V ' : -'v- "'"'.-- v^,. LIBRARY OF CONGRESS. ..Vr^.iopjjrtgllfo sbeif .:JL2J\. l UNITED STATES OF AMERICA. m?$ mi TEN LECTURES NASAL CATARRH, s r :tnw u, JeJiseetses of ifjc yripoai, -bye, etrja Oar, Je)ue fo r/ ers crl oerferppr), WITH A CHAPTER OF CHOICE PRESCRIPTIONS. BY J. H. KELLOGG, M. D. Member of the British and Ainerican Associations for the Advancement of Science, the A»icrica?i Public Health Association, the Societe d Hygiene, of France, the Amer- ican Society of Microscopists, the A7nerica?i Medical Association, Etc. ; Ed- itor of " Good Health;" Author of "Home Hand-Book of Hygiene and Rational Medicine " and various other works. / JK. 4 „ ILLUSTRATED. 389 5 *L BATTLE CREEK, MICH. : GOOD HEALTH PUBLISHING COMPANY. .Entered according to Act of Congress, in the year 1889, by J. H. KELLOGG, M. D., In the Office of the Librarian of Congress, at Washington, D. C. PREFACE This work consists of the substance of lectures given by the author at various times for the instruction of his pa- tients. The purposes of its preparation have been — I. To antagonize the popular notion that nasal catarrh is an incurable malady, an error that is productive of vast mischief, as it leads to neglect of the disease, entailing sufferings which timely attention might easily have pre- vented. ' 2. To provide in convenient form a manual of the hy- giene of this disease, which is the most essential feature of its successful, treatment. 3. To warn the public against catarrh charlatans, and the much-vaunted "catarrh remedies" so widely advertized. The evils wrought by these " workers of iniquity," are al- most beyond estimate. 4. To present an outline of the modern methods of treating this malady, as practiced by scientific specialists, and also the results of the author's personal experience and observation in the treatment of some thousands of cases of this disease. It is hoped that this little work will prove of service to both physicians and patients. While not undertaking to present the technical details of such treatment as can be administered only by a specialist, it will furnish the busy practitioner a foundation upon which to set his patient at work, under his supervision and instruction, with a good (iii) iv Preface. prospect of success in curable cases, ana amelioration in even the worst forms. Most of the treatment required in ordinary cases of catarrh, can be administered by the pa- tient himself, with proper instructions. Certain cases, as has been pointed out in the work, re- quire the services of the skilled specialist. Competent specialists in this line can now be found in nearly every large city. For those who are within reach of such, this work is not intended, as no popular treatment of this sort can render an unprofessional person thoroughly competent in the management of even a single malady. But to those unhappy sufferers who have considered themselves doomed to life-long miseries, and to those physicians whose studies and experience have not already made them familiar with the practical management of nasal catarrh and its accom- panying affections, it is hoped this work will prove of real value. The various instruments, medicaments, etc., required for use in the treatment prescribed in this work, may be ob- tained from leading druggists, or from the Sanitary Sup- ply Co., Battle Creek, Mich. J. H. K. Battle Creek, Mich., Feb. 20, 1889. CONTENTS FIRST LECTURE. THE NOSE AND ITS USES. The Structure of the Nose —The Nasal Mucous Membrane — The Pharyngeal Ton- sil — The Nose as a Strainer — The Sense of Smell — Cavities Connected with the Nose — The Eustachian Tubes — Natural Breathing — Snoring — Sneezing — Nasal Voice 7-19 SECOND LECTURE. ACUTE NASAL CATARRH. A Cold in the Head — Sneezing 20-26 THIRD LECTURE. CHRONIC NASAL CATARRH. First Stage — Second Stage — Nasal Hypertrophies — Nasal Polypus — Third Stage 27-35 FOURTH LECTURE. PREDISPOSING CAUSES OF NASAL CATARRH. What is a Cold ? — Predisposing Causes of Catarrh — A Gross State of the Body — Heredity — Too Much Coddling 36-43 FIFTH LECTURE. EXCITING CAUSES OF NASAL CATARRH. Contagious Colds — Imaginary Colds 44-51 SIXTH LECTURE. THE HYGIENE OF NASAL CATARRH. The Curability of Nasal Catarrh — Clothing — Diet — Tobacco-Using — Exercise — Sleep 52-59 SEVENTH LECTURE. THE TREATMENT OF NASAL CATARRH. •How to Treat a Common Cold — A Vapor Bath — A Hot-Air Pack — Local Treat- ment for a Cold — Inhalants — Snuffs — Solutions — Diet — Hardening — Bath- ing— Prevention of Contagion — Hygiene vs. Heredity 60-70 EIGHTH LECTURE. THE LOCAL TREATMENT OF CHRONIC NASAL CATARRH. How to Cleanse the Nasal Cavity — First Method — Second Method — Third Method — Fourth Method — Fifth Method— Sixth Method — Medicated Solutions, Vapors, Etc 71-78 (v) vi Contents. NINTH LECTURE. THE TREATMENT OF SPECIAL FORMS OF NASAL CATARRH. Simple Chronic Nasal Catarrh — Electricity — Dry Catarrh — Offensive Catarrh — Bad Breath — Coryza — Nasal Voice — Mouth-Breathing — Snoring — Cold Sores — Nosebleed — Urinary Deposits — Constipation — Headache — Faceache — Suffocative Colds — Snuffles — Nasal Polypus — Nasal Obstructions — Ulcer- ation of the Septum — Loss of Smell 79~94 TENTH LECTURE. DISEASES OF THE THROAT, EYE, AND EAR, DUE TO NASAL CATARRH. Acute Tonsilitis — Chronic Inflammation of the Tonsils — Enlarged Tonsils — Acute Sore Throat — Diseases of the Larynx — Hoarseness — Catarrhal Cough — Chronic Sore Throat — False or Spasmodic Croup — Diphtheria — Hay Fever — Disease of tLe Eye Due to Catarrh — Granular Lids — Diseases of the Ear, Resulting from Nasal Catarrh — Earache — Discharge from the Ear 95-H2' VALUABLE PRESCRIPTIONS FOR NASAL CATARRH. Cleansing Solutions — Disinfectant Remedies — Astringent , Remedies — Miscellan- eous — Remedies to be Applied to the Throat — Eye Lotions — Remedies to be Taken Internally for Cough 113-120' LIST OF ILLUSTRATIONS. PAGE. Examining the Nose and Throat 9 Post-Nasal Douche-Tube 75 Syphon Syringe 75 The Air Atomizer 76 The Steam Inhaler 78 Balsam Bottle 78 The Eye 106 The Ear 109 Pollitzer's Bag for Inflating the Ear 109 Eustachian Catheter no Otoscope „ no COLORED PLATES. Plate A. — The Nasal Cavity. Plate I. —.Posterior Hypertrophy and Enlarged Pharyngeal Tonsil. Same as Preceding, Seen from the Pharynx. Plate II. — The Larynx, Vocal Cords Open. The Larynx, Vocal Cords Closed. Plate III. — Acute Inflammation of the Larynx. Chronic Inflammation of the Larynx. Plate IV. — Acute Tonsilitis. Chronic Tonsilitis. Plate V. — Acute Pharyngitis. Chronic Pharyngitis. Plate VI. — Chronic Pharyngitis, Advanced Stage. Diphtheria. PLATE A. — The Nasal Cavity. i. The Frontal Sinus; 2. Sphenoid Cells; 3. Cavity communicating with the Nose ; 4. Upper Passage ; 5. Middle Passage ; 6. Inner Opening of Nasal Duct ; 7. Lower Passage ; 8. Cavity in Cheek Bone ; 9. Cavity in Opening of Eustachian Tube ; xo. Passage leading from the Nose to the Throat; n. The Uvula. NASAL CATARRH » ITS MATURE, SYMPTOMS, PREVENTION AND CURE. FIRST LECTURE. &\)z Nose anb Its Uses. Ladies and Gentlemen : It is my purpose to begin this morning a series of lectures on the subject of nasal catarrh, — its nature, symptoms, causes, consequences, pre- vention, and successful treatment. The increasing preva- lence of this disease, the common impression that it is in- curable," and the personal experience which many of you have had with this malady, assures me that the subject is one in which you will be interested. I shall endeavor to present this subject, as is my custom in all medical talks before an unprofessional audience, in such a way as to make it comprehensible, and, so far as possible, interesting, to those who are not versed in medical lore, and shall make use of no unnecessary technicalities. I hold that the laity have a right to as much medical knowledge as they are capable of comprehending and can make valuable use of. The medical profession is, or at least should be, the most thoroughly philanthropic of all professions ; and from my stand-point, it is the duty of a physician to diffuse as widely as possible such information, which he may gather by study and observation, as will be of service to the public in the prevention of disease and consequent suffering, and so to warn the ignorant respecting their dangers and liabilities, as to lead them to pay proper regard to the laws of health. Doubtless a vast deal of harm has come by the extensive use of various bad nostrums recommended in flaming news- paper advertisements for the treatment of nasal catarrh. All intelligent physicians condemn these remedies, and yet it seems hardly consistent to make a wholesale condem- (7) . 8 First Lecture. nation of this sort, without offering something better as a substitute. To accomplish this is one purpose of these lectures. Nevertheless, I wish clearly to state at the outset that it is no part of my purpose to convey to any one the impres- sion that nasal catarrh is a malady so simple that, by means of a few written or printed directions, every person can become thoroughly competent to treat all cases of the disease suc- cessfully. I am certain that any one who carefully follows me in the discussion of this subject, will defend me from the imputation of any such purpose. It is true, however, that a large part of the treatment of nasal catarrh is of such character that it may. be satisfactorily carried on by the patient himself ; and in many cases, especially those in which the disease is still in its infancy, the faithful em- ployment of such measures of treatment as the patient can himself administer with efficiency, may secure the most sat- isfactory results. Indeed, the satisfactory treatment of almost all cases of this disease requires that the patient shall him- self administer a large part of the treatment, and especially that he shall submit to a most careful system of restriction as regards clothing, diet, and general regimen, which it is a large part of the purpose of these lectures to define. Another important purpose of my presentation of this subject, is to communicate to you such information concern- ing this malady as will give you a just appreciation of its gravity, and will impress upon you the importance of con- sulting for the relief of its graver forms, not the advertis- ing or traveling quack, no matter what his pretensions as a specialist, but a well-informed, reliable physician, who has given to this subject special attention, in connection with a thoroughly scientific medical education. It is certainly important that the public should know that chronic nasal catarrh involves conditions which often require the most careful and skillful surgical attention, and which cannot be cured, and in many cases not even temporarily relieved, by any other measures whatever. Posterior Hypertrophy and Enlarged Pharyngeal Tonsil. !l!