CHRONIC RHEUMATIC LARYNGITIS, 
E. Fletcher Ingals, A. M., M. D., 
BY 
Chicago. 
Reprinted from the Transactions of the Thirty-eighth 
Annual Meeting, Illinois State Medical Society, 
held in Rock Island, May /y, iSSS. CHRONIC RHEUMATIC LARYNGITIS, OR 
CHRONIC RHEUMATIC SORE THROAT. 
E. Fletcher Ingals, A. M., M. D.* 
This is a painful affection of the throat, chronic in char- 
acter, but varying much in severity from time to time and 
attended by only slight physical changes in the parts in- 
volved. Usually some part of the larynx is affected, and as 
in the first cases which I observed this organ was always 
implicated, the first given name was applied to the affec- 
tion; but I have seen numerous other cases in which other 
parts of the throat have been affected, and this at times, 
without involvement of the larynx, therefore the name, 
Chronic Rheumatic Sore Throat, may be more appropriate. 
This is an affection of comparatively frequent occurrence, 
which has doubtless existed from time immemorial, but so 
far as I was able to discover by a careful search of the Sur- 
geon-General’s library at Washington, no description of it 
had been given prior to that which I presented in my paper 
on this subject at the Ninth International Medical Congress, 
held at Washington, September, 1887. The affection is one 
so frequently met with, and one which causes so much anx- 
iety, that I make no apology for again directing the atten- 
tion of the profession to it, believing, as I do, that its recog- 
nition by the general profession will often save patients an 
infinite amount of mental distress, as well as much physical 
discomfort. 
The affection is frequently mistaken for a simple neural- 
gia of the parts, but it is far too often ascribed to some 
* Professor of Laryngology, Rush Medical College, and Professor of Diseases of the 
Throat and Chest, Women’s Medical College, Chicago. 2 
lesion which the unaccustomed eye seemes to detect in the 
normal condition of the parts. Unfortunately, it is some- 
tunes supposed, even by the physician, as it generally is by 
the patient, to be one of the early manifestations of cancer. 
In one case of the kind which came to me from a neigh- 
boring State, the physician being unable to detect the cause 
of the pain, and discovering something which to him ap- 
peared abnormal, had unfortunately told the patient that it 
had the appearance of cancer. Even though months went 
by without the development of any lesion, and even though 
others beside myself repeatedly assured the patient, and 
temporarily convinced him, that it was not cancer, yet this 
unfortunate diagnosis, which corroborated the one he had 
himself made, so preyed upon his imagination that he be- 
came a monomaniac upon the subject, and finally, to relieve 
himself of the threatening spectre, committed suicide. 
I have said that I was unable to find any description of 
the affection in medical literature. However, affections 
similar in some respects have been described as neuralgia 
of the pharynx or larynx. Of the latter condition, Sir 
Morrell Mackenzie, in his classic work on diseases of the 
throat and nose, says: “It is apparently very rare. * * 
* I have met with only nine cases.’’ He says ‘that in 
these cases the pain was either on the right or left side, and 
darted from the larynx to the ear, but it was usually confined 
to one side. In all cases it was distinctly intermittent, and 
in three cases it was relieved by pressure. Eight of the 
cases recovered under persistent use of quinine and local 
sedative applications, but all were obstinate.’ 
Of neuralgia of the pharynx, he says: “The affection 
has not hitherto been accurately described;” but he states 
that he has seen many instances of the disease, mostly in 
young girls, though he did not consider it hysterical. This, 
like the laryngeal affection, was obstinate. Hanfield Jones, 
Clinton Wagner, Schnitzler and Turck have reported simi- 
lar cases, and at the last meeting of the American Laryngo- logical Association, held in New York, May, 1887, Dr. 
Chapman, of New Haven, reported several similar cases, 
which he believed to be of malarial origin. 
I have seen many similar cases which were not of 
rheumatic origin, but I suspect that not a few of the cases 
which have been described as simple neuralgia, were depend- 
ent upon the rheumatic diathesis. 
Chronic rheumatic sore throat occurs much the most 
frequently in men, and it is more common in the fall and 
spring months than at other times, though it is not infre- 
quent in winter, and it occasionally continues even during 
the warm weather of summer. The patients in whom I 
have observed it have all been adults, varying in age 
from twenty-five to sixty years. I have seen it in all classes 
—in the seamstress, and in the lady of luxury and ease; 
in the day-laborer, and in the retired millionaire; in the 
farmer, the merchant and the professional man. Indeed, it 
attacks all persons with the same impartiality as does 
rheumatism, but it is more frequent in those who are sub- 
ject to sudden exposure. 
The disease presents no anatomical characteristics, but 
in most cases there are circumscribed spots of slight, but 
changeable, congestion and swelling. 
