The Throat and its Diseases. 
BY 
J. SOLIS COHEN, A.M., M.D., 
OF PHILADELPHIA, 
LECTURER ON LARYNGOSCOPY AND DISEASES OP THE THROAT AND CHEST, IN JEFFERSON 
MEDICAL COLLEGE, PHILADELPHIA; PHYSICIAN TO JEFFERSON MEDICAL COLLEGE 
HOSPITAL AND TO THE GERMAN HOSPITAL OF PHILADELPHIA. THE THROAT 
The throat is a double passage-way through which the air we 
breathe reaches the larynx on its way to the lungs, and through 
which the food we swallow reaches the gullet on its way to the 
stomach. It is therefore a very im- 
portant portion of the body, being em- 
ployed in the two functions of respi- 
ration and alimentation (feeding), the 
former being the more essential of the 
two. 
As shown in the adjoining diagram, 
it will be seen that there are two 
routes by which the air is conveyed to 
the larynx : 1, The normal respiratory 
route through the nostril, as indicated 
by the upper dotted line in the dia- 
gram; and 2, The accessory respiratory 
route through the mouth, as indicated 
by the lower dotted line. The route 
taken by food and drink, the alimen- 
tary route, is indicated in the diagram by the solid line pass- 
ing through the mouth, beyond the larynx, into the gullet (food- 
pipe, oesophagus) behind. The larynx is composed of rigid struc- 
tures which keep its calibre open for the necessary ingress and 
egress of the air in respiration; while the gullet is a soft tube, 
composed of flexible structures, the walls of which are in close 
juxtaposition, except when forced open by the muscular act 
or effort of swallowing to receive the food or drink. As the 
food-pipe is behind the air-pipe, articles of food or drink might 
easily fall into the larynx by accident, were it not for a cover or 
valve at the top of the front part of the larynx, which is pressed 
right down upon it, like a trap-door over a hole or the lid on a 
molasses-jug, in the motion of swallowing, during the momentary 
Figure 114.—Diagram of the routes 
taken by the air to reach the lungs, 
and by the food to reach the stomach. 378 
THE THROAT. 
performance of which act respiration is necessarily suspended. 
If one talks or laughs while swallowing, the trap-door may remain 
open and some food or drink may get down the wrong way and 
enter the larynx, provoking spas- 
modic efforts of cough to expel it 
—an occurrence with which almost 
every one is familiar. 
The nostril is the proper pas- 
sage for respiration, but when 
stopped up by mucus, a swelling, a 
morbid growth, or a foreign body, 
the accessory respiratory route 
(the mouth) must be used for this 
purpose; and in fact it will be found 
that in most instances where peo- 
ple breathe by the mouth, there is 
more or less obstruction of some 
kind in the nose. 
That portion of the throat in 
which the respiratory and alimen- 
tary tracts cross, is known as the 
pharynx, and it extends from the 
base of the skull behind the nos- 
trils (see diagram) as far down as 
the entrance into the gullet, with 
which it is continuous. It is therefore somewhat the shape of 
the top of a buggy-wagon or a barouche. [For an account of the 
anatomy of the parts concerned, the reader is referred to the chap- 
ter on Anatomy.] 
Figure 115 -The soft palate and tonsils, 
as seen from the mouth. 
Care of the Throat. 
Many individuals are very subject to diseases of the throat and 
nasal passages; a slight exposure to wet, change of temperature, 
change of clothing, change of bed-room, or the like, rendering 
them susceptible to sore throat, quinsy, cold in the head or chest, 
or whatever may be the special affection to which they are liable. 
It is useless to attempt to avoid this by taking medicine. Much 
may be done, however, to secure immunity from attacks of the 
kind on slight provocation, by methodically inuring the body to 
withstand the unavoidable exposures to which every active person 
is more or less subject in our variable climate. This is not to be 
done by the use of chest protectors, mufflers, heavy overclothing, 
furs, and like wraps. Far from it. The habitual use of these THE THROAT. 
379 
things only serves to confirm the delicacy of constitution which 
they are fondly believed to protect; and when they are left off, or 
by accident or inadvertence forgotten, a severe attack of the com- 
plaint to which the individual is predisposed is almost certain to 
be the penalty. The causes of the predisposition alluded to are 
various. Sometimes the infirmity is hereditary. People are physi- 
cally very much what their parents make them. Delicate or ail- 
ing parents are likely to breed delicate and unhealthy children. 
Hence the great number of deaths during childhood—weedings out, 
as it wTere, of the immature. Daily sponging of the body with 
cold water, on rising, is the best method of inuring the skin to 
withstand accidental exposure to wet and changes of temperature. 
Among the exciting causes of diseases of the throat and nasal 
passages may be mentioned: Sudden exposures to excessive 
changes of temperature out of doors and indoors, especially expo- 
sure to cold when the body is overheated, no matter how the over- 
heating may have been produced; sitting, working, and sleep- 
ing in illy-ventilated apartments; sojourn in crowded places, 
whether church, school-room, theatre, court-room, ball-room, or 
street-car; exposure to air vitiated by illuminating gas, coal gas, 
tobacco-smoke, the products of chemical combustion, and the like; 
the indulgence in cold drinks on the top of hot viands; immoderate 
use of iced water in summer time, especially when the body is 
overheated by exercise; too protracted contiguity to patients with 
scarlet fever and diphtheria. 
It is much more rational to prevent disease than to trust to 
getting cured after contracting it. Persons subject to sore throat, 
whether hereditarily predisposed thereto or otherwise, should avoid 
all the sources of injury above enumerated. They should wear 
woollen or silken (animal fabrics) underclothing, changing the 
weight or texture of the garment on the positive approach of 
change of season. 
When going from a warm and especially from a crowded room 
into a chilly outside atmosphere, the precaution to breathe for the 
first few minutes through the nose only, or through the meshes of 
a shawl, handkerchief, or folded veil, is all that will ordinarily be 
needed. 
Where children are accustomed to breathe through the open 
mouth, this should lead to an examination, and it will probably be 
found that enlarged tonsils are the cause of the difficulty, and that 
they require removal by some of the methods to be hereafter de- 
tailed. The harm which results from breathing through the mouth, 
instead of the natural respiratory passage, is that the throat is 
rendered dry and apt to become inflamed ; that the air is not prop- 380 
THE THROAT. 
erly warmed and moistened by passing over the wet and warm 
surfaces of the bones of the nose before it reaches the delicate 
vocal organ, and that dust and irritating matter, which should be 
arrested in its passage through the nose, is carried into the respira- 
tory organs, and becomes a cause of disease. 
[In England, more commonly than in this country, it is custom- 
ary to wear a respirator made of some sort of gauze, or sponge 
over the nose and mouth ; but the instances in which such protec- 
tion is needed are far less than would justify the extent of the 
practice, if we except those connected with some of the trades. 
Indeed, among workmen who could derive decided benefit from 
the use of some such means for excluding foreign matter from the 
throat and air-passages, the use of respirators is much too seldom 
resorted to.] 
The Voice. 
A short account of the nature of the voice and its production, 
will insure a better comprehension 
of the method of taking care of it. 