|l"" ! ""' Same as above, seen from the Pharynx. The Nose and Its Uses. 9 The Structure Of the Nose. — But before we can undertake to study this disease understandingly, we must become somewhat familiar with the most important feat- ures of the structures involved in it. That portion of the face which we call the nose, is really the most insignifi- cant part of this important organ. To get anything of an idea of the nose proper, or of its most essential parts, we must take a peep inside. This we are able to do by means of a strong light and various instruments, specula, EXAMINING THE NOSE AND THROAT. mirrors, etc. But as we have not these conveniences at hand, we may obtain a fair idea of the territory to be ex- amined by means of this chart. (Plate I., Fig. I.) Here we have an inside view of the nose, such as would be obtained by dividing the head perpendicularly, exactly in the mid- dle line of the face. Looking at the cut surface of one-half, we first notice a large cavity in the skull, which con- tains the brain. In front and beneath this, we see another large cavity, nearly divided into two parts by the roof of the mouth and the soft palate. The lower portion of this cavity, or, as we may now say, the lower cavity, is what io First Lecture. we are familiar with as the mouth. The upper space is known as the nasal cavity, which from its more hidden position is less familiar to us. Please observe that it is nearly as large as the mouth, and freely communicates with the back part of the mouth through a space beneath the soft palate, the pendulous continuance of the roof of the mouth at its back part. Please notice, also, the consider- able extent of the nasal cavity. Also notice that the interior surface is largely increased by three scroll-shaped projec- tions standing out from either side. They are placed a little distance apart, thus forming three horizontal canals on each side of the nasal cavity. Next, I will call your attention to the fact that the nasal cavity is divided in its forward, or anterior, portion by a partition, or septum, which can be easily seen and felt through the external opening of the nose. This partition ex- tends backward about half way to the back side of the nasal cavity. It is mostly composed of bone ; but the front por- tion is a flexible cartilage, which gives to the end of the nose its flexibility, and prevents many serious injuries which would otherwise result to this projecting portion of the features. The back part of the nasal cavity is irregularly dome- shaped, its floor being formed by the roof of the mouth and the soft palate. Its back wall is continuous with the back of the mouth, with which, as before remarked, the cavity of the nose freely communicates through the opening behind the uvula and the soft palate. The Nasal Mucous Membrane. — Having now obtained a pretty good idea of the general form of the nasal cavity, let us observe that it is lined throughout with a delicate mucous membrane similar to that which lines the mouth. In health, this membrane is of a delicate pink color, closely resembling the color of the lips. In disease, it becomes very greatly changed. In health, the mucous membrane is constantly moist. This moisture is derived from several sources ; first, from The Nose and Its Uses. II certain little glands corresponding to the glands of the skin, which produce sweat, or perspiration. Some of these pour out from the mucous membrane a slightly viscid fluid ; others produce a thin, watery, or serous fluid. Another source of moistuie is the tears, or lachrymal secretion from the eyes, which constantly pour down into the nose through the little bony canals which communicate with each eye at its inner corner. Lastly, moisture from the expired breath is constantly deposited in the nose, which being nearer the outside of the body, is of a lower temperature than the recesses of the lungs, from which the breath es- capes. Nature's purpose in supplying the mucous membrane of the nose with moisture, is to enable it to moisten the air drawn into the lungs through the nose, which is ordina- rily drier than the air which escapes from the lungs. If no provision of this sort were made, the process of breath- ing would remove moisture from the body much too rap- idly, and the mucous membrane lining the lungs would be dried to such an extent that it could not perform its work of purifying the blood from poisonous gases. It is inter- esting to note the ingenious economy which nature prac- tices in using for this purpose the tears, which have first moistened and lubricated the eyeball in its movements be- neath the lids ; and further, in throwing out into the cavity the numerous shelf-like projections against which the warm, moist air from the lungs impinges in its passage outward, thus facilitating the condensation of the moisture, so that it is again taken up by the incoming air, which is thereby moistened, and its contact with the delicate lining mem- brane of the lungs, rendered more agreeable. Another wise purpose of the numerous scroll-shaped projections along the side of the nasal cavity is also apparent, as by this means a larger evaporating surface is secured. J^ still further and very useful purpose is also accom- plish by the bony projections referred to, in that they pre- sent a large surface covered with mucous membrane, which is densely crowded with blood-vessels, through which the 12 First Lecture. warm blood is rapidly coursing ; so that the external air, which is ordinarily of a much lower temperature than the interior of the body, is warmed in its passage toward the lungs. Nature seems also to have wisely calculated the proper size for the passages through the nasal cavity, so as to properly regulate the tide of air which is constantly made, to move in and out with the bellows-like action of the lungs. The Pharyngeal Tonsil. — At the top of the dome- shaped back portion of the nose, is found a conspicuous collection of glands, by which a considerable quantity of secretion is formed. These glands extend down upon the back side of the nasal cavity, nearly to a level with the roof of the mouth. Everybody is familiar with the fact that we have two tonsils in the throat; Tucked away in this hidden recess of the head is a third tonsil. The col- lection of glands just described is called the pharyngeal tonsil. It derives its name from its position. The back part of the nasal cavity is sometimes referred to in con- nection with the rear portion of the mouth, the two cavi- ties together being termed the naso-pharynx. It is impor- tant that all should be made acquainted with the pha- ryngeal tonsil, for the reason that it is an exceedingly troublesome part of one's anatomy, and in a diseased con- dition is responsible for a very large share of the incon- venience experienced by persons suffering from catarrh. The Nose as a Strainer. — A close inspection of the external openings of the nose, will reveal the fact that just within the outer edge of each opening may be found a collection of short hairs, the evident purpose of which is to act as a strainer, to prevent dust, insects, and other foreign matters which may be suspended or moving in the air, from entering the nasal cavity and the lungs. It is quite possible, too, that this provision may, to some extent, at least, serve a useful purpose in the exclusion of germs. The Nose and Its Uses. . 13 The Sense Of Smell. — The mucous membrane cov- ering the upper part of the nasal cavity, contains a great number of delicate nerve fibers, which pass upward between the cells covering the mucous membrane, until their very ends are even with the surface. This is probably the only place in the body where the nerve fibers are actually un- covered. These are the olfactory nerves, or nerves of smell. Minute particles of odorous substances entering the nose come in contact with these bare nerve ends, and thereby give rise to the sensation which we commonly call odor, or smell. From this we see that the sense of smell is really a delicate sense of touch. That it may be exer- cised, it is necessary that the nerve ends should be kept uncovered. If the mucous membrane becomes thickened so that the fibers do not reach to the surface, or if it is covered over with mucus, it is quite as impossible for the nerves of smell to detect odors as for the nerves of touch which are found in the fingers to perceive delicate objects with the hands encased in a thick covering of leather. It is also evident that in order for the sense of smell to be exercised, the passages of the nose which lead up to the upper part of the nasal cavity, where these nerves are located, should be open, so that the air can pass in without hindrance, and free from obstructions, as the air is the means by which odors are conveyed to the olfac- tory nerves. One peculiarity of the nerves of smell, is that the impression of an odor which has been received, often remains for some time after the odorous