That it is due to the same cause as rheumatism, is 
proven, first, by the fact that in nearly, if not in all cases 
the patients have inherited or acquired the rheumatic 
diathesis and are subject to rheumatic pains in other parts 
of the body; second, that these pains observe the same laws 
as other chronic rheumatic pains, as to intermission, remis- 
sion or exacerbation, with varying conditions of the weather; 
and, third, by the fact that only those remedies and sur- 
roundings which have proven most useful in the treatment 
of rheumatism seem in any way influential in curing this 
disease. 
The affection comes on insidiously or suddenly, as the 4 
case may be, but usually has existed for weeks or months 
before the patient consults the physician. 
In many of the cases that have come under my observa- 
tion I have found that many physicians have been consulted, 
and that almost as many different diagnoses have been given. 
In some of them the patient has become alarmed from fear 
of tuberculosis or syphilis, but in most cases there is a fixed 
fear and dread of cancer. In most cases the general health 
is good. The patient complains of a localized pain and 
tender spot over the larynx or upper portions of the throat, 
and occasionally of pains radiating toward the ears and in 
other directions, as in neuralgia. The pain may be referred 
to the thyroid or cricoid cartilages; it may be experienced 
in the trachea, and it may or may not be aggravated by 
phonation or deglutition; but it is nearly ahvays increased 
by pressure. More commonly, however, the pain is referred 
to the cornua of the hyoid bone, and it is more frequent 
upon the right than upon the left side. 
It is occasionally referred to the tonsil, or to the sides of 
the tongue or upper portions of the pharynx, but during 
the course of the disease it is apt to shift from place to 
place, however, being more intense in some of the localized 
spots just referred to. Frequently these patients suffer from 
slight rheumatic pains in other parts of the body, which are 
liable to be confounded with neuralgic pains. Sometimes, 
in addition to or exclusive of the pain, the patient will com- 
plain of a sense of fullness or swelling, of dryness, burning, 
tickling or itching, or simply of discomfort in the parts. 
There is neither fever nor acceleration of the pulse, ex- 
cepting as the result of anxiety or alarm. Usually there is 
neither cough nor expectoration, but in certain localities the 
irritation may excite cough. The tongue may be slightly 
coated, but usually the appetite is good, and, indeed, the 
general condition is that of perfect health. 
The affection is liable to be mistaken—for varicose veins, 
or enlarged glands at the base of the tongue; chronic fol- licillar tonsilitis, or glossitis; syphilitic, or tuberculous sore 
throat; for neuralgia, or for tobacco sore throat, or for cancer. 
Varicose veins, or enlarged glands at the base of the tongue, 
and chronic follicular tonsilitis or glossitis, all give rise to 
various symptoms similar to those complained of by patients 
suffering from the disease under consideration, but in all 
these a careful inspection will readily reveal a sufficient 
cause for the discomfort. Syphilitic sore throat may give 
rise to painful symptoms, but they are usually associated 
with ulceration, which does not occur in chronic rheumatic 
sore throat. Tuberculous sore throat causes localized pain, 
but it is attended by swelling or ulceration and by constitu- 
tional symptoms which do not appear in the rheumatic affec - 
tion. What has been termed the tobacco sore throat 
may be attended by plaques which would distinguish it 
from the rheumatic affection, but in other cases the diag- 
nosis must be based on a careful study of the history and 
the patient’s habits. 
Neuralgia causes symptoms like those of rheumatism, 
and can only be distinguished from the latter by the history 
and the absence of the localized, though slight, congestion 
and swelling, and occasionally by the difference in the sen- 
sations caused by pressure. In neuralgia, the pain may 
sometimes be relieved by pressure, whereas it is likely to 
be aggravated in rheumatism, and in neuralgia the pain is 
less constant, more affected by fatigue and less affected by 
changes in the weather than in rheumatism. In cases of 
cancer, the tumor or irregular thickening of the parts or 
ulceration, will usually distinguish the disease from rheuma- 
tism, and in other instances the history and progress of the 
case will soon enable one to make the proper diagnosis. 
The prognosis is doubtless always favorable, so far as 
life is concerned, but the disease may continue for months 
or years; though by appropriate treatment it can usually be 
cured in from six to twelve weeks. 
In the treatment, I have found considerable benefit from 
local sedative or stimulant applications, according to the 6 
nature of the case, but have placed greatest reliance upon 
the internal remedies which would be indicated in rheuma- 
tism of other parts. Of these, salicylate of soda, iodide 
and bromide of potassium, salol, cimicifuga, phytolacca, 
guaiac, oil of wintergreen, and stillingia have all been tried 
with more or less benefit, but I think I have derived the 
best results from the extract of phytolacca, gr. iii or iv, 
three or four times a day, with tonics and gentle laxatives, 
and the occasional use 6f iodide of potassium; or of the 
bromide of potassium when the throat symptoms were very 
annoying. 