The voice is the sound voluntarily 
made in the throat for the usual pur- 
poses of communication and inter- 
communication ; and it is broken up 
in an arbitrary manner, different as 
adopted by different nations or com- 
munities, by the physical action of 
the lips, tongue, teeth, and palate, in- 
to accentuated or articulated speech ; 
while the modulation of the pitch 
and volume of the sounds gives ex- 
pression to the utterances. The 
voice is formed in the larynx 
(vocal-box) (Fig. 116), on top of the 
windpipe, by the forcible action of 
an outward or expiratory current of 
air striking or impinging upon two 
tense bands or folds of membrane (vo- 
cal cords cv) which run from front 
to back in this box, in close contact 
in front, and movable behind a', their 
to-and-fro movement being similar 
to that of the handles of a pair of scissors. These vocal cords 
are set into vibration just as the reeds of an accordion are set into 
Figure 116.—Section through the car- 
tilages of the larynx, showing the inner 
surface of the right side. /, thyroid car- 
tilage cut through its centre, in front; 
c, e, front and rear portion of the cricoid 
cartilage, similarly divided; a, inner 
surface of the right arytenoid cartilage ; 
its anterior projection ; cv, thyro-ary- 
tenoid ligament. THE THROAT, 
381 
vibration by the wind from the bellows of that instrument. The 
hard, angular projection in the anterior part of the neck t, more 
prominent in men than in women, marks the junction of the two 
sides of this triangular vocal-box or larynx. If the finger is run 
down this projection, a soft depression ctli is felt just before it joins 
a circular base (cricoid or ring-cartilage c), which is situated direct- 
ly on top of the windpipe, of which it is actually an expanded 
continuation. If the finger be held against the soft part just 
indicated while the voice is sounded, the vibrations can be dis- 
tinctly felt, because a thin membrane is there which is actually 
continuous with the vocal cords, which are located a little above 
it in the shape of a rather horizontal V, the legs of which are 
directed backward. The production of voice is due to the vi- 
bration of these cords, and to the vibration of the air in the air- 
tubes, throat, nose, and mouth, as can readily be felt in the chest 
when one speaks in a deep-toned voice ; and even the trunk and 
limbs vibrate just like the sounding-boards or walls of musical in- 
struments in certain deep and sonorous tones. 
The intensity or loudness of the voice is due to the size of the 
vibrations, or, in other words, to the extent of to-and-fro movement 
impressed upon the vocal cords ; the larger the space through which 
they vibrate, the greater is the quantity of air set in motion, the 
larger the wave of sound, and the louder the voice; while the voice 
becomes more feeble as the space through which the vocal cords 
move becomes diminished. Intensity is independent of pitch and 
quality. 
The pitch of the voice (its position in the musical scale) is pro- 
portionate to the frequency of the vibrations; the greater the 
number per second, the higher the pitch. Pitch is independent of 
intensity and quality. 
The quality of the voice (that characteristic which distinguishes 
it from the sound of an artificial musical instrument, and which 
makes it easy to recognize the voice of any one individual as dif- 
ferent from all others) is due to the shape impressed upon the 
sound-waves by the consentaneous action of the different factors 
of the sound (fundamental tones, harmonic and unharmonic over- 
tones, combination tones), owing to the fact that all musical 
sounds are composed of series of tones, most of which are pro- 
duced by vibrations of the sounding body (vocal cords in man 
and animals) in certain aliquot parts, at the same time that it is 
vibrating as a whole. The more harmonious these individual 
tones, the sweeter the sound as a whole ; the more discordant 
these individual tones, the harsher the sound of the voice as a 
whole. The comprehension of this physical fact is rather difficult, 382 
THE THROAT. 
and would require a good deal of space for its elucidation. The 
reader is therefore referred for details to works on physics, on 
acoustics, or on sound. Quality is independent of intensity and 
pitch. 
To understand the physical formation of the registers of the 
voice, it is necessary to see the performance. This can be accom- 
plished by placing a small mirror in the mouth in such a position 
as to get a reflected view of the image of the vocal-box (larynx) and 
its contents, as shown in this figure below, in which the image of 
Figure 117.—The larynx in the respiratory position, as seen in an image reflected in a glass 
mirror held far back in the mouth. 
the larynx is seen as reflected in a mirror in the mouth. This in- 
genious and beautiful method of exhibiting the larynx of a living 
person and studying the action of the vocal cords in the forma- 
tion of voice is known as the art of laryngoscopy (viewing the 383 
THE TIIKOAT. 
larynx), and the demonstration of its feasibility is chiefly due to 
the assiduous efforts of Mr. Manuel Garcia, a celebrated teacher 
of vocal music in London, who devised it for the purpose of study- 
ing the mechanism of the voice. Since the publication of Garcia’s 
observations, the method has been extensively introduced into the 
practice of medicine in the examination and treatment of many 
affections of the throat. 
As depicted in the above illustration, the vocal cords are repre- 
Figure 118.—Method of examining the larynx by solar reflection. 
sented widely separated behind, as seen during a deep inspiration, 
which renders the rings of the windpipe visible below them. 
When the voice is produced, the vocal cords have to come to- 
gether posteriorly, as shown in Fig. 119, leaving a delicate slit 
between them, through which the ex- 
piratory current of air is forced, set- 
ting the cords into vibration ; an ef- 
fect which is readily observed in the 
mirror. Of course the rings of the 
windpipe and all the other structures 
below the vocal cords are shut off from 
view as long as the voice is being 
sounded. When the pitch of the voice 
is raised, the vocal cords are seen to become more tightly stretched, 
and the slit between them to become shorter, so as to leave a 
shorter and more tense portion of the cord free to vibrate ; the 
pitch rising just the same as when the cord of any stringed instru- 
ment of music is shortened, and stretched more tightly. 
Figure 119.—Vocal cords closed, as 
seen in the production of vocal sound. 384 
TIIE THROAT. 
There are three principal registers of the voice : chest, falsetto, 
and head-notes. In the formation of the chest-notes, the vocal 
cords are seen to vibrate their entire breadth. In the formation of 
the falsetto-notes, the vibration is confined to their edges. In the 
formation of the head-notes (common to women, exceptional in 
men), the vocal cords become so tightly pressed together behind, 
that there only remains an open slit or fissure for little more than 
half the length of the vocal cords, which vibrate only in their 
free edges.* 
SOPRANO. 
mi fa sol la si do re mi fa sol la si do re mi fa sol la si do re mi fa sol la si do 
11 1 11222 2222333 3 3 3 34444444 5 
| CONTRALTO. 
BASS. 
The usual range of the four varieties of the human voice. 
TENOR. 
Care of the Voice. 
When we consider that the entire compass of the voice is due 
to the symmetrical action of two vocal cords, little bands of tissue, 
as thin at their edges as a sheet of ordinary writing-paper, less 
than an inch in length, about one-tenth of an inch in breadth, and 
with but one free surface each, we can readily comprehend how del- 
icate must be the mechanism and arrangement of the nervous and 
muscular structures that animate them and alter their position and 
tension in order to produce those charming effects with which all 
listeners to good vocal music and good oratory are familiar. It is 
no wonder, then, that good voices are so often irretrievably in- 
jured by injudicious management. No teacher of elocution or of 
vocal music should be trusted now-a-days with the training of a 
voice of some consequence to its possessor, unless that teacher has 
a comprehensive acquaintance with the anatomy, physiology, and 
mechanism of the voice. As already mentioned, the special mech- 
anism of the sounds of the chest, falsetto, and head registers are 
dissimilar. If, then, an ambitious teacher tries to force the chest 
tones into the falsetto register, or the falsetto into the head regis- 
ter, he is apt to inflict injury upon the delicate mechanism, whether 
he accomplishes his object or not. The proper points of transition 
can be observed in the mirror, and can be detected by an educated 
* For more detail, the reader is referred to Mrs. Seiler’s reliable work on “ The Voice 
in Singing,” publi-hed in Philadelphia. TIIE THROAT. 
