies composed of bunched folds 
of mucous membrane, and are abundantly 
furnished with glands which produce a vis- 
cid mucous secretion useful for lubricating 
the parts, thus facilitating the passage of 
food during the act of swallowing. This 
act of swallowing is brought about through 
the agency of muscular bands which sur- 
round the back of the pharynx, and which 
act involuntarily in grasping any bolus of 
food that has been pressed far enough back 
by the tongue, and in pressing the food 
downward into the oesophagus, where the 
contraction of successive layers of muscles 
press the bolus along into the stomach. 
It will be observed that the food has to 
pass directly over the opening into the 
larynx, and on this account the top of the 
larynx closes tightly during every act of 
swallowing, and any attempt to draw air 
into the windpipe during the act, or of 
breathing through the mouth while food is Catarrh, Sore- Throat, and Hoarseness. 
in it, is apt to draw food into the larynx, 
causing the spasmodic cough that is no-' 
deed when food particles go “ the wrong 
way.” The act of swallowing necessitates 
a great deal of motion in the parts compos- 
ing the pharynx, and on this account are felt 
the pain and discomfort that accompany 
inflammation in this locality. This is the 
part of the upper air-tract usually affected 
in ordinary so-called sore throats. 
-111. The Larynx has very complex 
functions to fulfil It is an air-passage. 
It is also a valve that can close so tioht 
o 
that food cannot enter it, or air cannot 
escape when it is desirable to hold the 
lungs full of it; or it can be so regulated 
that the air may escape more or less freely 
as may be desired. This valve is opened 
during every inspiration by direct muscu- 
lar exertion on the part of the muscles of 
the larynx, which relax during the ensuing 
expiration, unless the expiration is a re- 
stricted one. The larynx is supplied with 
the vocal apparatus that enables it to pro- 
duce what is known as voice. This little 
machine which is so capable of producing 16 
Catarrh, Sore-Throat, and Hoarseness. 
an almost endless variety of sounds, pleas- 
ing or otherwise, is sometimes called a 
vocal box. It is walled in by several stiff, 
cartilaginous structures, all more or less 
movable, but together forming the frame- 
Cartilages of the larynx. E, epiglottis. A, left arytenoid 
cartilage. T, thyroid cartilage. C, cricoid cartilage resting 
on the trachea. 
Fig. 3- 
work of the larynx, preserving its shape 
and affording points of attachment for the 
various membranes, ligaments, muscles, 
etc., that constitute its make-up. These 
cartilages are represented in fig. 3. Catarrh, Sore-Throat, and Hoarseness. 
There is at the top of the trachea a car- 
tilaginous ring known as the cricoid carti- 
lage, shaped somewhat like a seal-ring. 
Rocking on this, with the joint at the back, 
and connected with it at the sides and in 
front by a thin flexible membrane, is the 
large thyroid cartilage, a shield-shaped 
Interior view of the larynx, looking from above downward. 
VB, left vocal cord or band. T, thyroid cartilage. C, C, 
cricoid cartilage. A, apex of left arytenoid cartilage. M, 
M, M, M, M, muscles. 
Fig. 4. 
body whose projected front forms the 
prominence at the front of the neck, well 
known as “Adam’s apple.” At the back 
of the cricoid cartilage and resting on it 
are two pyramidal bodies known as the 
arytenoid cartilages. These partly revolve  Catarrh, Sore- Throat, and Hoarseness. 
on their bases, as if on pivots. Attached 
to and running between these cartilages 
and the inner surface of the front of the 
thyroid cartilage, are the two white fibrous 
bands known as the vocal bands or cords 
(see fig. 4). These vocal bands, though 
a part of the mucous membrane lining the 
Fig. 5- 
Fig. 6. 
Interior of the larynx with 
the vocal bands adducted or 
approximated, the position 
taken during phonation or 
voice production. 
Interior of the larynx with 
the vocal bands drawn apart 
or abducted, being the position 
taken during inspiration. The 
white rings of the trachea show 
between the separated vocal 
bands. 
larynx, differ in structure, being of a white 
fibrous material essentially the same as the 
white tissue that forms in the cicatrix of a 
wound. To these various movable carti- 
lages are attached muscles (some are seen 
in fig. 4) which, when called into action, Catarrh, Sore- Throat, and Hoarseness. 
19 
can make these vocal bands more or less 
tense or flaccid, or can bring them together 
so that their edges are approximated, as in 
fig. 5, or can open them widely at the 
back part of the larynx, as in fig. 6. In- 
deed, at every inspiration taken, the mus- 
cles that open this aperture of the larynx 
or glottis, as it is often called, are brought 
into action, and it will thus be seen that 
there is incessant active motion in this 
organ. This is one reason why some lar- 
yngeal disorders are difficult to cure. 
Above the thyroid cartilage, in the folds of 
mucous membrane, are small muscles which 
help to press together the opening of the lar- 
ynx when that action is necessary. Above 
all is the epiglottis, very much like the lid 
of a molasses jug, that can be pulled down- 
ward and backward over the opening of 
the larynx, allowing food and drink to 
slide over it into the oesophagus. 
A word as to the mucous membrane lin- 
ing this upper air-tract. The prominent 
purpose served by this structure is to fur- 
nish a mucous secretion that shall properly 
moisten and lubricate the parts, protecting 20 
Catarrh, Sore-Throat, and Hoarseness. 
them from injurious influences, such as the 
friction that would take place if the parts 
were dry, or from the immediate contact of 
dust, vapors, and other irritating substances. 
This protective action is always needed, for 
the ordinary atmospheric impurities, such 
as dust, plant-pollen, disease-germs, etc., 
settle continually on the slight layer of 
Fig. 7. 
Schematic representation of the mucous membrane of 
the upper air-tract. E, epithelial cells of the surface of 
the membrane. F, deep layer of fibrous or elastic tissue con- 
taining the glands G, G, G, blood-vessels, nerves, etc. D, 
D, D, orifices to the ducts of the secreting glands. 
mucus protecting the membrane, and is now 
and then ejected from the air-tract by means 
of blowing the nose, swallowing, or expec- 
toration. Fig. 7is a schematic represen- 
tation of a part of the mucous membrane of 
the upper air-tract. It represents a section 
cut transversely from the surface to the Catarrh, Sore-Throat, and Hoarseness. 
21 
deeper layers, or to the bony wall. Among 
the principal features to be noticed are the 
mucous glands. These are compound in 
structure, and each one has a duct leading 
to the surface of the mucous membrane. 
These glands are thickly placed in the mu- 
cous membrane, and are lined with small 
cells which secrete the mucus that finds its 
exit through the ducts to the surface. The 
<_> 
next feature to be observed is the cells that 
form the surface of the mucous membrane. 
These are narrow and oblong in shape, and 
are furnished at their free edge with an 
immense number of small tail-like projec- 
tions known as cilise. These little ciliae, in 
the living mucous membrane, keep up a 
continuous rapid, waving vibration, that, 
under the microscope, looks like the waving 
of a field of tall grain swept by a brisk 
breeze. The object of this waving motion 
is to convey from the air-tract the excreted 
mucus and such foreign substances as dust, 
etc., that may be lodged on it. The mu- 
cous membrane is also furnished with blood- 
vessels and nerves, and the whole structure 
is completed and held together with various  Catarrh, Sore-Throat, and Hoarseness. 