substance has been removed, a fact the analogue of which is observed in the other special senses. This function of the nose is not only a source of pleasure, in that it enables us to enioy the delightful odors of flowers, perfumes, etc., but it is intended by nature to be of the greatest use to the body as an active signal against dan- ger, by the detection of foul and unpleasant odors, which are almost invariably found to be the accompaniments of dangerous or poisonous substances. The savage uses his nose for the purpose of aiding him in the selection of safe 14 First Lecture. and wholesome food. The sanitarian employs his nose as a delicate means of ferreting out unsanitary conditions. Unfortunately, this function of the nose is greatly neglected .among civilized nations. The sense of smell and the odors detected by it are little studied. Sounds, and even flavors, have been analyzed and classified ; but who has made a scientific study of odors ? Some lower members of the animal creation are so de- pendent upon the olfactory sense, and employ it so con- stantly, that it has become developed almost immeasur- ably beyond the stage in which we find it in human be- ings. For example, the scent of the dog is so keen that he can readily track the footsteps of his master hours after he has passed along ; and it is said that the members of some tribes of savages can distinguish in the dark, and at a distance of several feet, those of their own tribe from the members of other tribes. Those of you who are familiar with the habits of savages, may consider it doubtful whether the last fact really affords evidence of any extraordinary acuteness of the olfactory sense in savages ; but it is the uniform testimony of travelers among barbarous tribes, that the sense of smell is with them very much more acute than among civilized nations. The fear has been ex- pressed, and we apprehend that it is not wholly ground- less, that if the* sense of smell continues to deteriorate in civ- ilized nations in the future as rapidly as in the past, a few generations hence races may be found existing in whom this sense has become wholly extinct, as has the sense of sight in the eyeless fish of the Mammoth Cave. Undoubtedly, na- sal catarrh is largely responsible for the decay of this im- portant sense. The sense of smell is closely associated with the sense of taste ; that is, many things which we think we taste, we really smell ; and perhaps in some instances the reverse may be true. For example, the onion, the potato, and most other vegetables, have little or no real taste, but have char- acteristic odors, which during the chewing of the food find their way from the mouth through the passage behind the The Nose and Its Uses. 15 soft palate, and into the nasal cavity, and thus come in con- tact with the nerves of smell. One can easily demonstrate this fact by tightly closing the nostrils when eating any of the foods mentioned. In so doing, it will be found that the article seems to be almost devoid of flavor. The nose is very liberally supplied with blood-vessels, which are closely connected, through their branches, with the blood supply of the mouth, ears, eyes, and front part of the brain. This membrane is also richly supplied not only with nerves of ordinary sensation, but with branches from the sympathetic nerve, by which it is very closely related with the upper part of the spinal cord, and through it with every part of the system, particularly with the stom- ach, liver, lungs, face, scalp, chest, and neck. This con- nection of the nose with other parts, through the sympa- thetic system, is a fact which is very important for us to remember, as it is through these intimate nerve relations that the numerous and varied symptoms attending nasal catarrh in its several stages, arise. Cavities Connected with, the Nose. — "Rooms to let" is an expression we sometimes hear used respect- ing a person who is supposed to have a deficiency of in- tellect, notwithstanding a large development of the head. Doubtless those who make use of this expression are quite unaware of the fact that every person has a number of vacant rooms in his head. There are at least eia-ht such chambers in different parts of the skull, which communi- cate with the nasal cavity. Two of the largest of these — the so-called frontal sinuses — are found in the skull just above and between the eyes. Two others are found in the face bones, one on either side. Still others are found in the bones which help to form the sides and back of the' nasal cavity. These cavities are connected with the nasal cavity by means of small openings or canals. In addition, the nasal cavity is connected with each eye by a bony canal, as previously mentioned, and a canal also extends from the sides of the back portion of the nasal cavity to 1 6 First Lecture. each ear. The position of most of these various parts can be easily seen by reference to Plate I. The purpose of all these cavities it is not easy to explain, although the use of some of them is very apparent. They add sonorousness to the voice, and diminish the weight of the bones. * As already explained, the nasal ducts which connect the eyes and the nasal cavity, act as sewers to drain off the tears. Ordinarily, these canals are sufficient to carry away the watery secretion of the eyes ; but when the tears are secreted very abundantly, as in weeping, a large por- tion escapes over the lids, and runs down the cheeks. The Eustachian Tubes.— The canals which connect the nasal cavity with the ears, are exceedingly useful to the latter organ. They not only allow secretion from the middle portion, or drum, of the ear to escape into the nose, but provide for an interchange of air between the ear and na- sal cavity, by which the pressure within the ear is kept uniform with the external pressure. To facilitate this pro- cess, which might be termed " ear-breathing," the openings at the nasal ends of the ducts leading from the ears, which are known as the "Eustachian canals," are placed just oppo- site the inner extremity of the lowermost passage from the nose, and on a level with it. In ordinary breathing, almost the entire amount of air which passes through the lungs goes through these lower canals, so that the air-cur- rents strike directly upon the mouths of the Eustachian tubes, by which the entrance of the air to the ears is greatly aided. When the air is drawn into the nose with a forcible effort, as in snuffing, the air-current strikes the upper part of the nasal cavity. This is why we involuntarily sniff the air when we wish to sharpen the sense of smell. Natural Breathing. — From what has been already said, it must be apparent that the nose is the only proper channel for breathing, under ordinary circumstances. It will be remembered that in connection with breathing, the nose renders valuable service in several particulars. It not. The Nose and Its Uses. \J only moistens the air, but modifies its temperature, raising; or lowering the temperature of the inspired air, according; as the external temperature may be lower or higher than that of the body. It acts as a filter in excluding extrane- ous matters ; it is a sanitary detective, through its ability to> recognize bad odors ; it regulates the rate of the air-supply by the precisely proportioned size of its channels, and,, incidentally, by the direction given the air-currents, aids irr. changing the air in the cavities of the ears. When breath- ing is performed through the mouth, all of these various, useful offices are neglected, and numerous evil consequences arise, not only to the nose and ears, but to the throat and the lungs and other portions of the body, as will be pointed out at another time. A curious fact which illustrates the intimate relations between the nose and the lungs, may be made apparent by a simple experiment. Close one nostril, then take a deep -breath. It will be observed that the two sides of the chest do not expand equally. The side corresponding with the unobstructed nostril will expand freely, while the other will not. This is doubtless due to the stimulus imparted to the nerves of the nasal mucous membrane by the impact of the air-current forcibly drawn in. The reflex relation of the nose and the muscles of respiration, causes the more vigorous action of the unobstructed side. It thus appears that unobstructed breathing is a matter of vital import- ance, and not only to the lungs, but to the whole body^ Snoring. — Breathing is naturally performed without sound. Audible breathing is always unnatural and un- healthful. It is usually occasioned by partial or complete obstruction of the nose. Snoring is exaggerated audible breathing in which air is inhaled through both the nose and the mouth at the same time. A peculiar sound is produced by the rythmical vibration of the pendulous por- tion of the soft palate, the membrane which hangs loosely at the back of the throat, which is thrown into strong; vibrations by the action of the two currents of air, one 1 8 First Lecture. entering through the partially-obstructed nose, the other through the mouth, and meeting at the back part of the throat. Obstruction of one nostril may not be sufficient to produce snoring, provided there is a large opening through the other nostril ; but whenever the obstruction of the nose becomes so great as to render nose-breathing difficult, the mouth falls open as soon as the individual becomes unconscious in sleep, and snoring, which often renders night hideous to persons of sensitive ears, at once begins. A full consideration of the causes and cure of snoring and mouth-breathing, must be left for another occa- sion. Sneezing is a modification of breathing in which the nose is chiefly concerned, although it takes no active part. It is produced by a sudden contraction of the expiratory muscles, forcing the air out at both the nose and