385 
ear, so that there is no excuse for neglecting their study. Surely 
no master, with a real love for his art, should hesitate to avail him- 
self of the advantages to be gained by such observations. The 
manual skill necessary for the manipulation of the throat or laryn- 
goscopic mirror can be acquired in an hour ; the cost of the mir- 
ror is about one dollar. The anatomy of the parts, once carefully 
pointed out in a human larynx, can be thoroughly studied up at 
leisure in calves’ larynges (which can be had from any butcher 
for the asking), and the rest is a question of time and facility of 
comprehension. The result of the outlay, in intelligent knowledge 
of the tools with which he is to work, will be immeasurably in 
excess of its cost to any teacher of vocal culture, not to count its 
personal advantages in improving his own skill in the use of his 
voice, or in developing the vocal capabilities of his pupils. Any- 
thing which strains the vocal cords, such as screaming, prolonged 
use of the voice, talking or singing in too high a key, using the 
voice to any extent when fatigued, overfed, unwell, or hoarse, is 
sure to be injurious, and should be studiously avoided by all public 
singers and speakers. It is neglect of care of this kind which 
drives so many from the stage, concert-room, and pulpit during a 
prolonged period of inaction ; and it is rare that an injured voice 
recovers all its previous tractability. All those injurious influences 
enumerated in connection with the subject of care of the throat 
are injurious to the voice. A slight congestion of the cords, from 
cold or overstraining, is sufficient to withdraw them from the ex- 
quisite control of muscular effort so essential to the formation of 
pure tones ; and the swelling of inflammation changes their phys- 
ical capacity for tone still more so, and, in addition, sometimes 
prevents their being brought sufficiently near each other to pro- 
duce any tone at all, so that the voice is lost, for the time being, 
unless under the force of violent effort, in itself injurious. One 
should, therefore, cease speaking in public, or singing anywhere, 
the moment there is any manifestation of hoarseness, however 
slight. There is no compromise possible, if the individual is not to 
run the risk of more or less prolonged hoarseness, or trouble more 
serious. Indeed, preachers and professional and domestic vocal- 
ists should speak altogether in whispers whenever their voices are 
hoarse ; and those who do not sing or lecture, and to whom altera- 
tion of the voice is but of little moment, should use the voice as 
little as practicable whenever it is affected. Silence, ice to the 
throat, externally and internally, a smart saline or castor-oil purge, 
and the avoidance, for a few days, of red meat and alcoholic bev- 
erages of all kinds, will; in most instances of slight recent injury to 
the voice, suffice for treatment. In cases of severe injury, and in 
Vol. II.—25 386 
TIIE THROAT. 
cases of long standing the advice of the physician is essential. 
Silence in cases of affected voice is more than golden to the indi- 
vidual who is dependent on skill in its use for support. 
DISEASES OF THE THROAT. 
Sore Throat. 
Sore throat may be confined either to the parts back of the 
mouth (palate, tonsils, pharynx), or the deeper portions (larynx, 
windpipe), or it may affect all these structures more or less. Sore 
throat is a frequent accompaniment of scarlet fever, measles, 
small-pox, erysipelas of the face, and other affections. It is one of 
the prominent manifestations in diphtheria. It is also an accom- 
paniment of many cases of pulmonary consumption, especially 
toward their final stages ; and is a very frequent manifestation in 
the constitutional ravages of syphilis, after the system has become 
impregnated with the virus. It may be brought on by voluntary 
or accidental swallowing of hot and corrosive fluids ; by exposure 
to respiration of noxious gases and fumes ; by the inhalation of 
dust, smoke, grit, and the like ; by loud and continuous talking 
and overstraining the voice in various ways ; by the abuse of 
tobacco, alcoholic beverages, highly seasoned food, or of hot and 
cold viands in close succession. 
The most frequent cause of sore throat is exposure to cold when 
the body is overheated. 
The Symptoms of sore throat are pain, redness, swelling, diffi- 
culty of breathing, difficulty of swallowing, cough, expectoration, 
hoarseness, and impairment or loss of voice. The intensity of the 
symptoms vary with the amount of inflammation, the. extent of 
surface over which it extends, the nature of the tissue in which 
the diseased process is going on, and the mechanical interference 
with the functions of breathing, swallowing, and speaking. Some 
cases are so slight as hardly to attract attention, and others are 
more severe, so as to interfere with the due performance of one’s 
duties. 
Treatment.—Most cases will get well if they are only left alone 
without resort to any of the numerous advertised syrups, lozen- 
ges, and other remedies. All that needs to be done is to remain 
quiet, avoid conversation, to see that the body is well protected by 
proper clothing day and night, avoiding exposure to cold and wet; 
to suck bits of ice almost continually if the throat is hot, swollen, 
and painful, and to apply iced cloths or bags of pounded ice exter- THE THROAT. 
387 
nally, changing them as soon as they get warm, and to eat very 
plainly cooked food, and very little of it. If the bowels have been 
confined, a smart purging will be useful, and nothing is better than 
a dose of Epsom salt (a tablespoonful for the adult, in a tumbler 
of water, before breakfast) in summer, or of an infusion of senna 
(one or two drachms for the adult) and manna (one ounce for an 
adult) in winter. If the sore throat is not of more than twenty-four 
hours’ standing, it is a good plan to put the legs into hot water well 
impregnated with mustard, until they get very red, take something 
in the nature of a hot drink, and then jump right into bed be- 
tween blankets, and remain there until late the following morn- 
ing. This treatment will often cure a mild sore throat in two or 
three days ; and neglect of it will often convert a mild and easily 
managed case into a protracted and obstinate one. If the treat- 
ment here laid down is not promptly followed by amelioration of 
the symptoms, it may be taken for granted that the case is beyond 
the ordinary resources of home remedies, and the sooner the medi- 
cal attendant is summoned the more quickly will the patient get 
relief and be placed on the road to recovery. Meanwhile, the suf- 
ferer may suck a sal-prunell ball, and cover the neck with a flan- 
nel wrung out of heated camphor-water, or a mixture of oil of 
turpentine with three times as much sweet-oil. 
Severe sore throats should always be reported promptly to the 
physician. Delay of only a few hours often renders it impossible to 
institute measures to restrain inflammatory action, and the disease 
will have to run its course. The neglect of proper management is 
almost sure to be punished by chronic or protracted suffering. A 
brief description will be given of the severer forms of sore throat, 
in order that they may be promptly recognized, and such measures 
advised as are judicious to be employed until the arrival of the 
medical attendant. Any one ignorant of medical subjects and of 
the natural history of disease who meddles with powerful drugs is 
much more likely to do irreparable injury than temporary good. 
It is almost always “ hit or miss,” and the misses inevitably pre- 
ponderate ; not unfrequently they are the immediate precursors of 
fatal results. 
Enlarged Tonsils. 
[The tonsils consist of two rounded or ovoid bodies the size of 
a cherry, and are made up of connective tissue, holding together a 
number of glands which secrete a thick, glairy mucus, and have a 
number of openings upon the surface of the tonsil. They are 
situated on the sides of the throat between the folds of the palate. 388 
THE THROAT. 