22 
differing cells, and a fibrous elastic material 
known as connective tissue. In chronic 
inflammation this fibrous tissue is apt to in- 
crease in quantity, and subsequently con- 
tract, pressing out of existence those very 
important parts of the structure, the glands. 
This matter will be further spoken of in a 
following chapter. 
A general understanding of the method 
of voice production is necessary to compre- 
hend the causes of hoarseness. If the 
edges of the vocal bands are brought by 
the appropriate muscles so that they are in 
apposition, as in fig. 5, and certain other 
muscles exert a pulling power at the ends 
of the bands, so that they are held in a cer- 
tain degree of tension, and at the same 
time air is driven through the oblong slit 
between them, the vocal bands which are 
elastic, will be first pushed up somewhat 
and will then rebound. Then the outgoing 
air will push them up again, and so on. 
In short, they will vibrate. This vibration 
breaks the out-going column of air into 
waves, and these air-waves, striking the 
drum of the ear, cause it also to vibrate, Catarrh, Sore-Throat, and Hoarseness. 
23 
and in turn communicate its motion to the 
delicate auditory apparatus in connection 
with the nerves in the ear. This impres- 
sion being conveyed along the nerve-tract 
to the brain, will produce that sensation 
known as a voice-sound. This act of the 
larynx is known scientifically as phonation. 
If the to-and-fro vibration of the vocal 
bands occurs about twenty-five times in 
one second there will be formed a very low 
Fig. 8. 
Fig. 9. 
bass note. If the vibration be twenty-five 
hundred times in one second, there will be 
formed a very high treble note. These 
will be about the lowest and highest notes 
that can be formed by the human larynx. 
If this to-and-fro vibration of the vocal 
cord or band be very great, as is illustrated 
in fig. 8, the sound will be very loud. If, 
on the contrary, a mild, gentle sound issues 
from the larynx, we may know that the 
extent of the to-and-fro motion is small as 
in fig. 9.  Catarrh, Sore-Throat, and Hoarseness. 
24 
The pitch of the sound, that is, the rela- 
tive highness or lowness of the note in the 
musical scale, will depend upon the length 
and thickness of the vocal bands and the 
degree of tension to which they are sub- 
jected. The tighter and shorter the vocal 
band, the higher its pitch will be, just as 
in the strings of a piano. • However, the 
sound-producer of the human larynx is not 
like the sound-producer of any one musical 
instrument, though it is somewhat like the 
vibrating reed of a reed instrument. The 
important point for the reader to remem- 
ber is, that this vocal apparatus is actuated 
by a number of muscles, and when in use 
it is subject to ever-varying motion, strain, 
and variety of position, and, consequently, 
a great deal of wear and tear. The vibrat- 
ing column of air, after its production in 
the larynx, reverberates through the other 
air-passages. Some low tones reverberate 
in the air-passages below the larynx, and 
are known as chest tones. Certain others, 
known as head tones, gain their quality by 
having their reverberations confined to the 
cavities above the larynx. Other modula- Catarrh, Sore- Throat, and Hoarseness. 
25 
lations and variations of speech and song 
are the result of change of shape in the 
reverberatory passages, caused by the va- 
rious positions taken by the mouth, soft 
palate, tongue, teeth, and lips, together 
with varying pressures of air from the 
lunors. Some of the sounds are the result 
C> 
of the vibrating air-column being sent 
through the nasal passages, others through 
the mouth alone, while still others are pro- 
duced by the combined use of the two 
passages. It will be readily understood 
that the natural conformation of the parts 
concerned in voice production, as well as 
their health status, have a very direct rela- 
tion to the quality of the voice and the 
healthy action of the voice-producing ap- 
paratus. HYGIENIC CONDITIONS NECESSARY FOR 
THE MAINTENANCE OF HEALTH IN THE 
PARTS. 
IN order that the Nasal Passages, Phar- 
ynx, and Larynx be maintained in a 
good state of health, it is necessary : 
First.—That the parts be well nour- 
ished by a blood-supply that shall con- 
tain the necessary elements of nutrition, 
and be free from those excessive im- 
purities which result from imperfect ela- 
boration, secretion, and excretion of the 
various important organs of the body, 
such as the stomach, liver, kidneys, 
etc. This implies the necessity of eating 
proper food, both in quality and quantity, 
and the living of a generally correct hy- 
gienic life on the part of the individual. 
Blood impurities that may interfere with 
the health of the parts under consideration, 
may be the result of diseased principles 
that have gained access to the body from 
26 Catarrh, Sore-Throat, and Hoarseness. 
27 
without ; for example, the poisons of scar- 
let-fever and diphtheria, which produce cer- 
tain symptoms of throat disease, represent 
impurities received from outside the body, 
while the irritant that produces gout repre- 
sents an impurity that originates internally. 
Second.—That all the parts be used 
sufficiently to develop their full func- 
tional activity, otherwise the tissues enter- 
ing into their construction deteriorate and 
become unhealthy. The nasal passages 
are the normal routes for the passage of 
air, and the mouth is only an auxiliary av- 
enue to be used in case of great exertion. 
If an individual habitually breathes through 
the mouth, the nasal structures miss the 
natural stimulus of the rush of air through 
them, and the result is a relaxed condition 
of the mucous membrane that leaves it in 
a state inviting attacks of disease. Fur- 
thermore, the air entering the mouth ar- 
rives at the throat cooler, dryer, and con- 
taminated with more impurities than if it 
came through the nasal passages, and hence 
it is more irritating to the pharynx, and, in 
lesser measure, to the rest of the air-tract. 28 
Catarrh, Sore-Throat, and Hoarseness. 
The voice should be regularly used, but yet 
not abused ; as, for example, by too long 
talking ; or strained by too loud phonation, 
as in shouting ; or by excessive tension, as 
in striking too highly pitched notes in sing- 
ing, etc. The voice can be much strength- 
ened by judicious culture. Reading aloud 
and singing may thus be made hygienic 
procedures, as well as agreeable pastimes. 
Third.—That the air-passages should not 
be made delicate through excessive protec- 
tion from the ordinary wear and tear and ir- 
ritations of surrounding atmospheric influ- 
ences, such as temperature-changes, etc. 
The pursuit of the ordinary avocations of 
life requires that this part of the body be 
exposed to a certain amount of these influ- 
ences, and that they should not produce a 
deleterious effect, it is necessary to some- 
what accustom the air-tract to exposure to 
stimulative irritation, but this exposure 
should not be overdone. When the breath- 
ing of very cold air is a necessity for a part 
of the day, the individual should be careful 
not to breathe for any length of time an 
overheated atmosphere in the house, espe- Catarrh, Sore-Throat, and Hoarseness. 
29 
dally during the sleeping hours, which at- 
mosphere would tend to weaken the mu- 
cous membrane lining the air-passages, and 
make it more sensitive to the deleterious 
influences of the very cold out-of-door air. 
The breathing of impure air should be 
avoided, as it will not only irritate the air- 
passages, but will produce a depressing ef- 
fect upon the general health. The throat 
should not be weakened by over-clothing 
the neck. Clothing should be equably dis- 
tributed over the body. When a large fur 
collar is worn around the neck that part is 
overheated and weakened. Enough cloth- 
ing, but no more, should be worn to keep 
the body up to the normal healthy temper- 
ature of 98°, and the clothing should be 
regulated as to quantity in strict ref- 
erence to the amount of exposure of the in- 
dividual to cold, winds, moisture, etc. 