the mouth. The act of sneezing is usually excited by an ir- ritation of the mucous lining of the nose. When one sneezes in connection with taking cold, it is due to con- gestion of the lining membrane of the nose, and is the result of an effort of nature to counteract the injurious effects of the chill by producing a reaction. Sometimes sneezing results from looking at a bright object. This is due to the sym- pathy between the nose and the nerves of sight. The same sympathy is exhibited in the profuse flow of tears which usually accompanies a fit of sneezing. Nasal "Voice. — A few words respecting the relation of the nose to the voice : Every one who has ever had a severe "cold in the head," will remember an embarrassment in speaking words containing certain sounds, when the nose was obstructed. The sounds of n and m are either not artic- ulated at all, or are converted into the sounds of d and b. For instance, the word pudding is spoken as though spelled without an n, and dumb is pronounced dub. We usually say that a person speaking thus has a nasal tone, or that he speaks through his nose ; this is quite incorrect, for in fact he is trying to talk without his nose, which is an The Nose and Its Uses. 19 unnatural and awkward proceeding". The nose seems to be indeed a sort of resonating chamber for the voice ; and when the nostrils are obstructed, even to a small extent, the. voice is materially and unpleasantly modified. This is a consideration which every person who is suffering from catarrh, even to a limited extent, should seriously bear in mind ; and such should also be informed that these harm- ful modifications of the voice often become so grave in character and extent that even the highest degree of medical skill can afford only partial relief. In conclusion, for the present occasion, I wish only to remark that I have given no description of the throat, or pharynx, first, because our chief business is to study the nose and its diseases ; and second, because by standing before a mirror, and pressing down the tongue with a spoon, each of you, without the aid of a teacher, may become quite familiar with the construction of the throat. I may merely mention that the pendulous membrane at the back of the throat is called the soft palate, the central and more dependent portion being termed the uvula, and that the two small lumps on either side, placed between the two loose folds of membrane termed the fauces, are the ton- sils, of which we shall have occasion to speak more fully at another time. SECOND LECTURE 3xute Nasal Catarrl). "A COLD IN THE HEAD. THE literal meaning of the word catarrh is a " flow," or " discharge." The term is applied to the disease which we are considering, on account of the prominence, as a symptom, of the discharges peculiar to this malady ; but it is important that we should at once divest our minds of the common notion that catarrh of the nose is neces- sarily accompanied by a profuse discharge. We frequently find persons suffering seriously from chronic catarrh, who have been so little inconvenienced by nasal discharges that they have never suspected the presence of the dis- ease until other of its more serious results have begun to make their appearance. An excess of secretion is present in some form in most cases of this disease, at least in its earlier stages ; but this symptom is by no means the most serious or the most constant of the various unpleas- ant features of this disease. Before we undertake to define more exactly the nature of the disease which we are considering, let us recall some of the chief facts which we have learned respecting the- nasal cavity and its surroundings : — i. We have learned that the nasal cavity is an irregu- larly shaped space which is divided into two nearly equal parts by the septum of the nose. 2. The outer walls of the cavity present a number of deep furrows, which are formed by projecting ridges of the bone, which jut out toward the septum. 3. The nasal cavity communicates with the mouth by a large opening behind the soft . palate, the latter acting as a sort of valve by means of which the opening be- tween the nose and the mouth may be controlled. (20) Acute Nasal Catarrh. 21 4. The nasal cavity is also connected with the drum of each ear by a duct on either side, which allows the air from the nasal cavity to enter the ear. 5. The nasal cavity is connected with a number of other similar cavities, the chief of which are two quite large cavities in the bones of the face, the cavity called the frontal sinus, found in the skull just between the eyes and on a level with the eyebrows, and several large cells in the base of the skull. 6. The nasal cavity is lined with a delicate pink tissue called mucous membrane. This same covering extends through the small ducts connecting the nasal cavity with other cavities, and also lines these cavities. The ducts extending to the eye and the ear are also lined with mu- cous membrane, as is also the drum of the ear. 7. In the upper part of the nasal cavity the mucous membrane contains very delicate nerve fibers, in which resides the olfactory sense. In order that we may understand the nature of this delicate membrane which lines the nasal cavity, let us compare it with the skin, a structure with which we are more familiar. If we place a small portion of the skin under a magnifying glass of moderate power, the first thing we shall notice is that we are scaly creatures. The scales which cover our bodies are not like the great horny plates which constitute the covering of most fishes and some species of reptiles, but are so minute and delicate that a magnifying glass is required to render them visi- ble. We may at any time collect a few for examination, by gently scraping the surface of the skin with the edge of a knife. These scales we are constantly shedding, they being rubbed off by the friction of clothing, and by various objects with which we come in contact. When one takes a Turkish bath, these skin scales are sometimes rubbed off by the shampooer in astonishing quantities. If we study the skin more closely, we find in it two sets of se- cretory organs, or glands. One set produces the watery fluid called perspiration, or sweat ; the other produces a 22 Second Lecture. thicker, fatty, or oily, matter, by which the surface of the skin is lubricated. The skin also contains numerous nerves, in which reside the senses of touch and tempera- ture. The mucous membrane is a sort of inner skin, or, as has been termed, a lining skin, and very much resembles in structure, though less in appearance, the outer cover- ing of the body. The mucous membrane, like the skin, is covered with scales. These do not, however, dry up and fall away, as in the case of the skin, but are washed away by the fluid which is always found moistening the surface of a healthy mucous membrane. If you will place under a microscope a drop of saliva from the mouth or of clear mucus from the nose, you will find in it a great abundance of these scales. The mucous membrane, like the skin, contains glands also. As in the case of the skin, one class of these glands produce a thin watery fluid, much like the serum of the blood, from which they are called serous glands. The other set of glands produce a thicker and somewhat tenacious fluid, termed mucus, which is quite unlike the oily secretion of the skin. You see, then, that the fluid formed by the mucous membrane is made up of three things, — the watery fluid formed by the serous glands, the mucus formed by the mucous glands, and the scales which are shed by the mucous mem- brane. In catarrh accompanied by a discharge, there is always an increase in some of these elements. If the dis- charge is watery, it is because there is an increase of the serous fluid. If it is thick, it is because there is a great increase in the amount of mucus formed, and in the quan- tity of mucous scales thrown off. Catarrh is not confined to the nasal cavity. It may af- fect the membrane lining the eye-lids and covering the eye-ball, that which lines the ears, the lining membrane of the cavities adjacent to the nasal cavity, the mouth, the air passages, the stomach, the intestines, the bladder, or, indeed, any portion of the body which is covered or lined by mucous membrane. From the similarity between the Acute Nasal Catarrh. 23 skin and the mucous membrane, it may occur to you that these two structures might easily be affected by the same disease ; and this is exactly true. When a child has scarlet fever, the eruption upon the skin is accompanied by a similar eruption upon the mucous membrane. It is this which produces the strawberry tongue and the sore throat which accompany these diseases. ' The nasal and throat symptoms which accompany measles are another illustration of the same fact. The same is also true of catarrh. The skin, as well as the mucous membrane, may be affected by a disease essentially the same as catarrh. A common disease of this character is ordinarily known as eczema, salt rheum, or moist tetter. A " Cold in the Head."