(See Fig. 120.) They are often swollen in children and young per- 
sons, as a result, so it is thought, of a scrofulous constitution, and 
quite frequently on account of repeated attacks of sore throat. ] 
A slight enlargement of the tonsils produces no unpleasant 
symptoms ; but when they are large enough to project some consid- 
erable distance into the free passage of the throat, they interfere 
with swallowing and sometimes with respiration. They push the 
soft palate away from the back part of the throat and produce a 
nasal twang of the voice, with the addition of a peculiar tone due 
to interference with proper articulation. Sometimes they are large 
enough to touch each other, and they then prevent a proper amount 
of air from entering the lungs, and compel the patient to maintain 
a certain position of the neck, which renders him what is called 
round-shouldered.” When very large they have been known to 
produce suffocation. The liability of chronically enlarged tonsils to 
become inflamed is quite great, and such attacks are usually severe. 
Sometimes they become ulcerated. Sometimes the glands secrete 
a mucus, which cannot escape freely from the little orifices, and it 
undergoes a transformation into a cheesy material of very fetid 
character. These little masses are often spat out from time to 
time, and when crushed emit a very offensive odor. 
Treatment.—The treatment of enlarged tonsils usually demands 
the use of nutritious diet and often that of cod-liver oil to improve 
the general health. The best home treatment, when they are soft, 
is the application of ox-gall, either fresh or partly dried by evapo- 
ration, twice or thrice daily; the application being made by a 
finger of one hand while the fingers of the other hand support the 
neck outside so as to press the tonsil in both directions. Simple 
compression of this kind, without any local medication, applied 
several times a day, will sometimes promote the absorption of 
these bodies if the enlargement is soft and of recent standing. 
Gargles of water containing chlorate of potassium, alum, white- 
oak bark, or rliatany, are sometimes useful, and so is the local use 
of sprays, as recommended for chronic sore throat. [For the pro- 
portions of these, see the formulas at the end of the second vol- 
ume.] If the increase in size is very great (and these simple 
measures are not of any service after a few weeks’ trial), the ser- 
vices of a surgeon will become necessary to cut off a portion of 
the gland or reduce its size by the application of strong caustics. 
\Pigeon breast is also a result of considerably enlarged tonsils. 
When the diaphragm contracts during inspiration and the floor of 
the thorax is pulled downward, a vacuum tends to be made in the 
chest cavity, air rushes in to fill it from without, and the vacuum 
is prevented. If air is not admitted as rapidly as the vacuum de- 389 
THE THROAT. 
mands, the weight of atmospheric pressure on the flexible walls of 
the chest causes the ribs and cartilages to bend inward and assume 
the appearance characteristic of this deformity. Furthermore, 
the development of the chest is interfered with, and the lungs, 
especially about their upper portions, never acquire the capacity 
essential to health: and as the period during which development 
can take place is limited to youth, the person who has been allowed 
to suffer in the manner described remains deformed for life, and 
is especially liable, it is thought, to the development of consumption. 
Inflammation of the Tonsil—Quinsy Sore Throat. 
This is almost entirely a disease of temperate and changeable 
climates, is most common among persons between sixteen and 
thirty years of age, and is only rarely seen among children. It 
consists of an inflammation of the mucous membrane covering the 
tonsil or of the deeper portion of the glands, and either one or both 
tonsils may be affected, although it is more common that one alone 
is inflamed at a time. Persons who have a tendency to suffer 
from rheumatism are thought to be especially liable to this trouble. 
The most frequent exciting cause (where one can be recognized) 
is exposure to wet and cold, particularly during a north-east wind 
(in the Atlantic States). When atmospheric causes exist there 
will usually be a number of cases in the same community. 
Symptoms.—A chill usually occurs at the outset, followed by 
considerable fever, which is accompanied by aching of the muscles 
generally, “ as if they had been pounded.” There is headache and 
a pain in the throat on the side affected, and the pain will very 
probably be increased by movements of the jaw and efforts to 
swallow. On looking at the tonsil, it is seen to be red and swollen. 
As the disease progresses, the swelling and pain increase, until 
swallowing becomes difficult or almost impossible; while, to aggra- 
vate the trouble, the saliva is increased in quantity, and, rather than 
subject himself to the torture of swallowing, it is allowed by the 
patient to run from the mouth. In a well-marked case of quinsy 
the breath acquires a peculiar odor, quickly recognized when once 
smelled, and the voice becomes thick and muffled, so that the words 
can hardly be understood. ] 
The swelling may be so great as to prevent closure of the mouth, 
on the one hand, and as to impede respiration, on the other, so that 
the patient, for the time being, is in a deplorable condition. In 
cases of moderate severity the symptoms gradually abate; but in 
severe cases they continue until an abscess is formed, and when 
that is discharged spontaneously, or by the surgeon’s knife, the 390 
THE THROAT. 
severity of the symptoms cease almost instantly, and complete 
recovery ensues in a few days. 
Treatment.—There is some danger in allowing an abscess in the 
tonsil to open of itself, as the pus 
may fall into the larynx, and pro- 
duce suffocation. In all cases, 
therefore, where the tonsil is in- 
flamed, medical aid should be 
promptly solicited. Meanwhile ice 
or iced water externally and inter- 
nally, a purging enema of salt and 
water, and rest in the recumbent 
posture, may be instituted at home 
until the arrival of the physician. 
[The inhalation of vapor from 
hot water will often give tempora- 
ry relief to some of the symptoms. 
The patient must not attempt 
to swallow solid food, but should 
take as freely as the pain of swal- 
lowing will permit, ice-cream, 
soups, gruels, iced milk, custard, 
etc. The prescription of stimu- 
lants had better be left to a physician. The use of guaiacum in 
doses of two grains of the powder, repeated every hour, will some- 
times put an end to an attack in its earliest stages.] 
Figuke 120.—Enlarged tonsils and elon 
gated uvula. 
Diphtheria. 
Diphtheria is a form of blood-poisoning, of which inflammation 
of the throat is but one symptom. It is often fatal; occurs at all 
seasons; is often common in certain localities where there is exces- 
sive ground-moisture from bad drainage; and attacks individuals 
of any age. 
It is due to a peculiar poisoning of the blood, the exact nature 
of which is unknown, but which is believed to be in great measure 
connected with poisonous emanations from defective sewerage. 
Young children who have been weaned from the breast are quite 
liable to it up to the age of ten or eleven years; after which the 
susceptibility declines, though it is never lost entirely. The chief 
manifestation, apart from general symptoms of sore throat, with a 
state of low fever, is the appearance of a peculiar membrane on 
some part of the throat, usually commencing on the tonsils, which 
in some cases may eventually cover the entire throat, the walls of THE THliOAT, 
391 
the nasal passages, the larynx, wind-pipe, and bronchial tubes, 
and even other mucous membranes, as well as abraded portions of 
the skin. When the air-passages become involved, there is an 
additional danger from suffocation; but though many cases die 
from this cause, the greater number die exhausted by the debilitat- 
ing effects of the poison. There is a mild form of sore throat, not 
accompanied by low febrile symptoms, in which there also appears 
an exudation upon the throat. This is apt to be mistaken for 
diphtheria, but differs from it in there being no tendency to death 
from blood-poisoning. It is often very difficult for even a physi- 
cian to discriminate between the two affections at the outset; and 
hence the occurrence of sore throat with any evidence of a whitish 
or yellowish patch or streak about the tonsils or palate should 
always occasion sufficient alarm to send for medical advice at 
once, for if a mistake is made it may be fatal, inasmuch as severe 
cases of diphtheria are not likely to recover unless judiciously 
managed from the start. If there be languor, fever, sore throat, 
and patches in the throat, especially if there is swelling of the 
glands under the jaw on the side affected, it is quite likely that 
the case is diphtheria. 