One of the best methods of becoming 
accustomed to the effect of undue exposure 
to cold, is to adopt the practice of sponging 
the body with cold water, and to follow 
this by a brisk rubbing until reaction oc- 
curs, producing a fine glow in the skin.  Catarrh, Sore-Throat, and Hoarseness. 
30 
This practice, besides being a good general 
tonic and stimulant, toughens the skin, and 
renders it less sensitive to temperature 
changes. 
Fourth.—That undue exposure be avoid- 
ed to such causes as would provoke disease 
in the parts, as, for example, excessive high 
or low temperatures. Air should not be 
breathed that is laden with such irritating 
dust vapors or gases as may prove preju- 
dicial to the good-health status of the parts 
under discussion. Where exposures to 
such irritants are unavoidable, the wearing 
of a respirator will be very desirable in 
preventing the usual troublesome results. 
There are various good respirators sold by 
the instrument-makers, but a home-manu- 
factured article answers every purpose. A 
bunch of thin gauzy fabric, such as ladies 
use for veils, held or fastened over the nose 
and mouth, is sufficient. This will act me- 
chanically to strain from the air many of its 
atmospheric impurities; and the expired 
air, being somewhat retained in the meshes 
of the material, warms the ingoing air very 
considerably, which thus loses in a measure Catarrh, Sore-Throat, and Hoarseness. 
31 
its injurious influences. Where a tendency 
exists to affections of the air-passages, the 
adoption of the open-grate fire, as a means 
of heating and ventilation, is almost a 
necessity in the prevention, and in the 
curative treatment, of diseases of these 
parts. This method of heating gives am- 
ple opportunity to warm the body just to 
the degree of its requirements by direct 
radiation, without overheating the air re- 
spired. It gives a fine mechanical ventila- 
tion to the apartment in which it is located, 
and in the removals of the body to and 
from the fire one is subject to such frequent 
changes of temperature that the formation 
of a delicate habit is prevented, and the in- 
dividual is inured in a measure to the tem- 
perature-changes that must be met in the 
best-protected life. ON CERTAIN DISEASED CONDITIONS AND 
PROCESSES TO WHICH THE PARTS ARE 
SUBJECT. 
THE mucous membrane, as well as the 
deeper structures entering into the con- 
struction of the upper air-tract, may exhibit 
a departure from the healthy state in many 
ways. Among others—the parts may be 
too poorly nourished. They may be in a 
state of excessive nourishment. They may 
be inflamed. There may be a loss of func- 
tion or usefulness in the parts. There may 
be excessive functional activity. There 
may be diseased growths present. 
First.—With regard to a poor state of 
nutrition. In this condition the parts are 
relaxed and lack tone. They are not 
able to meet the wear and tear of the 
ordinary uses required of them. They 
are more liable to attacks of the more 
serious diseased processes. This condi- 
tion may be the result of a poor 
32 Catarrh, Sore-Throat, and Hoarseness. 
33 
state of nutrition of the whole body, or it 
may be due to lack of use of the parts, or, 
in other words, of calling out their functional 
activity. For example, if a person breathes 
habitually through the mouth, the nasal 
passages will be apt to fall into this con- 
dition. Ulcerations or loss of tissue are 
liable to be present in this state. 
Second.—The state of over-nourish- 
ment is one in which there is too great 
an amount of blood supplied to the 
parts, which are swollen and red, and 
in an irritable, sensitive state too easi- 
ly aggravated into more serious condi- 
tions by even the ordinary atmospheric in- 
fluences present, as well as through the 
ordinary use of the parts. This condition 
is apt to be present in those who use alco- 
holic beverages ; the alcohol acting either 
as a direct irritant to the parts while being 
swallowed, or by increasing the force of the 
general circulation, or in other ways in 
furnishing too great a local blood-supply. 
Third.—Inflammation is a difficult thing 
to define even to the professional student. 
We can only say that it is a process marked 34 
Catarrh, Sore- Throat, and Hoarseness. 
by certain phenomena. These are mainly, 
an increased blood-supply to, and elevation 
of temperature in, the part inflamed, with 
more rapid waste in the diseased tissue. 
The increase of temperature may extend to 
the whole body. There is swelling and 
pain, and if the process progresses to a cer- 
tain extent, the formation of pus, and per- 
haps even the production of gangrene or 
death of the part will take place. If the 
part inflamed be a mucous membrane, as 
in the nose, pharynx, and larynx, the pro- 
duction of the mucous secretion will be inter- 
fered with ; at first there will be a deficiency, 
but later on there will be a greater pro- 
duction than is natural. There is also apt 
to be an extensive increase in the shedding 
of the cells that compose the surface of the 
mucous membrane. If the inflammation 
be deep, the pus formed collects in a 
cavity forming an abscess, from which 
after a certain maturity, the pus works its 
way to the surface, and, with a free vent 
thus formed, the process usually comes to 
an end. This is the process that occurs in 
the familiar throat trouble known as Quinsy Catarrh, Sore- Throat, and Hoarseness. 
35 
sore-throat. In the mucous membrane, as 
a rule, the pus finds its way to the surface 
without forming in collections or abscesses. 
If muscles are involved in the inflamma- 
tory process their action will be interfered 
with so as to produce more or less paralysis 
in them. If the process goes through a 
regular course in a few days, or a week or 
so, it is called an acute inflammation, and 
after the parts become quieted down to 
their normal state it will be found that no 
considerable changes have occurred in the 
parts themselves. Chronic inflammation 
extends over weeks and even years, and 
is not characterized by such severity of 
action as the acute attack ; but, if it per- 
sists a certain time there will be changes 
of a decided nature in the anatomical 
elements forming the structure of the 
parts inflamed. There may be an increase 
in all the elements, or some one element 
may preponderate in the increase. Take, 
for instance, a chronic inflammation of the 
mucous membrane of the pharynx ; the 
glands may be the element mostly affected, 
and become much enlarged, producing the 36 
Catarrh, Sore-Throat, a7id Hoarseness. 
condition known as Clergyman’s sore- 
throat. As another example :in a chronic 
inflammation of the mucous membrane of 
the nose, the fibrous element in the mem- 
brane may become increased and afterward 
contract, completely obliterating the glands, 
thus producing ozrnna or fetid catarrh, that 
very unfortunate complaint, hard to endure 
both by the patient and those with whom 
he is brought in contact. It is of course 
only attempted here to outline something 
of the nature of these diseased processes. 
A complete idea of the nature of inflamma- 
tion requires years of study for its compre- 
hension. 
Fourth.—There may be loss of func- 
tion in a part. Among the conditions 
coming under this head, may be loss or im- 
pairment of the voice, such as hoarseness ; 
difficulty in swallowing, or in the articula- 
ting powers ; loss of smell, etc. These 
disorders may be caused primarily by some 
diseased condition of the parts themselves, 
or they may be secondary to some trouble 
either in the parts themselves, or in some 
distant locality, as in the nervous system. Catarrh, Sore-Throat, and Hoarseness. 
37 
Many of these affections may be classed 
under the head of paralysis, and this par- 
alysis may be due to inflammation, presence 
of growths, hysteria, etc. 
Fifth.—Excessive functional activity in 
the upper air-tract is chiefly noticeable in 
the production of excessive secretion 
by the glands. Frequently the mus- 
cular apparatus of the throat is im- 
plicated, having an involuntary action of 
a spasmodic nature, an example of which 
is so often seen in the so-called spas- 
modic croup. Other examples, are where 
excessive sensibility of the sense of 
smell and great irritability of some part of 
the mucous membrane exist. An hysterical 
tendency in an individual will tend to de- 
velop these diseased peculiarities. 