— We are now prepared to enter a little more deeply into our subject. Let us study first the symptoms by which we may know when this disease is present. The simplest form of nasal catarrh is that common affection ordinarily termed " a cold in the head." The symptoms present in this condition must be familiar to most of you from personal experience ; but in order that we may understand the relation of this simple form of disease to its more serious and chronic phases, it is well that we should study them somewhat closely. In order to illustrate the subject for you, I have asked a gentleman who has just consulted me for the relief of an acute cold, to present himself before you as a clinical subject, and allow us to question him. While I have been talking, you have noticed that he has sneezed several times. He is obliged to use his handkerchief almost con- stantly, on account of a watery discharge from the nose. You observe that his eyes are red. As I open his nostrils by means of a little instrument called a nasal speculum, I see that the lining of his nose presents a red appearance, like his eyes. We say that his eyes are "blood-shot, 1 ' which means that the blood-vessels are so distended with blood that they are visible. The mucous membrane lining the nose is also blood-shot, or congested ; and as 24 Second Lecture. the patient opens his mouth and allows me to hold down liis tongue with a tongue depressor, I look in, and find that liis throat presents the same red and congested appearance. "You observe also that his face is flushed. There is too much blood in his head. He says that his head aches ; and as I take his hand to feel his pulse, I notice that the skin is hot and dry. He says he feels feverish, and is obliged to drink very often. I count his pulse, and find that it indicates a slight fever; and if we place a ther- mometer in his mouth, we shall find that his temperature is one or two degrees above the normal, or healthy, stand- ard. Very likely it is about ioo° F. If you observed his tongue when we were looking into liis throat, you noticed that it was covered with a white coat. The patient says he has a bad taste in his mouth, and has no appetite. His bowels are inactive. The se- cretion of the kidneys is disturbed, as is indicated by a pink, whitish, or brick-dust sediment. The patient says that his " bones ache," that his flesh is sore, that he feels ^veak and unable to perform his usual duties. He feels dull and stupid. Now and then he has shivering sensa- tions along the spine. If we ask our patient when he contracted this cold, he will tell us that he has not been feeling quite so well as •-usual for a day or two ; that he was a little bilious ; ap- petite not quite so good as usual, and bowels inactive ; iDut that he thought little of his condition until two or ■three hours ago, when, as he was sitting at work in a room without a fire, he began to sneeze ; and knowing at -once that he was taking cold, he removed to a warmer room, but 'has been sneezing at short intervals ever since, .and his cold seems to be getting worse every moment. Sneezing. — Our friend thought, and this is the com- mon notion, that the sneezing was a sign that he was taking cold. This is quite a mistake. Sneezing is an evi- dence that a cold has already been taken. 'When a per- son begins to sneeze, he already has a cold, and the Acute Nasal Catarrh. 25 sneezing is nature's atcempt to cure it. This idea probably strikes you as a curious one, yet I believe it to be true, nevertheless. When one makes a vigorous sneeze, the action is not of the nose, but of almost the entire body. In other words, he sneezes all over ; almost every muscle of the body makes a jerk. Our unfortunate friend is just now getting ready for an explosion. Notice how strangely the muscles of his face twist his countenance out of shape. He is taking a deep breath. Nature is getting ready to fire a powerful blast at the enemy which is invading her domain in the shape of a cold. There it goes, " ker- chew ! " It nearly lifted him off his chair. Every mus- cle in his body made a jump. A sneeze is a spasm by which nature undertakes to re-establish the equilibrium of the nervous forces and the circulation, which have been disturbed by a cold draught or some other cold-producing influence to which the individual has been exposed. I have really sometimes seriously considered whether it would not be a proper thing to revive some of the old- fashioned sternutatories of the pharmacopoeias of two cent- uries ago, as remedies to be used in the first stage of a cold. At any rate, I imagine that a few pinches of snuff at this particular period, provided nature is not able to get up a sufficient number of vigorous sneezes, might be beneficial ; only I should insist that it be not " Scotch snuff," or any other narcotic mixture. We have already noticed that the discharge at this stage of a cold is of a watery character. In the course of a few hours, the discharge will become somewhat thicker and opaque. If the patient has not previously suffered from repeated attacks of cold, the discharge will gradually lessen, and the various other symptoms will disappear ; and in the course of a week, he will feel as well as usual, provided he takes ordinary care of himself; and that without any special treatment, either general or local. His cold will have been cured by the natural recuperative efforts of the system. If, however, through exposure, our patient gets an addition to his cold before he has fully 26 Second Lecture. recovered, or if his system at the time the cold was con- tracted was in a state of preparation for catarrh, a. condi- tion in which the liver, skin, and other organs of excre- tion were inactive, so that the blood and tissues were filled with effete or impure matters which should have been eliminated, then the cold will not terminate so quickly. Instead, several weeks or months may elapse be- fore nature is able to complete the remedial process, or, in other words, the disease may become chronic. It may, indeed, become so thoroughly seated that nature will break down in her attempt to restore the patient to health, and a permanently diseased condition will be established. THIRD LECTURE. €l)ronic Nasal Catarrh CHRONIC catarrh of the nasal cavity and adjacent parts may be divided into three stages, which are sometimes considered as distinct diseases, but are really different de- grees of development of the same disease. First Stage. — The first stage of chronic nasal catarrh is simply a continuation of the acute disease. Instead of getting well, the patient continues to be troubled with a profuse thick discharge from the nasal cavity, which obliges him to use a handkerchief frequently, and often annoys him by frequent droppings or accumulations in the throat. In some cases, the disease is confined almost wholly to the front part of the nasal cavity, while in others, it is chiefly located in the back, post-nasal, or naso-pharyngeal region. At first, the discharge is of a whitish color ; but after a time, it becomes greenish. The discharge is variable in quantity, sometimes disappearing entirely ; at other times, especially when aggravated by a cold, becoming exceedingly profuse. Indeed, the amount of mucus sometimes discharged by the nasal cavity in twen- ty-four hours, is quite astonishing. Frequently the amount is so great as to seriously disturb the breathing, especially during sleep, and to give the voice a nasal tone, by ob- structing the nasal passages. The patient finds, however, that this inconvenience may be relieved by vigorous blow- ing of the nose, and frequently resorts to this method of ridding himself of the obstruction. In many cases, this violent blowing of the nose is found to produce serious inconvenience, as distress across the forehead, faceache, a stuffed-up feeling in the ears, and earache. These symp- toms are due to the fact that in violent blowing of the nose, the air is forcibly driven into the various cavities of (27) 28 Third Lecture. the nose, which have been previously described. The ex- tra strain to which these cavities, and also the delicate structures of the ear, are subjected, produces the unpleas- ant symptoms mentioned ; and it is possible, indeed, that through violent blowing of the nose, portions of mucus may be carried from the nasal cavity into the adjacent cavities referred to, thereby setting up the disease in new localities, and thus increasing its extent. I ought, perhaps, to remark right here that catarrh is to some degree conta- gious ; that is, if we transplant a portion of the discharge from a catarrhal nasal cavity to a healthy nasal mucous membrane it may create the disease where it did not exist before. I would again impress the warning that the nose should not be cleared with violence. We frequently see per- sons, in blowing the nose, take first a deep breath, then, closing the nose, make such violent efforts to expel the air through it as to cause themselves to become so red in the face, through the distention of the blood-vessels, as to give one the impression that the head is about ready to explode. This is undoubtedly a very efficient method of clearing the nasal cavity, as the air is so compressed that when the nose is released, it rushes out with almost explosive violence ; but it is productive of great mischief, and there are, undoubtedly, many cases of ear diseases and other serious troubles to which catarrhal patients are subject, that are due to this cause alone. The Second Stage. — After a time, however, the patient finds that although the discharge may be lessened, the nasal obstruction still continues, especially in damp weather or when he has been exposed to a slight chill or dampness. There is also a noticeable change in the voice, which acquires the so-called nasal tone. Really this term is a misnomer, as the cause of the peculiar quality of voice referred to, is a lack of nasal resonance, due to the obstruc- tion of the nasal passages of one or both sides. Chronic Nasal Catarrh. 