Treatment.—A case of diphtheria should be isolated as far as 
practicable from every one but the necessary attendants, and no 
stuffed furniture or drapery should be permitted in the sick-room; 
for the disease is contagious, and the infecting matter is very apt 
to adhere to upholstery, carpets, and the like. The best thing to be 
done pending the advice of a physician, is to place the patient in a 
room of not less than 70° temperature, avoiding draughts, while 
securing free ventilation; and to encourage the patient to keep bits 
of ice in the mouth; to place cloths wrung out of iced water around 
the throat, ajid replace them every two or three minutes as they get 
warm, and to keep up a plentiful supply of good, strong soup, milk 
punch, and as liberal an allowance of well-cooked animal food as 
can be taken without disgust. There need be no hesitation in giv- 
ing brandy, whiskey, or rum, in small quantities, quite frequently, 
even every hour if the patient is getting weak, so long as there are 
no signs of approaching intoxication. If there are any such signs 
of its intoxicating influence, it is evidence that too much liquor is 
being given. It is useless to mention here any remedies to be used. 
In a malady so serious as diphtheria remedies are unsafe in unskil- 
ful hands. There is no remedy that will cure the disease, but such 
means will be used by the physician as will best keep up the pa- 
tient’s strength, promote his appetite, soothe his sufferings, and 
detach the membrane from the air-passages when they become 
involved. If the physician’s services cannot be promptly secured, 392 
THE THROAT. 
it is usually safe to administer chlorate of potassium (two grains 
to a child about one year of age, five grains to one of twelve, and 
ten to an adult) and tincture of the chloride of iron (five drops to a 
child of a year or two, ten drops to one over twelve, and twenty to 
an adult) in sweetened water made palatable by lemon-juice or 
lemon-syrup, every two or three hours. In bad cases, sleep should 
be disturbed to give the medicine. Sometimes the membranes in 
the air-passages threaten eventual destruction by suffocation, and 
it becomes necessary, as in croup, to avert this danger by making 
an artificial opening into the windpipe through which the patient 
can breathe; and if the deposits be not too extensive below this 
opening, it gives the patient a good chance to live longer, so that, if 
his strength and vitality are sufficient, he may pass through the 
remaining stages of the disease and recover; but the operation is 
not in itself curative. Active measures are still requisite, and 
extra attention is essential to take care that the artificial opening 
does not get clogged up with mucus or false membrane, and thus 
make matters worse than before. Sometimes the matters expec- 
torated accumulate in the mouth in dangerous quantity, and require 
to be removed by the fingers or the mop. This operation, often 
effective in children between two and twelve years of age (in 
whom the small size of the windpipe admits of less swelling of 
the lining membrane than is the case with a grown person), is 
rarely of any avail in the adult. 
Relaxation of the Palate—Elongated Uvula. 
This is a frequent ailment in persons subject to sore throat, the 
chief symptom being a frequent cough from titillation of the 
tongue, or of the valve on top of the larynx, by the tip of the uvula, 
especially while lying down. Many cases of chronic cough are 
due to this cause. (See Fig. 120.) 
The Treatment consists in cutting off a portion of the elongated 
uvula, and thus removing the source of the evil. Slight cases 
and ordinary relaxation of the palate can sometimes be cured by 
the frequent use of pellets of ice in the mouth, or by sucking alum, 
catechu, or borax. A long tapering uvula can rarely be relieved 
without an operation. 
Chronic Pharyngitis; Clergymen’s Sore Throat; Chronic Sore 
Throat. 
Clergymen are by no means the only individuals affected with 
chronic pharyngitis ; public speakers generally, teachers, actors, 393 
THE THROAT. 
newsboys, salespeople—in fact, all persons who are compelled to 
use the voice a good deal in all weathers, are extremely liable to the 
affection. Chronic pharyngitis is characterized by increased red- 
ness of the various structures of the throat,—enlarged blood-vessels 
being visible on various portions of the surface, with a rough or 
raw appearance of the parts, and little groups of elevations here 
and there, due to enlargement of the glands which secrete the 
mucus that keeps the throat moist, pliable, and comfortable. There 
is more or less accumulation of viscid mucus, which is prone to 
adhere in strands or clumps to the raw surface. 
The Symptoms are chiefly those of annoying sensations of dis- 
comfort in the throat, with more or less hawking to free the throat 
from mucus. Sometimes, however, there is considerable pain and 
heat in the throat, and often more or less hoarseness from exten- 
sion of the disease into the larynx. (See Chronic Laryngitis.) There 
Fig. 121. 
Fig. 122. 
Figure 121.—Apparatus for making a spray by means of steam-pressure. (Codman & Shurt- 
lefFs apparatus.) 
Figure 122.—Apparatus for making a spray by means of air-pressure. 
is a good deal of apprehension on the part of the public that the 
disease in the throat may extend to the lungs and eventuate in 
consumption; but this does not take place unless the individual is 
predisposed to consumption, or acquires a disposition to it. When 
there is a predisposition to consumption, however, it is quite likely 
that it may be accelerated by this chronic sore throat. 
Treatment.—The disease is a chronic one, usually of long 
standing before it attracts much attention; and it is therefore 
one which requires a good deal of time in its treatment. The 
habitual use of weak gargles of alum, borax, and chlorate of 394 
THE TIIUOAT. 
potash (five to ten grains to the ounce of water), is advisable; 
and it is well to use these solutions in the form of spray by 
means of the so-called atomizer (Figs. 121 and 122), which 
breaks the fluid up into a minute spray, and at the same time 
propels it with considerable force so that the remedy reaches a 
great many parts that cannot be reached by gargling. A care- 
ful attention to easily digested diet is also of great importance; 
while the bowels, kidneys, and skin should be kept in as healthy 
a condition as possible. If this simple treatment does not suffice, 
the aid of the physician must be invoked to make local applica- 
tions of tincture of iodine, nitrate of silver, or other remedies. 
There is a great deal of prejudice against the use of nitrate of sil- 
ver, which is far the best agent in most cases; and this arises 
from the idea that it is to be used as a caustic to burn something 
away. This is not so. An application of nitrate of silver leaves 
an impermeable white coating on the parts, which protects them 
temporarily from the air and from impure saliva, and thus gives 
the parts beneath the coating a chance to get well. This is the 
whole secret. The application must be thoroughly made by a 
competent person, and need not be repeated until the coating falls 
off, which usually takes place in from one to three days. Two or 
three thorough applications a week, with a strong solution, or even 
with the solid nitrate of silver, will be much more effectual than 
daily pencillings with a weak solution. These applications should 
never be made by unskilful hands, or they will do harm instead 
of good. Hence no directions are given as to the strength of the 
solution and the manner of application. 
Internal remedies are incompetent to cure the disease, no matter 
how skilfully selected ; hut they are almost always required to cor- 
rect some defect of nutrition, the continuance of which retards the 
cure ; and these remedies vary, of course, with each individual case. 