Sixth.—There are various kinds of 
growths that occur in the nasal passages, 
pharynx, and larynx. Some are so 
benign that they may not materially inter- 
fere with the usefulness of the organs 
invaded. Others are not dangerous to 
life, and can be removed without per- 
manent injury to the individual, while 38 
Catarrh, Sore-Throat, and Hoarseness. 
still others are but manifestations in 
the upper air-tract of serious if not abso- 
lutely fatal disease that involves more or 
less of the whole body. As examples of 
the latter may be mentioned malignant 
cancer, and tuberculosis or consumption of 
the larynx. In the very serious cases, the 
diseased growths in forming displace and 
destroy the natural healthy parts, and then 
finally break down themselves, ulcerating 
and leaving vast cavities. In some of the 
serious cases the ravages of the disease 
may be stopped and life saved, but after 
healing the parts are left permanently de- 
formed. 
All the above conditions and processes, 
and others not mentioned, may either be 
present in connection with, or have been 
the cause in the production of, one or other 
of the symptoms known as Catarrh, Sore- 
Throat, and Hoarseness. A BRIEF MENTION OF THE MORE COMMON 
DISEASES PRODUCING CATARRH, SORE- 
THROAT, AND HOARSENESS, 
ACUTE Nasal Catarrh, or Cold in 
the Head, or Coryza.—This is a 
transient inflammation of the mucous 
membrane of the nasal cavities, the con- 
tiguous cavities being usually affected 
also. It is marked by swelling and 
stuffiness in the nose, followed by a dis- 
charge, at first thin and watery, but which 
later becomes thick. The attack usually 
passes off, in from three to ten days, spon- 
taneously. It can sometimes be aborted, 
and can always be much shortened in its 
duration, and alleviated by appropriate 
local treatment. 
■ Chronic Nasal Catarrh is character- 
ized by a persistent abnormal discharge 
from the nose. There are various con- 
ditions that may be present in this dis- 
order. The discharge may be thin, watery, 
39  Catarrh, Sore- Throat, and Hoarseness. 
40 
and abundant, or it may be scanty and 
tenacious, and fetid in odor. The mucous 
membrane may be thickened, or in other 
cases it may be atrophied or shrunken 
away. This condition requires long and 
varying treatment, and in some cases sur- 
gical operations, to bring about a cure. 
Obstruction of the Nasal Passages 
from Growths and Malformations may 
become a cause of disease, as well as a dis- 
ease itself. Surgical procedures are gen- 
erally necessary for its correction. 
Fetid Nasal Catarrh, sometimes known 
as Dry Catarrh or Ozsena, is a most un- 
fortunate disorder for the possessor and all 
those with whom he is brought in contact. 
The terrible stench emanating from the 
nostrils repels even the warmest friend. If 
this affection has continued too long, it is 
not possible to entirely cure the case, but 
every case can be much improved, and the 
patient can be brought into such a con-' 
dition that his life will not be a burden, and 
he wall cease to be a nuisance to his friends. 
Some cases are entirely curable. 
Ulcerations in the Nose are sores Catarrh, Sore-Throat, and Hoarseness. 
41 
that do not heal, and that result in the loss 
of tissue. They may be the result of a 
poorly nourished condition of the parts, 
and readity heal under an appropriate 
stimulating treatment; but the great cause 
of this condition is the ravages of syphilis, 
that terrible venereal disease that is the 
scourge of the world. If not promptly 
checked by the most energetic medical 
measures, there may be much destruction 
in the parts, resulting in great permanent 
deformity. 
Hay Fever is a disease of which the 
peculiar characteristic is a profuse watery 
catarrh from the nasal passages. It can 
be much alleviated by suitable medicated 
applications, but cure can only be assured 
by the removal of the patient to a locality 
where the atmosphere is free from the ir- 
ritating plant pollen, etc., which is the cause 
of the disease. 
Foreign Bodies in the Nose, which 
have become impacted in the sinuosities of 
the nasal passages by children, generally 
too young to know of their wrong-doing, 
usually set up a persistent, though slight 42 
Catarrh, Sore-Throat, a?id Hoarseness. 
catarrh. There may be a slow inflam- 
matory action present that eventually will 
enlarge the tissues and shut in the body 
from view, but a thorough examination by 
the surgeon will generally discover the 
cause of trouble, and the removal of the 
body brings about a cure. 
Acute Sore-Throat—Almost every- 
body has experienced this trouble. It is a 
transient inflammation of the mucous mem- 
brane of the lower pharynx and neighbor- 
ing parts, and its chief symptom is a pain- 
ful sensation occurring during the act of 
swallowing. It is usually self-limited to a 
very few days’ duration. If taken at the 
start it may usually be cured in one, or at 
least two days, by skilful treatment. This 
is one of the few throat complaints that 
can be successfully treated by the patient 
at home. (See Chapter on Domestic Trea- 
tment.) 
Chronic Sore-Throat, often called 
Clergyman’s Sore-Throat, is the result of a 
long course of abuse of the pharynx. The 
changes in the mucous membrane are 
o Catarrh, Sore-Fhroat, and Hoarseness. 
43 
marked, especially in the glands, which be- 
come enlarged. The curative treatment is 
generally very tedious, and in some cases 
rather severe measures have to be adopted 
to bring about a change for the better. 
Post-Nasal Catarrh is the name of a 
catarrhal affection of the vault of the phar- 
ynx, generally chronic in character and as- 
sociated with nasal catarrh. It is the throat 
and nasal affection most frequently treated 
by the professional man, and is exceedingly 
common. Its treatment requires much at- 
tention at home by the patient, in the way 
of constant cleansing, as it occurs just at the 
remote angle in the air-tract, where impuri- 
ties, such as dust, together with the abnormal 
secretions, are apt to become lodged, and 
further provoke diseased action in the part. 
Inflammation of the Tonsils.—Some 
people have a predisposition to inflamma- 
tion of these glands. The inflammation 
may only implicate the surface of the ton- 
sils and their deep folds or follicles, which 
trouble is often mistaken for diphtheria by 
ignorant practitioners, and, being so desig- 
nated by them, these men get the reputa- 
tion for effecting great cures. 44 
Catarrh, Sore-Throat, and Hoarseness. 
Quinsy Sore-Throat is a deep inflamma- 
tion of the tonsils in which there is formed 
one or more abscesses. It is an exceedingly 
painful and severe disorder, causing great 
general prostration, and almost closing the 
mouth, so that swallowing or even opening 
the mouth is extremely difficult. Children 
and young people who have these attacks 
of tonsillar trouble are apt to have their 
tonsils become permanently enlarged. All 
of these cases are much improved by the 
removal of the enlarged organs. In some 
cases their removal is imperatively neces- 
sary, as they interfere with breathing, and 
thus lead to a deformity of the chest that 
causes future trouble in the lungs. These 
enlarged glands may interfere with the 
hearing, with proper articulation in speech, 
and with the general nutrition, on account 
of the difficulty they cause in swallowing. 
A Relaxed Soft Palate and Elon- 
gated Uvula may cause a persistent in- 
flammatory condition, not only of the 
pharynx, but of the larynx as well. The 
trouble may usually be rectified by simple 
applications of astringents and stimulants, Catarrh, Sore- Throat, and Hoarseness. 
45 
but frequently the removal of a portion of 
the uvula is a necessity. It is not a pain- 
ful operation, and affords great relief. 