29 As time passes on, the nasal obstruction increases, until respiration during sleep is carried on almost entirely through the mouth. The patient has now become an habitual snorer, much to the annoyance of those who sleep in his vicinity, and even to his own great inconvenience ; for there are numer- ous morbid conditions and really serious diseases, which are directly traceable to mouth-breathing, as we shall take occasion to point out more fully at another time. When the conditions we have just described are present, the disease has reached its second stage, which is charac- terized by thickening of the mucous membrane, and growths of various sorts. We have here a patient who presents so many characteristic features of the disease at this stage, that I have asked him to allow me to examine him in your presence, so as to illustrate as fully as possible the con- ditions usually found in the second stage of catarrh. A glance at this gentleman's face is sufficient to discover to an experienced eye the fact that he has had catarrh for many years. First, we notice that his lips are held slightly apart, even when he is not speaking. This is because he is obliged to breathe through his mouth, which is an evidence of nasal obstruction. We notice, too, that his nose seems to be unnaturally broad at the upper part, commonly termed the bridge of the nose. This is due to abnormal thickening of the bones of the nose at this point, or an en- largement of this portion of the nasal cavity from the presence of the thickened tissues within. You ob- serve, also, that his nose is not perfectly straight with the rest of his face. It is twisted a little to one side. This, too, is a result of catarrhal disease, and is due to a deviation, or bending, of the septum of the nose toward one side, one of the most common results of chronic ca- tarrh. If we ask this gentleman to speak, the decidedly nasal character of his voice is very conspicuous, and is es- pecially noticeable if we ask him to utter such words as him, pnddi?ig, or other words containing the sounds of m or ng. Notice that he pronounces him as hib, and pudding ?o Third Lecture. as pnddig. The patient confesses that his friends accuse him of being a very loud snorer, and adds that he even some- times awakens himself by his noisy breathing. He com- plains that he finds his mouth very dry in the morning, and his tongue covered by a brown coat, which he charges to his liver, supposing it to be indicative of "biliousness." Very likely he will be quite surprised when we tell him that his liver has nothing whatever to do with the con- dition of his tongue, but that the brown coating is really a sort of fungus growth, which develops from spores, or germs, received from the air. Nasal Hypertrophies. — If we use the nasal specu- lum, to look into this gentleman's nose, we shall discover that the nasal passages seem to be entirely closed. A brownish red mass projects from the outer wall of the nasal cavity toward the septum, and completely closes the pas- sage. If we press upon this red mass with a probe, we •easily make a depression in it, which quickly fills out again when the probe is removed. This is what is called an hypertrophy. If we examine the opposite side of the nose, we find another hypertrophy, though not so large as on the other side. The passage is quite as completely closed, however, on account of the bending of the septum of the nose toward this side. If, now, I throw into the nostrils a spray consisting of a solution of that new and wonder- ful anesthetic, cocaine, we shall presently discover that these hypertrophies have, to a considerable extent, disap- peared, so that we can look beyond them. In the meantime, while waiting for this change to occur, we will have the patient open his mouth, and allow us to examine his throat. Pressing down the tongue, we get a view of the throat, and notice two red lumps, one pro- jecting from each side. (See Plate IV.) These are hy- pertrophied, or overgrown, tonsils. The mucous membrane of the entire throat is of a dark red color, and is usually thick, and in places hangs into the throat in loose folds. The soft palate is also thick, and hangs Acute Tonsillitis. Chronic Tonsillitis. IV. Chronic Nasal Catarrh. 31 down too far in the throat. The uvula is enlarged and elongated. The back wall of the throat, also, has a red and angry appearance. The blood-vessels are so much en- larged, and stand out so prominently, that their course can be traced. The main trunks, with their many branches, look much like a great river with its tributaries, as seen upon a map. Here and there we" see little red patches, looking somewhat like warts. These are enlarged, or hypertrophied, mucous follicles. We notice that some of the larger patches are covered by a tough secretion, which we can wipe away with a probe having a little cotton wound around the end. If we make the patient draw up the soft palate so that we can see higher up in the throat, we observe that these same red patches extend upward into the back part of the nasal cavity. By the aid of a little mirror set at an angle on the end of a long handle, and the strong light reflected from a large concave mirror, we may look up behind the soft palate into the back portion of the nasal cavity, which we find looking very much like the throat. We see masses of thickened tissue here and there, and in the middle we, find standing out prominently, a thick red growth looking somewhat like an enlarged ton- sil ; and, indeed, this is just what it is — an enlarged pha- ryngeal tonsil. (See Plate I.) The two cuts on this plate are copies of drawings made from a patient, a young wo- man, whose nose was so completely obstructed that no air whatever passed through it. Her health was most wretched. By removal of the growths, she was restored to health in a few weeks. Most persons who have chronic throat troubles are proba- bly of the opinion that two tonsils are enough for one throat, but, as a matter of fact, we have three tonsils, one on each side of the throat, and another high up in the mid- dle, behind the soft palate. This third tonsil is also en- larged, like the rest, from chronic inflammation. By skill- ful use of the little mirror, we are able to find still other evidences of disease in the nasal cavity. We find in the back part of the nose, several other hypertrophies similar 32 Third Lecture. to those which we found obstructing the nasal passages in front (Plate I.) ; and here and there are masses of green- colored mucus adhering to the mucous membrane. The method of examining the back part of the nasal cavity is shown in the cut on page 5. Nasal Polypus. — Now, returning to the examination of the nasal cavity through the nostrils, we find that un- der the influence of cocaine, the hypertrophies have dis- appeared to such an extent that we can look beyond them, when the nostrils are stretched widely open ; and in so do- ing we see two or three gray-colored masses hanging down from the upper part of the nasal cavity, and filling up the back portion of the air-passages. If we ask our patient to throw his head forward and attempt to blow his nose, we find that these masses come down near the entrance of the nostrils. When touched with the probe, we find they are soft, almost gelatinous in character. These are what are termed polypi. Sometimes they are found grow- ing straight out from the side, or the septum, of the nasal cavity. Sometimes they are attached to the roof of the nasal cavity by a long slender neck. They may be found singly, or in masses almost resembling a bunch of grapes. Some time ago I removed from a patient's nose between thirty and forty of these growths. Both sides were filled to overflowing with polypi. The nasal cavity was enor- mously enlarged, and the polypi were present in such num- bers that they hung down at the back part of the throat. Sometimes these polypi are dense and fibrous in character. Very frequently, bony or cartilaginous growths may be seen projecting out from the nasal septum or the other bony structures of the nose. When our patient speaks, we notice that his voice is not only nasal, but somewhat husky and weak. He has con- stantly to clear the throat from a thick and tenacious phlegm which accumulates in it. He says that on rising in the morning he is greatly annoyed by being obliged to " hem " and " hawk " for half an hour, before his voice becomes Chronic Nasal Catai r 7'h. 33 even tolerably clear. All these are the results of nasal ca- tarrh in its second stage, as the disease extends into the throat, setting up there the same changes which occasion so much mischief in the nasal cavit}\ Third Stage. — All persons who pass inrougii the sec- ond stage of catarrh do not suffer from all the conditions described ; but all are afflicted with more or less of the evil consequences which grow out of the overgrowth and thick- ening of the various structures of the nose, which are the natural results of chronic congestion of these parts. After a long time, however, many of these symptoms begin to disappear. The patient finds that he is less troubled with, obstruction of the nasal passages. The discharge decreases, perhaps disappears entirely. Occasionally, however, pa- tients are troubled with a slight itching on one side, just within the nostril. To relieve the itching, a small scab is removed, which is usually followed by a little blood. The scab grows larger and larger, until, after a time, profuse bleeding of the nose follows each time the scab is removed. This goes on for months or even years, until by and by the patient or some physician discovers that there is an opening through the septum of the nose from one side to the other. The ulcerative process which the presence of the scab indicated, has continued until the cartilaginous portion of the itching septum has been eaten away. In the meantime, the patient has been congratulating himself that he has outgrown the disease, or worn it out. The disappearance of the nasal discharge and nasal obstruc- tions seem to indicate this. He notices, however, a slight impairment of hearing ; and on consulting a specialist in ear diseases, finds that he has catarrh of the ear, the ori- gin of which was the nasal catarrh, which has extended through the Eustachian tubes to the ears. The patient observes that his eyes are red in the morn- ing. This is another relic of the frequent chronic catarrhs, which have extended from the nasal cavity to the eyes. Close contact with the patient will acquaint us with c. 34 Third