Public speakers must use the voice as little as possible during 
the treatment, and the use of tobacco and alcoholic beverages 
should be given up. It is not necessary to observe that absolute 
disuse of voice so essential to prompt recovery in inflammatory 
affections of the larynx itself, in which the vocal cords participate 
directly in the diseased process. 
Acute Laryngitis—Inflammation of the Larynx. 
This is an acute inflammation of the mucous membrane of the 
larynx, from cold or from local injury. It sometimes occurs in pa- 
tients affected with typhoid fever, small-pox, and other diseases ; 
it occurs from swallowing and inhaling hot or acrid substances ; 395 
TIIE TIIROAT. 
but in the great majority of cases it is the result of abrupt expo- 
sure to excessive changes of temperature. The symptoms, though 
severe, are not threatening, and the inflammation is superficial. 
Still there is a liability to the sudden, or more or less prompt effu- 
sion of serum (fluid part of the blood) beneath the mucous mem- 
brane of certain portions of the larynx, producing a dropsy of the 
part, which may seriously interfere with respiration and even pro- 
duce suffocation if not promptly relieved by the knife of the sur- 
geon,—for medicines are of no avail in this critical condition. 
Whenever, therefore, in the course of a sore throat, any serious 
impediment to respiration takes place suddenly, or during the 
course of a few hours, a physician should be promptly summoned, 
or a fatal disaster, that could otherwise have been averted, may 
ensue from neglecting to do so. 
The Symptoms of laryngitis are pain in the deeper portion of 
the throat (often increased on pressure externally), hoarseness, 
brassy cough, difficulty or pain in swallowing, and some impedi- 
ment to respiration. 
The Treatment consists in maintaining absolute rest in the 
recumbent posture, disuse of the voice, unloading of the bowels 
by a dose of Epsom salt (one ounce for an adult) or other saline, 
and keeping them in a soluble condition, and the local use of ice 
externally and in the mouth. The diet should be fluid and muci- 
laginous, so as to be swallowed with the greatest ease, and acid 
drinks may be allowed if they do not hurt the parts. If the patient 
goes about his usual pursuits, he is liable to a serious and sudden 
increase of the inflammation, which may lead to suffocation before 
he can get medical assistance, and the danger of this complication 
exists in almost every case. An amount of inflammation which 
would be insignificant in any external part of the body, and devoid 
of immediate danger anywhere else, is a very serious affair in the 
narrow portibn of the larynx, and apt to end in death by suffoca- 
tion. Most cases of laryngitis, therefore, demand the assiduous 
attention of a physician. If there is much fever, a small dose of 
Epsom salt (one teaspoonful for an adult) and tartar-emetic (one- 
eighth of a grain for an adult), or antimonial wine (a few drops) in 
water, may be taken at intervals of eight, six, or four hours, ac- 
cording to the urgency of the symptoms. 
Chronic Laryngitis—Chronic Inflammation of the Larynx. 
This disease is often the result of a succession of more or less 
acute attacks. Sometimes it is an extension of chronic inflamma- 
tion of the pharynx. (See page 392.) 396 
THE THROAT. 
Symptoms.—These are chiefly hoarseness, a brassy sort of 
cough, with or without a sense of pain deep down under the breast- 
bone, due, usually, to extension of the disease to the windpipe, and, 
finally expectoration. The structures affected cannot be examined 
without the laryngoscope (see Fig. 117, p. 382), and when thus 
examined reveal the usual signs of chronic inflammation, redness, 
swelling, more or less mucus in the parts, and sometimes super- 
ficial ulcerations. There are no deep ulcerations in simple chronic 
laryngitis; but in that form of the disease attendant upon tubercu- 
lous consumption there is certain to be ulceration, often with more 
or less destruction of various tissues, even including the cartilages. 
The same remark holds good with regard to the chronic laryngitis 
of syphilis, and some other blood diseases. Simple chronic laryn- 
gitis, properly managed, is a curable disease (though otherwise 
likely to continue for years uncured); so is the chronic laryngitis 
of syphilis, provided the destruction of tissue has not proceeded so 
far as to be mechanically incompatible with life ; but the chronic 
laryngitis of tuberculous consumption is, in most instances, incu- 
rable, though, on the whole, consumptive patients with ulceration 
of the larynx are apt to live a year or two longer, on the average, 
than those in whom the disease does not involve this organ. From 
four to seven years may be said to be the average duration of life 
after the development of tuberculous inflammation in these cases. 
The Treatment of chronic laryngitis demands attention to the 
general health, in the first instance. Scrofulous and consumptive 
individuals need cod-liver oil; syphilitic patients require anti-syphi- 
litic treatment; those who are anaemic or pallid often (not always) 
require iron in some form, and so on, according to the defect or 
injury in the general condition. Local treatment by inhalation of 
medicated vapors, or sprays, or the application of fluid substances 
by means of brushes or swabs, is almost always indicated, and the 
Figttre 123.—Sponge attached to a curved whalebone, called a probang, used for applying 
medicated fluids to the throat. 
choice of these must be left to the medical adviser, since much 
harm is done by the injudicious and promiscuous resort to these 
agents without competent advice. In severe cases, especially those 
of tuberculous ulceration, there is great difficulty in swallowing ; 
each effort producing an amount of distress that appears incredi- THE THROAT. 
397 
ble when detailed to those who have not witnessed it. The swal- 
lowing of a little sweet-oil, before each attempt at swallowing 
food, will often be of great service in such instances. Feeding by 
the bowel, for a few days, is often of great use in these cases, let- 
ting the throat rest from swallowing until it is better able to re- 
sume its functions. 
Great difficulty of respiration exists in many cases, and some- 
times threatens suffocation to such an extent as to demand an 
artificial opening into the windpipe. This operation, when timely 
performed, will often prolong life for months in tuberculous cases— 
occasionally for years. In syphilitic laryngitis this operation may 
really save the patient’s life; for the disease itself is not at all ne- 
cessarily fatal, as tuberculous disease is apt to be, and time will 
thereby be gained for the effect of remedies which improve the 
general condition of the system. 
Croup—Membranous Laryngitis; Hives. 
Croup is an inflammatory affection of the upper air-passages 
attended with the formation of a false membrane on the walls of 
the larynx and windpipe and even in the bronchial tubes, similar 
to that which is formed in diphtheria, with this difference: that 
there is no blood-poisoning in croup, and the main source of danger 
is from suffocation. Neither is there the debility in the earlier 
stages of croup that is present in diphtheria. The number of 
respirations keep their normal proportion to the beats of the pulse 
(about 1:4) for a long time, instead of soon losing in ratio, as is 
the case in diphtheria. The disease rarely attacks the adult, and 
is not contagious. The immediate exciting cause of croup in chil- 
dren is usually more or less sudden exposure to cold, as in taking 
a child from the bed to the window to see a procession, and so on. 
The vicious method in which silly parents keep their little children 
half-undressed, with neck and shoulders, and legs and knees, 
more or less exposed, is responsible for many deaths-a-cold by 
which the lives of their little ones are sacrificed at the shrine of 
vanity. 