Diphtheria, though a septic disease of 
the whole body, may be mentioned here, 
because it peculiarly manifests itself in an 
intense inflammation of the throat. Some- 
times its only manifestation is a slight sore- 
throat. These slight sore-throats are apt 
to be present during epidemics of diph- 
theria. This disease is apt to leave the 
muscles of the throat in a paralyzed condi- 
tion, thus becoming one cause of hoarse- 
ness and difficulty in swallowing. Of 
course this dangerous disease requires the 
immediate and constant care of a trained 
physician. 
Ulcerated Sore-Throat may be due 
to a poorly nourished condition, or to a pe- 
culiar inflammatory state ; but usually it is 
the result of syphilitic formations in the 
tissues of the throat, and these, breaking 
down, produce the ulcerated condition. 
Croup is the designation given by the 
laity to almost every acute affection of the 46 
Catarrh, Sore-Throat, and Hoarseness. 
larynx. There are a number of inflammatory 
and functional disorders that are so called, 
but whatever the affection may be, the 
prominent feature which arrests the atten- 
tion, is the impairment of the voice known 
as hoarseness. The exception to this is 
the affection known as spasmodic croup, 
when uncomplicated with inflammation ; in 
which case the difficulty in breathing, and 
the hard, brassy, croupy cough, are the 
prominent signs. This latter trouble is 
simply a spasm of the muscles of the larynx, 
and comes as a reflex action from some 
distant source of irritation, as, for example, 
the presence of an excess of indigestible 
matter in the alimentary canal. Though 
alarming, this condition is not a serious 
one, but when it occurs in connection with 
an acute catarrhal inflammation of the lar- 
ynx, it is a serious disorder, and needs the 
prompt attention of an intelligent physician. 
In children these inflammatory laryngeal 
troubles are serious, because the swelling: of 
the mucous membrane encroaches so much 
upon the naturally small air-space in the 
larynx, all of which is needed for the pas- Catarrh, Sore- Throat, and Hoarseness. 
47 
sage of air. In some of these cases an im- 
mediate artificial opening into the windpipe, 
through the front of the neck, is impera- 
tively necessary to save the life of the pa- 
tient. The ordinary mild attacks of “ croup,” 
or acute catarrhal laryngitis, in the adult, 
usually result in self-cure in the course of a 
week or ten days, if the patient be only care- 
ful to avoid exposures to any cause that would 
increase the difficulty by further irritation ; 
but proper medicinal local applications to the 
larynx by the surgeon will afford great re- 
lief and materially shorten the duration of 
the attack. If the inflammation be very 
severe, or is the result of diphtheria, there 
is apt to form in the larynx a false mem- 
brane that may fill up the air-space so that 
more or less speedy suffocation of the pa- 
tient ensues. These cases usually end 
fatally, though a few do recover. 
Chronic Laryngitis may, among other 
causes, be the result of a neglected acute 
inflammatory attack, or it may be due to a 
long-continued irritation, as from over use 
of the larynx. The mucous membrane 
becomes unequally thickened and other- 48 
Catarrh, Sore-Throat, and Hoarseness. 
wise changed. Though there will be dis- 
agreeable symptoms, such as burning, 
tickling, excessive secretion, cough, etc,, 
the prominent symptom is apt to be some 
impairment of the voice. Either there will 
be hoarseness, or the voice cannot be con- 
trolled as well as usual; a condition more 
noticeable in singing and declamation. 
Some of these cases merely require rest of 
the voice to bring about a cure, but the 
great majority require local medicinal appli- 
cations in the larynx. Some of these cases 
prove to be very obstinate, and require 
great perseverance on the part of the 
patient in submitting to continued treat- 
ment before a cure can be effected. Some 
very bad cases of long standing can only 
be promised alleviation and improvement. 
It is most important, if these patients ex- 
pect to be cured, that they do not neglect 
early treatment, and they should not allow 
the trouble to exist for any length of time 
without consulting a trained physician. 
Paralysis of the Laryngeal Muscles 
may cause hoarseness, and even loss of 
voice or aphonia. The condition may be Catarrh, Sore- Throat, and Hoarseness. 
49 
a temporary one, caused, for instance, by 
an acute inflammation, and resulting in 
self-cure upon subsidence of the inflamma- 
tory attack. Other cases may be amenable 
to treatment, and especially to applications 
of electricity. Still other cases are abso- 
lutely incurable, and if certain muscles are 
affected, the result is apt to be fatal. 
Cancer, Consumption, and Syphilis of 
the Larynx are all troubles, fortunately 
not very common, whose first symptom 
may be hoarseness of the voice. The first 
two are almost always fatal in the end. 
The diseases here mentioned are only 
among those that are commonly met with, 
having a connection with our subject. 
Enough, however, have been cited, to 
show how great a variety of disorders may 
be the cause of the symptoms known as 
Catarrh, Sore-Tpiroat, and Hoarseness. CERTAIN SYMPTOMS OF NASAL AND 
THROAT DISORDERS AND THEIR SIG- 
NIFICANCE. 
BAD BREATH is caused by vitiation 
or putrefaction of the secretions of 
the food- and air-tracts. It may also result 
from putrefaction of broken-down tissues of 
those parts, as in ulcerative processes. It 
may come from imperfect or unclean teeth, 
disordered stomach, fermenting food, ul- 
cerating growths, decomposing secretion 
in the follicles of the tonsils, and retained 
secretion in the bronchial tubes. One of 
the most terribly offensive breaths is the 
result of dry catarrh in the nose, and also 
that produced by large masses of retained 
and putrefying secretions in the cavities 
adjoining and emptying into the nose. 
Deep ulcerations in the nose, producing 
cavities containing decomposing broken- 
down tissue, give rise to an indescribably 
terrible stench. 
50 Catarrh, Sore-Throat, and Hoarseness. 
51 
Catarrh.—The ideas of the average 
layman on the nature of catarrh are not 
only vague, but usually incorrect. Scien- 
tifically the word signifies an inflammatory 
discharge of fluid from any mucous mem- 
brane in the body, but‘the word, in com- 
mon parlance, is used to designate an ab- 
normal discharge from the nasal cavities 
and from the vault of the pharynx. The 
ancients thought that this discharge was an 
efflux from the brain, discharging certain 
morbid humors from the system. Even in 
this later day of supposed enlightenment, 
quacks and charlatans, who advertise ca- 
tarrhal remedies, claim that a catarrhal dis- 
charge is the result of the presence of 
these vicious humors in the blood, which 
find vent from the nose. Of course, their 
pet remedy will search out and eliminate 
all such disagreeable constituents of the 
nourishing fluid. The glands of the air- 
tract normally discharge a certain amount 
of secretion, whose purpose is to keep the 
parts properly moistened and lubricated. 
A catarrhal discharge may merely be an 
excessive production of this secretion, and  Catarrh, Sore-Throat, and Hoarseness. 
52 
this simply indicates an over-stimulation of 
the glands from some cause. If the secre- 
tion is very thin and watery, it is due to a 
large amount of the serum of the blood 
being exuded from the mucous membrane. 
This is present in the first part of acute ca- 
tarrhal discharges. In proportion as this 
watery serum is wanting, the discharge be- 
comes thick and more sticky, owing to a 
greater proportionate amount of mucus be- 
ing present. In violent inflammation, and 
in the later stages of milder ones, the 
discharge becomes clouded, owing to the 
presence of pus-cells, and also to the shed- 
ding of many of the small cells composing 
the outer layer of the mucous membrane. 