As local applications, I have derived most benefit from 
a spray of a mixture of morphia, gr. iv, carbolic acid and 
tannic acid aa, gr. xxx, glycerine and water aa, drachms iv, 
to be applied once a day; or a weaker solution of the same 
applied more frequently. But in some cases tincture of 
iodine, a sixty-grain solution of nitrate of silver, or a super- 
ficial application of the galvano-cautery, has proven useful. 
The all-important thing is to be sure of the diagnosis, and 
then to convince the patient that it is not a mortal dis- 
ease. 
Those who are especially interested in the subject I 
would refer for report of cases, etc. to my previovs paper 
which will be found in the January number of The Ameri- 
can Journal of the Medical Sciences or in the forthcoming 
transactions of the Ninth International Medical Congress. 
I have seen several cases of the kind, probably thirty 
or forty in all, but will add reports of two only, simply by 
way of illustration. 
M. M., 35 years of age, laborer, consulted me only a 
few days since. For four years he had been troubled more 
or less with his throat, complaing of soreness or rather dis- 
comfort in the region of the hyoid bone which was not af- 
fected by swallowing. He also complained of the sides of 
his tongue, and owing to the constant annoyance and the 
numerous diagnoses, he had imagined various lesions on the 7 
tongue, such as cracks, blisters, etc. During fine weather, 
either in winter or summer he was frequently free from dis- 
comfort, but with changes in the temperature and hygromet- 
ric conditions of the atmosphere he would again be 
troubled with dryness, itching, or discomfort which he 
called soreness though he admitted it was not actual pain. 
He had consulted various physicians and had obtained as 
many different diagnoses and finally he had become much 
alarmed, believing the trouble to be malignant. 
I found that he was subject to rheumatic pains in other 
parts of the body, that he was not subject to neuralgia and 
that the parts complained of were of normal appearance; 
therefore I did not hesitate as to the diagnosis and the 
remedies to be employed. 
This was almost a typical case, though from the de- 
scriptions I have given of others it will be found that the 
throat pain often moves to different parts more than in this 
instance. The following case illustrates well the more 
severe manifestations of the disease. 
The patient, C. D., age 31, railroad clerk, came to me 
in Sept., 1887, complaining of soreness in the fauces and 
larynx. He stated that eighteen months previously he had 
been attacked by a persistent tickling in the throat which 
was soon succeeded by pain. At that time the difficulty 
had become very aggravated, and finally he had been sent 
south for the winter. After several months he had obtain- 
ed relief and subsequently had been quite well until shortly 
before consulting me. 
At the time he consulted me he frequently found it dif- 
ficult to speak because of a catching sensation in the 
throat, and he was much alarmed for fear of a repetition of 
his former sickness. His general health was good; there 
was neither fever nor excitation of the pulse and his digestive 
organs were acting perfectly. Upon examination of the 
fauces, I found the right tonsil much enlarged and present- 
ing besides several diseased follicles, a sore spot on its 8 
anterior surface which extended to the anterior pillar of the 
fauces. This spot was about half an inch in diameter. It 
was of a bright red color but was not swollen. On touch- 
ing t great irritation was produced, simulating that from 
which he constantly suffered. 
Although this patient had never suffered from rheuma- 
tism, the absence of constitutional symptoms and the ab- 
sence of specific or tuberculous taint, together with the 
history of his former attack and the variability of his symp- 
toms with changes of the weather, led me to suspect rheum- 
atic sore throat. Applications of tincture of iodine or solu- 
tions of nitrate of silver only aggravated his trouble, and 
even troches of guaiac were irritating, in consequence of 
the peculiar sensitiveness of his throat. I removed the ton- 
sil, but without apparent benefit, so far as his symptoms 
were concerned. After the healing of the wound, he still 
complained of the tickling and soreness in the throat. At 
this time, five weeks after he first consulted me, the 
only abnormal appearance consisted of circumscribed red- 
ness on the right pharyngo-epiglottic fold. This was 
touched with mildly stimulating pigments, but without 
benefit; indeed, the pain was increased by the remedies. 
Anti-neuralgic remedies, colchicum and salol and guaiac 
were given internally, but without apparent benefit, though 
at times the painful symptoms became much better, but 
they would soon be aggravated, apparently by changes in 
the weather. The patient passed several weeks in great 
discomfort and extreme anxiety, a part of the time being 
scarcely able to attend to his work; but finally, after the 
trial of many local and constitutional remedies, I ordered 
to be taken in capsules four times a day, the extract of col- 
chicum gr, ss, ext. phytolacca gr. ii, and salol gr. iii. 
He obtained immediate benefit from these and in a few 
days was completely cured of the affection, which has not 
since returned.