Lecture. another symptom, of which the patient himself is not usu- ally aware ; namely, a peculiar fetor of the breath, which is characteristic of the third stage of nasal catarrh. The patient himself is not conscious of the odor, for the rea- son that nature _'*indly deprived him of the sense of smell before this stage of the disease was reached. If we glance into the nasal cavities of a patient suffering from catarrh in this stage, we find a condition very different from that in the preceding stage. The hypertrophies and thickenings have disappeared. The lining «>f the nose is no longer red and congested. There is now no obstruction of the nasal passages. There seems, indeed, to be too much room. The patient sometimes complains, especlc^v when breath- ing cold or dry air, that the air passes thro igh the nasal passages so freely and forcibly as to produce unpleasant symptoms in the throat. The nasal passages are dry from insufficient secretion. Their walls have a gray and shining appearance. The mucous membrane seems to be so thin as to be almost transparent. Here and there we notice little masses of hard, dry crusts, which, when removed and examined, are found to have a most disgusting odor. These are little masses of secretion which, being too thick to be discharged in the ordinary manner, remain where formed, and undergo decomposition. Underneath these decaying masses, the thin mucous membrane is eroded by the de- composing mucus, and finally ulcerates, forming an open ■sore, from which bloody scabs are thrown off, finding exit through the nostrils or falling backward into the throat. This is the source of the putrescent odor. If we look into the throat, it will be found to have the same pale color observed in the nose, and a dry, shiny appearance. Here and there are small red patches and en- larged blood-vessels. The tonsils, like the hypertrophies of the nose, have shrunken away. The symptom of which the patient himself complains most, is the annoyance of •'" hawking" and " spitting," which is necessitated every morn- ing to clear out the throat or to relieve a most unpleasant irritation or itching which is frequently experienced there. Chronic Nasal Catarrh. 35 Sometimes he is made wretched by a sensation like that of a hair in the throat. This is caused by the presence of the enlarged follicles previously described. So we find that although our patient may have imag- ined that he had outgrown or worn out his catarrh, his last condition is really worse than the first. There is really no such thing as outgrowing or wearing out the disease. Unless it is cured by proper treatment, it marches steadily on from the first stage to the last, developing in each case more or less of the various symptoms and conditions which have been described, with numerous others which we have not taken time to mention. At our next lecture we shall consider " The Causes of Acute and Chronic Nasal Catarrh." FOURTH LECTURE. flrebisposing Glauses of Nasal Olatarrt). This increasingly common malady is usually attributed to taking cold ; but a more careful study of the subject clearly shows that catarrh owes its origin to a variety of causes, and that, in many cases at least, " taking cold " is only the exciting, not the real or chief cause of the malady. "What is a Cold ? — Before we undertake to classify or to definitely state the causes of this disorder, let us briefly consider the intimate nature of this disease. As we have previously learned, there is in catarrhal conditions a relaxed or congested state of the blood-vessels of the affected parts. The small blood-vessels have muscular walls, by which their size is constantly varied, according to the require- ments of the .part as regards blood-supply. These deli- cate muscles operate in obedience to impulses received from certain nerve centers in the brain and the spinal cord, known as vaso-motor centers. There are two sets of nerves connected with these cen- ters, — one set going from the surface of the body and passing inward to the centers ; the other set passing from the centers to the blood-vessels of the internal parts. It thus appears that the outer portion of the body is inti- mately related to the inner portion, through the nervous mechanism. A relation of the most intimate kind exists between the tissues of the back of the neck and those of the throat and nose. A more remote relation exists be- tween the soles of the feet and the mucous membrane lining the air-passages. The effect of an irritant of any kind applied to the outside of the body, is, first, a contraction of the blood-vessels in those internal parts to which the portion irritated is related. These internal (36) Predisposing Causes of Nasal Catarrh. 37 parts may be immediately beneath the irritated portion, or quite remote. Cold acts as an irritant when, for instance, it is applied to the back of the neck, as in case of expos- ure to a draft, or to the evaporation of moisture from neg- lect to dry the hair. The effect is, at first, contraction of the blood-vessels in the mucous membrane lining the nasal cavity or the throat, or both. Afterward, however, this con- traction is followed by relaxation, and the extent and du- ration of the relaxation or congestion is usually in pro- portion to the intensity of the irritation produced ; in other words, to the degree or continuance of the exposure to cold. There is thus an apparent and very simple reason for the phenomena which occur in taking cold. The conges- tion which immediately results, gives to the mucous mem- brane its red, glossy appearance, and causes it to swell. Irritation is produced, which occasions sneezing. Sneezing is a nervous expression on the part of the nasal cavity, which exactly corresponds to pain in some other part of the body, and is produced in the same way ; namely, by compression of the delicate nerve ends by the swollen blood-vessels. With this brief explanation of the nature of a cold and the mode of its production, we have a key to the various symptoms attending an acute cold. For example, neural- gia, which may affect any part of the body as the result of a cold, is caused by congestion of the blood-vessels of the sheath which covers the nerve trunk, thus producing compression and likewise pain, which would result from compression in any other way. Sciatic neuralgia, lum- bago, facial neuralgia, hemicrania, or migrain are all oc- casioned in this way. The same is likewise true of such sensations as soreness and stiffness of the muscles, which are so common in colds. The peculiar sensations of the skin, as numbness, the abnormal irritability or soreness frequently felt in the scalp, stiffness or soreness of the eyes, weakness or loss of voice (partial paralysis of the swollen vocal cords), profuse secretion of urine, — all these and 38 Fourth Lecture. numerous others of the varied symptoms attending a com- mon cold, are fully explained by the principles briefly outlined above. Sometimes the morbid impression is made upon the blood-vessels of the air-passages of the lungs ; then the patient has " a cold on the lungs." Acute catarrh of the bowels, the bladder, or other parts, may originate in the same manner, and all chronic neuralgic affections, catarrh of the stomach, bowels, bladder, etc., are invaria- bly aggravated by a cold. Predisposing Causes of Catarrh. — From the foregoing it is evident that catarrh is a disease inti- mately connected with the nervous system, and hence,, that its production must be to some degree dependent upon conditions which affect the nervous system. It is evident, also, that whatever affects the general system, lowering the vital tone, and hence the nerve tone as well, must be a predisposing cause of this disease. The immediate or exciting cause of catarrh, whether it be exposure to a draught, wetting the feet, exchanging heavy for lighter clothing, or similar accident or indiscre- tion, is not the real cause of the cold. The exposure to which the catarrh is usually attributed, is, in fact, only the provoking cause of a morbid process, favorable conditions for which have been previously prepared. In other words, it is like the throwing of a lighted match into a powder- magazine. It is not the match which explodes ; the match simply ignites the powder, and would do no harm if the magazine contained none. So with reference to taking cold. The causes to which colds and catarrh are ordi- narily attributed, do little or no mischief, except when brought to bear upon a system prepared for the setting-up of the diseased action which* we call a cold. This is a point of very great practical importance, and we may con- sider it with profit, at some length. Let us, then, inquire, What are the conditions which may be called the real causes of a cold, or which render a person susceptible to the influence of the exciting causes Predisposing Causes of Nasal Catarrh. 