If there are ulcerations present, the dis- 
charge may be colored with blood. A 
nasal catarrh may be the result of an acute 
inflammation or a chronic one. It may be 
confined to the nasal passages, or the con- 
necting cavities may also be implicated. 
It may be the result of ulcerations in the 
nose, or be due to the presence of a foreign 
body, or of growths in the nose. 
Cough, when caused by inflammatory Catarrh, Sore-Throat, and Hoarseness. 
53 
tickling or presence of secretion in the 
larynx, has a peculiar brassy tone known 
as a “ croupy cough.” There is also a 
peculiar cough used to expel secretion 
from the lower pharynx. 
Difficulty in Swallowing. This 
symptom may be the result of paralysis of 
the muscles used in the act, or it may be 
due to a swollen condition of any of the 
parts of the throat. It may also be caused 
by growths, especially those in the lower 
part of the pharynx, obstructing the pas- 
sage of food. Spasm of the pharyngeal 
muscles wall also make swallowing difficult. 
Dryness and Burning in the throat 
may be due to deficient secretion, or may 
be one of the sensations of the inflamma- 
tory process. 
Expectoration. Children under six 
years of age, as a rule, do not expectorate. 
Expectorated matter usually comes from 
the lower pharynx, larynx, or bronchial 
tubes, but it is frequently the secretion of 
the mucous membrane back of the nose, 
which reaches the mouth by dropping into 
it, or by being drawn backward and down- 
ward by an inspiratory effort. 54 
Catarrh, Sore-Throat, and Hoarseness. 
Hawking is the act of clearing the 
pharynx from excessive or redundant se- 
cretions. It is usually caused by morbid 
secretions beina- formed at the back of the 
o 
nasal passages and in the vault of the 
pharynx, though the lower pharynx is 
sometimes the seat of its production. It 
indicates a catarrhal affection of those parts. 
Hoarseness is a rough, harsh, grating 
quality of the voice that is heard under 
certain diseased conditions of the larynx 
and its muscular apparatus. When we 
hear a hoarse voice we may know that 
something is interfering with the normal 
action of the voice-producing machinery, 
preventing an harmonious rhythmical ac- 
tion in the parts. A growth may prevent 
the approximation of the vocal bands. In- 
flammation may thicken the whole mucous 
membrane, or the vocal bands themselves, 
or it may prevent those muscles from prop- 
erly working, that control the position and 
tension of the vocal bands. Ulceration in 
the larynx may destroy more or less of the 
vocal apparatus, and thus bring about the 
trouble. Paralysis may also produce 
hoarseness. Catarrh, Sore-Throat, and Hoarseness. 
55 
Loss of Voice, or Aphonia, is usually 
due to paralysis of the laryngeal muscles, 
and this may be produced by inflammation, 
or by some trouble in the nerves which 
produce motion in the muscles. Of course 
extensive destruction of the larynx from 
any cause is followed by more or less loss 
of voice. 
Painful Swallowing may be caused by 
pressure on inflamed and swollen parts 
during the act, or it may be due to ulcer- 
ated, raw surfaces being rubbed by the 
passing bolus of food. 
Sense of the Presence of a Foreign 
Body may be caused by growths, presence 
of abnormal secretion, swelling, and excori- 
ated surfaces that have been produced by 
rough food, bones, etc., scraping the 
mucous membrane. 
Shortness of Breath may be due to 
inflammatory swelling partly closing the 
larynx, or a laryngeal growth may more or 
less prevent air from freely passing, or 
there may be a spasm of the muscles that 
bring the vocal bands together, or it may 
result from a paralysis of the muscles that 56 
Catarrh, Sore-Throat, and Hoarseness. 
open the glottis or laryngeal aperture ; but 
more frequently this symptom will be found 
to be due to disease of the bronchial tubes, 
lungs, or heart. 
Sore-Throat is a painful sensation, pro- 
duced by pressure on the end filaments of 
the nerves of the mucous membrane of the 
throat, by the swelling of that membrane 
from inflammation. Less frequently 
growths, such as cancer, exert the pressure. 
This symptom is most frequently confined 
to the lower pharynx where there is much 
motion, and where the act of swallowing- 
increases the pressure on the tender nerves. 
Where there is much swelling, as in inflam- 
mations of the tonsils, the pain is very 
severe. THE PRODUCTIVE CAUSES OF NASAL AND 
THROAT DISEASES. 
TAKING cold is probably the most 
frequent cause of disease in the up- 
per air-tract. This “ taking cold ” is the 
effect of exposures to extremes of tempera- 
ture, which result in disturbances in the 
circulation of the blood, through mechani- 
cal and nervous influences. The normal 
temperature of the body is about 98° F., 
and its functions are interfered with more 
or less in proportion as that degree of heat 
is increased or diminished. Although ex- 
posures to excessive temperatures may act 
in different ways to bring about disease, as 
the effects are nearly identical, the process 
is generally spoken of as taking or catching 
cold. 
The following are among the ways of 
“ catching cold.” A person may breathe 
air so cold that it acts as an irritant to the 
57 58 
Catarrh, Sore-Throat, and Hoarseness. 
mucous membrane of the air-tract; this is 
especially the case if the air is also damp. 
Great cold may deprive the mucous mem- 
brane of so much of its vitality, that it is 
not able to withstand the usual effect of the 
blood-pressure of the general circulation. 
A strong wind may blow into the nose, and 
prove to be over-stimulating to the mucous 
membrane. If the whole body, especially 
when the individual is overheated or per- 
spiring, is unduly exposed to cold, there 
will follow a general state of chill and de- 
pression. A reaction follows this state, and 
it is apt to be an over-reaction which is pe- 
culiarly liable to affect in its excitement the 
weak parts of the body; so, if the upper 
air-tract happens to be the weak spot, it 
will result in an inflammation of its mucous 
membrane. Again, a cold current of air 
may strike one part of the body, unduly 
cooling it. The impression thus made may 
be conveyed by the nervous system to cer- 
tain nerve-centres, and thence may be re- 
flected to the nose and throat, bringing 
about an inflammatory excitement. The 
cooling of one part of the body may drive Catarrh, Sore-Throat, and Hoarseness. 
59 
out blood from that part into the weaker 
part, and thus start up inflammation. 
These are the most frequent ways of 
taking cold. A less frequent method is the 
result of breathing too hot air, as one would 
be apt to do when employed over a stove, 
thus overheating the mucous membrane, 
partly depriving it of its vitality. This par- 
alyzes the muscular tissue controlling the 
supply of blood in the blood-vessels, which 
furnish too great a blood supply to the 
part, and thus starts the inflammatory pro- 
cess. It is proper to state here that the 
taking of most colds is due to an improper 
regulation in the amount and distribution 
of the clothing worn. The fault may be in 
the fact that the whole body may be insuf- 
ficiently clad, or it may be that a part of 
the body only, as the head or the feet, is 
not properly protected. Thin shoes, by 
causing cold or wet feet, have made 
numberless human beings miserable in- 
valids. The next most frequent direct 
cause of throat and nasal affections is the 
inhalation of irritating matters in the form 
of dusts, vapors, or gases. Of course the  Catarrh, Sore- Throat, and Hoarseness. 
atmosphere is always contaminated with 
floating impurities, and it is only when the 
impurities are in excess, or too irritating 
for the mucous surfaces which they come 
in contact with, that they become noxious. 