Symptoms.—Croup usually commences in a cold with the ordi- 
nary symptoms, but in a few days, sometimes in twenty-four 
hours, there is difficulty of breathing with more or less impair- 
ment of voice. Some cases of croup are attended by spasm of the 
air-passage, but not nearly so frequently as is generally supposed, 
many cases being entirely without it. The hoarseness usually 
attracts attention at night or toward morning, for the first time ; 
and at the same time there is a harsh, brassy sounding cough 398 
THE THROAT. 
likened to the sound of a cock’s crow. After a while the cough 
gets hoarse like the voice, and then, often, both become gradually 
muffled, so that they do not attract attention when the child is not 
watched. When the membrane is on the vocal cords, the voice and 
cough will hardly be audible. There is a shrill sound in drawing in 
the breath, and the hollow of the neck just above the breast-bone 
will be seen to become deeper at each inspiration. As the case gets 
worse, the soft parts below and between the ribs will also be seen 
to sink in during inspiration. These phenomena are mechanical 
altogether. Sufficient air to fill the lungs cannot be forced through 
the narrowed air-passages; and hence, as the ribs are raised by the 
action of the chest muscles, the atmospheric air outside presses 
the soft parts inward. When the air-passages are similarly im- 
plicated in diphtheria, the same mechanical phenomena take place 
from the same physical cause. Many cases of croup cannot be 
distinguished from diphtheria. Indeed, some physicians believe 
the two to be identical in character; while others (whose views 
seem most reliable in the writer’s estima- 
tion) contend that there is no element of 
blood-poisoning in croup. To ward off the 
threatened suffocation, the same operation 
is often required as in diphtheria when 
the larynx and windpipe are involved ; 
but the chances of success are infinitely 
better in croup, because there is no special 
blood-poisoning to counteract. 
When a child has the difficulty of breath- 
ing just described, an atmosphere of steam 
from boiling clothes in a boiler, or some 
other means, as a croup-kettle (Fig. 124), 
for instance, or some extemporaneous 
substitute for it, as it is rarely to be had 
when required, should be maintained near 
it, to keep the deposits moist and loose, so that they can be coughed 
out. Raising the clothes now and then out of the vessel diffuses 
an atmosphere of steam about, just as is seen in the laundry or 
kitchen. Slacking lime in the room near the patient is a good 
Figure 124.—Croup-kettle.* 
* [In having this made by a tinsmith, the lamp should be provided with three or four 
wicks, instead of a single one, and the tube for conveying the steam should be longer, 
and made double, that is, with an outer tube somewhat larger than the inner one and so 
constructed that an air-space of about half an inch will intervene. This will serve as a 
non-conductor of heat and prevent the steam condensing to water before it reaches the 
interior of the crib. The funnel in the top is closed with an ordinary cork and admits 
of the introduction of hot water without disturbing the steam-pipe.] THE THROAT. 
399 
method of getting up a vapor of steam ; besides which there is a 
certain amount of mechanical benefit from the minute particles of 
lime held in suspension in the vapor, which assists in detaching 
the membranes from the air-tubes. An occasional vomit of mus- 
tard and water, a tablespoonful to the half-pint, or of equal parts 
of alum and molasses in tablespoonful doses, is advisable in most 
instances, pending the arrival of the physician who should be sum- 
moned at the first moment of alarm. Very few physicians will 
blame a parent for instituting the measures just recommended 
before he reaches the bedside. Anything more active is hardly 
safe in unprofessional hands, unless it be the rubbing of the throat 
and chest with a lotion of turpentine and sweet-oil (half and half), 
the turpentine liniment of the apothecary shops [or that described 
in the chapter of Formulas]. 
Should the case be urgent and no medical aid be at command, 
more active measures may be resorted to to induce vomiting, if 
those mentioned are insufficient. The vomiting is very necessary 
in order to excite involuntary expectoration in young children, 
whose air-passages are rather tolerant of accumulating products, 
and who cannot be taught to make voluntary efforts at cough and 
expectoration. In larger children this necessity for the emetic is 
not so urgent, and sometimes is entirely wanting. In the action of 
an emetic there is a perspiration, so to speak, excited in the inte- 
rior of the air-passage, similar to the visible perspiration in the 
skin so often accompanying this act. This loosens and detaches 
the membrane and excites the paroxysms of cough by which it is 
expelled. Before there is any membrane it is worse than useless 
to vomit the child • it may be injured and so reduced by it—for all 
emetics are weakening—that it will not have strength to withstand 
this treatment when the time comes for its judicious administra- 
tion. On account of this debilitating tendency, tartar-emetic, or 
antimonial wine, sulphate of mercury (turpeth mineral), or sul- 
phate of copper, should never be used to vomit a young child ex- 
cept by the advice of a competent attendant who knows what he 
is about, and usually has some special reason for resorting to these 
measures. Syrup of ipecac (one teaspoonful to a child about a 
year of age, and a tablespoonful to one of twelve years) may be 
used instead, and repeated, if it does not operate, every ten minutes 
for two or three doses and no more; for, if the emetic fail to vomit 
and be retained in the stomach, it not only is liable to produce 
injurious effects at the time, but will do so afterward if the child 
gets better and stronger, when the stomach and intestines, resum- 
ing their functions, absorb, to their detriment, the drugs that lay 
inert, like a drug in a box, while these organs remain too de- 400 
THE THROAT. 
pressed to absorb them. Tickling the back part of the throat with 
a feather, or passing the forefinger down the gullet, is sometimes 
successful mechanically even when drugs fail, and should be re- 
sorted to in preference to powerful drugs, if simple emetics like the 
mustard or alum fail to effect their purpose. But, before any emetic 
is used, it must be certain that there is an indication for it. This 
is surmised by the rattling in the windpipe beneath the breastbone, 
and the difficulty in breathing freely. The emetic may be repeated 
every six or four hours with young children, and on a return of 
symptoms with children of a few years of age. If the bowels have 
not been moved recently, a dose of castor-oil or of magnesia suffi- 
cient to produce a loose stool should be employed. The diet of a 
young child should be milk only ; but eggs, light meat-broths, and 
a moderate amount of farinaceous food (corn-starch, arrow-root, 
tapioca, farina, and so on) may be given to a child of two years of 
age or more. If the child is weak, a dose of quinia (half a grain 
to two grains to a child under two years, and three to four grains 
to one from four to six years or more) may be given and be repeated 
at intervals of six or eight hours ; or the tincture of chloride of 
iron may be given (two drops to a child under one year, three to 
five drops to one from two to three, and ten drops to one of ten or 
twelve) at intervals of four or six hours. If there is much evi- 
dence of inflammation in the throat, the neck may be enveloped 
in a wet poultice of raw cotton or spongio-piline, which is to be 
covered with a layer of oiled silk or oiled paper, to retard evapora- 
tion and keep up the moisture. 
When the voice and cough become muffled, showing the for- 
mation of membrane, the temperature of the apartment is to be 
elevated to 85° or 90°, and the atmosphere is to be kept more copi- 
ously loaded with steam to keep the products soft and easy of 
expectoration. If the methods already narrated are insufficient, 
wet cloths may be hung around the bed or crib, and be changed 
from time to time. A wash-boiler may be brought to the bedside 
and the immersion and withdrawal of towels be kept up. A large 
tin-pan of water may be placed on a portable stove near the patient 
and kept boiling, the vapor being directed over the mouth by means 
of large sheets of stiff paper, or some other contrivance. Care must 
be taken to keep up this evolution of steam without cessation. 
The air of the bedroom should be kept ventilated by an open win- 
dow in an adjoining room or stairway, a screen formed by a sheet 
hung over a line being placed in front of the door of communica- 
tion, or around the bed or crib, to protect the patient from draught. 