Among these impurities are the dust of the 
street, those produced in grinding and 
other pursuits., especially in tobacco facto- 
ries, smoke, soot, chemical vapors, etc. 
The lining membranes of the air-tracts 
of individuals differ in their sensibility 
to the same and different irritants. Thus, 
the well-known hay fever, which is a 
catarrh of the nasal tract and connecting 
mucous surfaces, is caused by floating plant 
pollen in the air ; it being quite harmless to 
the great majority of individuals, while it 
is the cause of disease in the hay-fever 
patient; and not only that, but some per- 
sons are affected by one kind of pollen, 
while others are affected by that of quite a 
different plant. The presence of a diseased 
condition in one part of the upper air-tract 
may be the cause of trouble in another; 
for example, nasal catarrh may cause laryn- 
gitis. Catarrh, Sore-Throat, and Hoarseness. 
61 
Again, those diseases that interfere with 
the proper circulation of the blood, such 
as of the heart and kidneys, may cause and 
keep up throat disorders. Inflammatory 
catarrhal attacks weaken the parts and 
predispose them to renewed diseased 
action. General constitutional weakness 
and delicacy of tissue predispose the 
individual to these affections. 
Insufficient or improper nourishment, de- 
bilitating habits, residence in intemperate 
climates and unhygienic dwellings and sur- 
roundings, all have their effect on the causa- 
tion of these troubles. Breathing foul air 
is a very prominent factor as a cause of 
nasal and throat disease, and in preventing 
their cure. 
Locality is often the source of the trouble. 
It may be that the general locality is un- 
suited to the best hygienic needs of the in- 
dividual, or some local source of dampness 
or impurity in the immediate vicinity of 
the dwelling may be at fault. Deprivation 
of sunlight may so depress the general 
physical health as to be the predisposing 
cause. The poisons of infectious diseases, 62 
Catarrh, Sore-Throat, and Hoarseness. 
the presence of foreign bodies in the air- 
tract, abuse of function, and functional dis- 
use, especially breathing through the mouth 
instead of the nose, are also causes of the 
diseases under consideration. THE DOMESTIC TREATMENT OF NASAL AND 
THROAT DISORDERS. 
THE most successful treatment, in a 
domestic way, of the diseases under 
discussion, is such as will be preventive 
in its action. If the general health-status 
be maintained at a high level, the air-tract 
will participate in that good condition, and 
will be able to resist causes of disease that 
would otherwise bring about these dis- 
orders. 
Proper food, regularity of habit, suffi- 
cient clothing, especially of the feet, plenty 
of muscular and out-of-door exercise, 
proper ventilation and heating of the family 
residence—and this means the breathing of 
pure air in-doors, free from dust and other 
impurities—are among the requirements of 
living up to a good hygienic standard. In 
the family it should be an aim to avoid un- 
due exposure to those influences that cause 
these troubles, but yet efforts must also be 
63 64 
Catarrh, Sore- Throat, and Hoarseness. 
made to inure sensitive persons to a cer- 
tain amount of exposure ; and among the 
best means of doing this is the adoption of 
a regular habit of cold sponge bathing, and 
heating by means of the open-grate fire. 
Sleeping-rooms should be kept well venti - 
lated and tolerably cool, say from so° to 
60° in winter, and the terrible, elevated 
temperatures of our furnace-heated homes 
should be avoided. If there is an open 
fire to sit by and warm one’s self at, the 
average general temperature of the house 
need not be over 6o°, except for great 
invalids and the very weak and aged, 
or in case of actual disease, where an ele- 
vated temperature may prove beneficial for 
the case in hand. It is much better to 
wear more clothing than to breathe air in 
the house that is very much warmer than 
the out-of-door atmosphere. 
The ordinary mild acute attacks of the 
upper air-tract have a tendency to quick 
self-recovery if the patient be only pro- 
tected from adverse conditions. Thus, if a 
person with an ordinary attack of acute 
•“ cold in the head,” “ sore-throat,” or Catarrh, Sore- Throat, and Hoarseness. 
65 
“ hoarseness,” will remain quietly reclining 
and covered on a sofa or bed in an apart- 
ment moderately warm, eat a moderate, 
mild, unstimulating diet, and keep the in- 
testines freely open, he will be surrounded 
by conditions favorable to a quick recovery. 
In case of sore-throat, ice may be melted 
in the mouth, or ice-water, with or without 
the addition of a mild astringent, may be 
taken in the mouth and allowed to bathe 
the inflamed parts. It is an important 
principle in the treatment of acute inflam- 
mations, that rest be given to the part in- 
flamed ; so, if the larynx is the seat of 
trouble, talking, singing, etc., will increase 
the trouble. Acting upon the same prin- 
ciple, swallowing should be avoided as 
much as possible in attacks of sore-throat ; 
and frequent, forcible blowing of the nose, 
and breathing even an ordinarily irritating 
atmosphere, must not be done when a 
“ cold in the head ” is present. 
Severe Acute Attacks should be 
treated only under the care of an intelligent 
physician. 
Chronic nose and throat troubles usu-  Catarrh, Sore-Throat, and Hoarseness. 
66 
ally need the attention of a competent 
physician. At least his assistance should 
be sought for, to point out the nature of 
the trouble and to suggest the outline of 
the treatment. In most cases this treat- 
ment can only be efficiently carried out by 
the trained surgeon, but most patients can 
assist in the cure by partial treatment at 
Fig. 10. 
home. There is a large class of cases 
where regular cleansing of the nasal pas- 
sages aud vault of the pharynx is an im- 
portant and even necessary procedure. 
The cleansing fluid may need to be bland 
or stimulating as the particular case re- 
quires. It may sometimes be efficiently 
applied by snuffing it into the nose from 
the palm of the hand, but it is more de- 
sirable to possess a spray-producer to do Catarrh, Sore- Throat, and Hoarseness. 
67 
the cleansing with, constructed upon the 
principle of the instrument represented in 
fig 10. In the incurable cases of fetid catarrh, 
such an instrument should be an adjunct of 
Fig. 11. 
every toilet-stand, for, as in this condition 
the nose cannot clean itself, the patient 
should clean out his nasal cavities with as 
much regularity as he would clean his 
teeth or any other part of his body. In many 68 
Catarrh, Sore- Throat and Hoarseness. 
cases of throat trouble, the patient receives 
benefit from taking medicated inhalations at 
home. These can be taken from a resfu- 
<_> 
lady constructed inhaler, such as is shown 
in fig. 11 ; or, what is nearly as good, a pint 
of boiling water can be placed in a pitcher 
of convenient size, the medicament added, 
and the nose and mouth applied to the top 
of the pitcher, while a towel is held to the 
interstices between the face and pitcher so 
as to confine the steam, which is breathed 
into the throat for some minutes. 
Sometimes a steam atomizer, shown in 
fig. 12, is very desirable to use. Of course 
Fig. 12. 
the various medical substances used in the 
inhalations should be indicated by a phy- 
sician for the peculiar condition present. THE SURGICAL AND MEDICAL PROFES- 
SIONAL TREATMENT OF DISEASES OF 
THE UPPER AIR-TRACT. 
I immense improvement made 
X during late years in the treatment 
of the class of disorders under discus- 
sion, has been greatly due to, and stim- 
ulated by, the discovery and adoption 
of the rather simple instrument known 
as the Laryngoscope. The essential 
part of this instrument is a small mirror 
of a size fitted to the throat to be ex- 
amined, attached to a long, slender han- 
dle that allows the mirror to be held at 
various angles at the back of the throat. 
See fig. 13. This procedure enables the 
operator to look around the corners, so to 
speak, of the throat; and after some prac- 
tice, in overcoming the practical difficulties 
of the examination, the observer can see 
reflected in the small mirror almost all the 
internal parts of the throat and the region. 
69 70 
Catarrh, Sore- Throat, and Hoarseness. 
Fig. 13 shows the laryngoscopic mirror in position for view- 
ing the larynx. Catarrh, Sore-Throat, and Hoarseness. 
71 
back of the nasal passages. The front 
parts of the nasal passagesi 
are inspected directly through 
the nostrils, which are dilated 
for that purpose with a proper 
instrument. Throat mirrors 
are represented in fig. 14. 
An essential to the working 
of the laryngoscope is a ray 
of intense light properly di- 
rected onto the throat mirror 
or into the parts to be ex- 
amined. To attain this end 
the most convenient method 
is to use an artificial source 
of light, located at the side 
of the patient’s head, which 
liofht is condensed and thrown 
on a perforated concave mir- 
ror attached to the forehead 
of the operator, and thence 
reflected through the open 
mouth onto the throat mir- 
ror as it is held in position ; 
or, if the front of the 
nose is under examination, the light is 
Fig. 14. 72 
Catarrh, Sore-Throat, and Hoarseness. 
directed into the nostrils. Fig. 15 represents 
Fig. 15. 
Fig. 16. 
the light condenser most frequently used, Catarrh, Sore-Throat, and Hoarseness. 
73 
and fig. 16 the forehead mirror, through 
the perforation of which the operator gazes 
with the eye nearest the source of light, 
the other eye being uncovered, but shield- 
ed from the light by the rim of the mirror. 
Fig. 17 shows the relative positions taken 
by the patient and the operator in the ex- 
amination of the larynx by artificial light. 
Most of the lower pharynx can be exam- 
ined without the throat mirror, the tongue 
being merely depressed with a tongue 
spatulum. 
Having made the physical examination 
by the important means of sight, perhaps 
aided by feeling with the finger-tip, or 
various probes, and having the patient’s 
history of his troubles, and the symptoms 
connected therewith, the experienced 
physician is enabled to arrive at a diag- 
nosis of the case. This necessary and 
important preliminary being attended to, 
what can the surgeon do for the relief of 
the patient ? 
His treatment may be hygienic, con- 
stitutional, and local. Sometimes one 
method of treatment is sufficient; while 74 
Catarrh, Sore-Throat, and Hoarseness. 
Fig. 17.—Examination of the larynx with the laryngoscope. Catarrh, Sore-Throat, and Hoarseness. 
75 
again, all are necessary. Frequently a 
mere pointing out of some infraction of 
hygienic living, and the correction of 
the same, will be all that is necessary 
to insure a cure. In some cases, only a 
very energetic course of internal medica- 
tion will meet the exigencies of the case. 
The majority of cases coming under the 
care of the laryngologist are most appro- 
priately and beneficially treated by a course 
of local medicinal applications made to the 
diseased structures—this course being more 
or less extended, according to the nature of 
the affection, or its chronicity. For exam- 
ple, a sudden hypersemic condition of the 
larynx, causing a considerable amount of 
suffering to the patient, may often be en- 
tirely relieved by one appropriate applica- 
tion ; while old chronic cases, such as laryn- 
gitis, or post-nasal catarrh, can only be 
promised cure after a long and tedious 
course of treatment, very trying to the per- 
severance of the patient. It may be some 
compensation for such tedious cases to con- 
sider that, if they were not submitting to 
treatment, their difficulty would persist in- 76 
Catarrh, Sore- Throat, and Hoarseness. 
definitely ; or, what is more probable, be- 
come progressively worse. The value of 
making medicinal applications locally to 
diseased structures of the body is so im- 
mensely superior to the old method of in- 
ternal medication that there can hardly be 
instituted a comparison. As an example : 
with the improved methods of to-day it is 
possible to make applications to the trachea 
and larger bronchial tubes, usually the seat 
of bronchitis, and accomplish as much in 
one day toward curing troubles in this part 
of the body as could be done in four days 
by giving medicines internally, besides 
avoiding injury to the stomach and other 
tissues of the body. 
Of course the more strictly surgical 
procedures are necessary in treating some 
of the affections under consideration, such 
as removal of the tonsils, enlarged mucous 
glands, amputation of the uvula, etc., but 
the majority of cases do not need such 
rigorous treatment. Among the indica- 
tions to be fulfilled in making local appli- 
cations to the air-tract are the following; 
Ist, To CLEAN THE PARTS. 2d, To DISIN- Catarrh, Sore-Throat, and Hoarseness. 
77 
FECT. 3d, To PRODUCE A SEDATIVE ACTION. 
4th, To RELIEVE PAIN. sth, To AFFORD AN 
EMOLLIENT OR PROTECTIVE EFFECT. 6th, 
To CONSTRINGE THE PARTS, ESPECIALLY THE 
* 
BLOOD-VESSELS. 7th, To STIMULATE THE 
PARTS. Bth, To PRODUCE AN ALTERATIVE 
EFFECT OR CHANGE IN THE ACTION. 9th, To 
RECOVER LOST FUNCTIONAL ABILITY. lOth, 
To DESTROY OR REMOVE REDUNDANT TISSUES. 
Medicinal applications are best made to the 
upper air-tract in the form of atomized 
sprays, produced through the agency of 
compressed air. Fig. 19 represents the 
usual compressed air-receiver, pump, and 
spray tube used for the purpose. Differ- 
ently arranged tube-tips allow the opera- 
tor to direct the sprays from different points 
into the various cavities. Sometimes the 
application is best made in the form of 
a powder, applied with an insufflator. 
Fig. 20 represents an insufflator that is 
operated by the air-pressure produced with 
a rubber hand-ball. 
This is very convenient for personal ap- 
plication by the patient, and in the case of 
small children, who are apt to object to a 78 
Catarrh, Sore-Throat, and Hoarseness, 
Fig. 19. 
wet spray. Reference has already been 
made to inhalations in the preceding chap- 
Fig. 20. Catarrh, Sore- Throat, and Hoarseness. 
79 
ter. Direct contact of medicated solutions 
by brushes, such as are shown in fig. 21, or 
by cotton pledgets wound on 
a probe, or by the solid drug 
fused on a proper instrument, 
are also methods of applica- 
tion. To produce the effects 
desired, the surgeon has open 
to his use the whole realm of 
chemical and pharmaceutical 
preparations, and a very long 
list of such substances are 
thus employed, many of them 
producing substantially the 
same effect. No two cases 
are entirely the same, and to 
produce the best result do 
not necessarily require iden- 
tical treatment, nor does the 
patient require the same 
treatment at all times, it be- 
Fig. 21. 
ing a matter of good judgment on the sur- 
geon’s part, at each sitting of the patient as to 
what remedies and measures are best fitted 
for the condition then present. Electricity 
has proved to be a remedial agent of such 80 
Catarrh, Sore-Throat, and Hoarseness. 
efficiency in treating certain of the diseased 
conditions under consideration, that men- 
tion of it should not be omitted. In its 
various forms it is used to effect removals 
of diseased tissue, and in re-establishing 
functional ability. In some hysterical cases 
its action is seemingly miraculous, one ap- 
plication of electricity to the larynx some- 
times being sufficient to restore voice to a 
patient who has been voiceless for months 
or years.