If the room is large, the bed may be brought close to the stove, 
with sheets hung around it so as to retain the steam in its vicinity. THE THROAT. 
401 
The writer knows of no treatment more efficacious than the steam- 
ing in this stage. 
When respiration becomes difficult from accumulation of mem- 
brane in the air-passages, small pieces of lime should be slacked 
by the side of the bed, in any convenient vessel, and the fumes that 
rise from it be directed toward the mouth of the patient by a fun- 
nel-shaped cone of stiff wrapping-paper, or a stiff paper bag (such 
as a flour-bag) with one corner cut off, and inverted over the ves- 
sel. The patient must not be brought too near the hot vapor, and 
the attendant in charge should protect the eyes by the hand or by 
a cloth. This should be kept up for ten or fifteen minutes at a 
time and be repeated every half-hour, hour, or at longer intervals, 
according to circumstances, the indication for its removal being 
increased difficulty in respiration. It excites cough and the extri- 
cation of quantities of the false membrane. 
This treatment by steaming and lime is apt to produce capillary 
bronchitis and even inflammation of the lungs, which require 
attention subsequently, but it often succeeds in overcoming the 
fatal effects of the croup when nothing else will do so. Care must 
be taken to avoid exposure after treatment of this kind, and the 
withdrawal of the steam and diminution of the temperature should 
be accomplished gradually after they have become no longer requi- 
site. When the writer has been asked professionally how it will 
be known when the ebullition of steam is sufficient in bad cases, 
he has been accustomed to reply, “ When the wall-paper gets loose 
from the walls.” 
During all this time care must be taken to sustain the child by 
food, stimulating it, if requisite, by the free use of alcoholic liquor 
in some form. 
[Owing to the prompt relief which often follows the thorough 
inhalation of steam or vapor, and the difficulty which may some- 
times be met with at night and in a cool room in filling the air 
with the necessary amount of vapor, the following plan may be 
found serviceable: 
The child being put into a crib or cradle, if it is not already in 
one, it should be covered with a heavy blanket or quilt supported 
on chairs, or the ends of the crib, if they are high, or upon barrel- 
hoops fastened to the head and foot, so as to form an enclosed air- 
space. 
If a gas-stove or kerosene-stove is at hand, a tea-kettle partly 
filled with water may be put on it and arranged at the side of the 
crib so as to be covered by the blanket. Some person should sit 
constantly by the crib, with the head under the covering, to pre- 
vent the child being alarmed by the procedure, to regulate the 
Vol. II.—26 402 
THE THROAT. 
amount of steam, guard against the clothing taking fire from the 
stove, and prevent the limbs of the child being scalded by coming 
too closely in contact with the escaping steam. 
Where a portable stove of the kind mentioned is not obtainable, 
a large dish, such as is used in making cake, can be partly filled 
Figuke 125.—Arrangement of a crib with blankets for nsing a croup-kettle. 
with boiling water and will give off steam for several minutes. 
By heating smoothing-irons, or pieces of brick, and immersing them 
gradually into the water in the bowl, an abundance of steam can 
be formed. Lime can also be slacked in a dish so arranged with- 
out the necessity of filling the entire room with its vapor. 
Another method of limiting the space to be filled with vapor is 
to choose a corner of the room into which the crib can be put, and 
a blanket hung across so as to form a curtain.] 
The remarks concerning tracheotomy in diphtheria (p. 392) are 
equally applicable to croup. 
Spasm of the Larynx—False Croup. 
Spasm of the larynx is not an infrequent disease of young chil- 
dren, and is often mistaken for croup. It is a nervous affection, due 
to what is known as “ reflex irritation.” The exciting cause may be 
indigestion (especially during teething), worms, earache, or run- THE THROAT. 
403 
ning ears, elongated fore-skin, glandular swellings anywhere, rick- 
ets, or scrofula. There is no special impairment of general health. 
There is a sudden attack of difficult breathing, with a peculiar strid- 
ulous or crowing noise in the throat, and after the spasm has lasted 
a few seconds or a minute, it usually gives way, and then there is 
no more evidence of disease than before. The voice is good; there 
is little or no sore throat. The larynx becomes spasmodically 
closed in the paroxysm, and if it does not let up in a minute or so, 
death from suffocation may result. This result is rare, but does 
occur now and then. These attacks are more frequent at night, but 
take place in the daytime also, and may recur several times in the 
twenty-four hours, or at longer and irregular intervals. The dis- 
ease also occurs in adults, and is a reflex manifestion due to dis- 
eased conditions elsewhere, the same in nature, though not always 
the same in kind, as in the child. Though the disease is compara- 
tively rare in the adult, it is, perhaps, even more proportionately 
fatal. 
The Treatment of this disease during the suffocative spasm 
consists in dashing cold water on the face and chest, in holding 
ammonia near the nose, the use of one of the emetics recommended 
in the foregoing section, and immersion in a warm bath, if acces- 
sible. In a child subject to these spasms, a warm bath should al- 
ways be at command. In the intervals, such general treatment is 
required as the nature of the case demands. Swollen gums should 
be scarified, the bowels should be kept in good condition, running 
ears should be kept well syringed, and so on. In addition to this, 
cod-liver oil or extract of malt are often of great value, with warm 
clothing, avoidance of draughts of air, and of all measures calcu- 
lated to alarm or excite the child. Bromide of potassium and bel- 
ladonna are the drugs most frequently serviceable to counteract 
the tendency to spasm, but they must be given in accordance with 
the direction of an attending physician. 
Aphonia—Loss of Voice. 
Aphonia, or loss of voice, without any other evidence of dis- 
ease, is usually a nervous complaint, due to paralysis of the vocal 
cords, as a reflex result of disease elsewhere. It usually occurs in 
females, and most frequently in hysterical individuals. Some- 
times it persists for weeks or months, occasionally for years ; but 
in most instances the voice comes and goes at irregular intervals 
of a few days or a few weeks. 
Aphonia is sometimes due to tumors of various kinds in the 
head, neck, and chest, compressing the nerves that are necessary 404 
THE THROAT. 
for the muscular movements of the voice ; and in these instances 
the paralysis is usually unilateral. Loss of voice also accompanies 
some cases of inflammation of the larynx ; and sometimes is due 
to the presence of warts or other morbid growths which prevent 
the vocal cords from being properly approximated. A laryngo- 
scopic examination is usually necessary to determine the nature 
of the aphonia. 
Treatment.—Simple nervous aphonia is usually cured promptly 
by the passage of a current of electricity through the vocal cords. 
Sometimes an acrid inhalation will restore the voice by inducing, 
for the moment, spasm of the cords, thus overcoming the paraly- 
sis. The passage of a sponge into the larynx will often do the 
same thing. Sometimes it can be accomplished by the action of a 
smart emetic. The use of a tonic, such as quinia, or cinchonidia 
(which is much cheaper and just as efficacious), in doses of from 
three to ten grains in the twenty-four hours, is often serviceable. 
Aphonia from inflammation of the larynx will pass off with the 
inflammation. Aphonia from disease of the brain, neck, or chest, 
requires treatment for the original disease, all merely local treat- 
ment being injurious. Aphonia from tumors in the larynx requires 
the removal or destruction of such growths. Reflex aphonia re- 
quires treatment of the organ from which the reflex paralysis 
originates (womb, bowels, spinal cord, etc.). 
J. SOLIS COHEN, M.D.