59 of this disorder ? Some of the most important of these conditions we will now consider : — 1. A Gross State of the Body. — A gross condi- tion of the body must be regarded as eminently active among the predisposing causes of catarrh. By this we mean such a state of the body as is the result of retaining the worn- out particles which ought to have been carried off through the lungs, skin, liver, kidneys, bowels, and the depuratory, or purifying, organs of the body. This state may be produced in several ways. It may be the result of gross eating ; that is, eating foods of a clogging character, as excessive quantities of sweets, fats, and flesh-meats. It may be the result of eating top much in quantity of even the best food. Or it may be the re- sult of inattention to the proper care of the body, so that the excretory organs become more or less disabled, and hence fail to do their work properly. (a.) How does gross eating cause a predisposition to catarrh ? — It is well known that sugar and fats are clog- ging in their influence. The liver, especially, is literally clogged by the free use of fats and sweets. The liberal use of flesh-meats results in clogging the whole system. Condiments — mustard, pepper, pepper-sauce, and articles of this kind — act as irritants, and injure the stomach and liver, thus producing general derangements of the body, and a morbid and impoverished condition of the blood. Chronic indigestion, or dyspepsia, is undoubtedly in many cases productive of chronic nasal catarrh. In indi- gestion, a considerable part of the food, instead of being converted into healthy blood, undergoes fermentative and putrefactive changes, by means of which various poisonous substances are formed, such as acetic, lactic, butyric, and oxalic acids, and various other poisonous matters known as ptomaines, which, being absorbed into the blood, act as irritants not only to the system in general, but espe- cially to the mucous membranes and other tissues which are liable to congestions from changes of temperature or 4-0 Fourth Lecture. other exciting - causes. Functional disturbances of the liver are almost always associated with chronic disturbances of other digestive organs, as the result of which the liver fails to do its duty in converting and eliminating the waste substances of the body, causing an excessive ac- cumulation of uric acid and allied substances in the blood and general system. (&.) The eating too abundantly, even of proper food, es- pecially by persons whose habits are sedentary, produces a gross state of the body, which in the highest degree fav- ors the development of catarrh. The mucous membrane of the nose comes to be used as a sort of depurating sur- face, through which effete matters are drained away. This fact is shown by chemical analysis, by which it appears that the discharges of nasal catarrh contain a large amount of cholesterine, a poisonous excretory product which is usually carried off through the liver, thus showing that the discharges of catarrh are, to some degree at least, excretory in character. Unused material in the body, a surplus resulting from excessive eating, must be treated like so much effete matter, — the result of the natural wear and tear of the body, — and must be eliminated in the same way that waste matters are removed from the body. The clogging of the general system, and the overwork of the eliminating organs, are unquestionably powerful pre- disposing causes of catarrhal diseases of all sorts. (V.) Inattention to bathing, thus allowing" the skin to become inactive, is unquestionably one of the most com- mon causes of bodily grossness. A neglected skin not only fails to do its duty as an excretory organ, but is abnor- mally sensitive to change in temperature, moisture, etc., thus exposing the individual to a doubly increased danger of contracting catarrhal diseases. (d.) The use of tobacco, or intemperance of any sort, which checks the action of the excretory organs, or clogs the system, is productive of this condition. (e.) Neglect to supply the body with the proper amount of fluid, renders the system unable to rid itself of ac- Predisposing Causes of Nasal Catarrh. 41 cumulating impurities through the excretory organs. Wa- ter is a. great solvent. It is needed to dissolve the waste matters of the system, — the first essential requisite for their elimination. Tea, coffee, wines, and similar drinks, are not substitutes for water. Their use, in fact, creates a demand for an additional quantity of fluid to rid the system of the injurious substances which they introduce. The free use of water is the best means for maintaining a pure state of the blood, and of the body in general, and the habit should be cultivated by those who are subject to this disease. We shall dwell more particularly upon this point in speaking of the proper treatment of catarrh. 2. Living in unventilated rooms, especially stove-heated rooms, which subject the upper part of the body to a high temperature, while the lower portion is exposed to cold, thus producing habitual derangement of the circulation, is a predisposing cause well deserving of mention. 3. Neglect to clothe the body properly is a predispos- ing as well as an exciting cause. Tight-lacing may pro- duce a tendency to this disease in women, by causing con- gestion of the head. 4. Heredity. — A cause which ought not to be omitted in this enumeration, is heredity. It is a common remark by persons suffering from this malady, that they have inherited the disease. This is not really the case, although it is frequently observed that the disease ap- pears in infants seemingly too young to have contracted it from ordinary exciting causes. In these cases it is probable that a tendency to contract catarrh has been in- herited, as is true of most other diseases, but not the dis- ease itself. The inheritance of disease is usually nothing more than a peculiar vulnerability to the causes of disease, or a state of body which invites disease. Thus the children of con- sumptive, scrofulous, or simply weakly parents, are much 42 Fourth Lecture. more liable to this disease than are others, not because they inherit the disease, but because they are less pre- pared to resist the exciting causes of the malady. Men who exhaust their systems by the use of tobacco or whisky, by dissipation, by gluttony, by abuses of any sort, transmit to their children that vulnerability of constitution which opens the way not only for chronic catarrh, but for all constitutional maladies. It is in this way that the children of parents afflicted with catarrh seem to inherit the disease from them. There is no doubt that in this disease, as in others, a tendency received by heredity may be extinguished by a proper regimen begun early in life. 5- TOO Mnch. Coddling. — Too much coddling is unquestionably one of the most common predisposing causes of catarrh. One who is inured to hardships is able to en- dure without injury exposures and privations under which one unaccustomed to a similar experience quickly suc- cumbs. The habits of civilization — air-tight houses, close and unventilated super-heated rooms, even protection of the body by clothing required by man in a civilized state — are active causes of preventing the development of hardihood, as the result of which colds are usually taken, and catarrh becomes an ever-present and almost universal malady among all civilized people. The lumberman in driving logs, wet to his knees all day long, and taking every now and then an involuntary plunge, suffers no inconvenience from the sort of exposure that would give a man unaccustomed to such a life his death cold. The native of Terra del Fuego shelters him- self from the wind and sleet of his unfriendly climate, by a single bit of skin, which he throws over the shoulder most exposed. Surely such a man would not incur taking cold from exposure to the draught of an open window. Historians tell us that the ancestors of the Anglo-Sax-* ons wandered over the bleak hill-sides of their chilly island, with no other protection than here and there a daub of paint. It is not to be supposed, then, that our Predisposing Causes of Nasal Catarrh. 43, aboriginal ancestors suffered serious inconvenience in con- sequence of making a change of garments. When visiting the primitive Indians of Arizona and New Mexico, I was informed by the Catholic Sisters in charge of the school at Fort Yuma, that the children of the Yuma tribe, who, through the efforts of the good Sisters, are rapidly becoming civilized, at once become subject to colds, catarrhs, and other indispositions after exchanging the no-clothing fashion which prevails in that part of the country, for pantaloons and petticoats. This fact, indeed, stands more in the way of the advancement of the work of civilizing this tribe than does any other. The Indian boy who has lived all his life in a state of nudity, plunges into the stream for a swim, or races about for hours through the wet grass of the marshes in quest of seeds or mesquite beans for his dinner, and experiences no inconven- ience whatever from the wetting which he receives ; but as soon as he puts on civilized clothing, he becomes sensitive to the same causes of cold which affect other people who wear clothes. His skin loses, in part, its ability to regu- late temperature, relying largely upon the non-conducting covering afforded by the clothing for this protection. In- dian men and women who have never acquired the cus- tom of wearing hats or bonnets, never take cold in conse- quence of going bare-headed. We do not wish to be understood as recommending the adoption of savage customs in dress as a protection against catarrhs, but excessive protection, especially the subjection of the body to too high temperature, so common in civi- lized communities during cold weather, is certainly produc- tive of a vast deal of mischief. FIFTH LECTURE. (Exciting Causes of Nasal (Hatarrt). DURING the cold season, a very large proportion of per- sons living in civilized communities find themselves suf- fering more or less from this annoying malady ; for a "cold" is a disease as much as is consumption or typhoid fever. Colds are also frequently contracted even during the warm season of the year. Let us now inquire, What are the principal exciting causes of that most common of all our bodily afflictions, a " cold " ? The various causes of colds may be classified under the following heads: — 1. Disturbances of the circulation by prolonged chilling of some portion of the surface of the body. 2. Contagion. 3. Imagination. Let us consider more at length the particular applica- tion of each of these causes. 1. Usually, and, in the majority of cases, correctly, colds are attributed to becoming chilled, getting the feet wet, having the hair cut, exchanging heavy under-clothing for lighter, or perhaps leaving it off altogether. These are, perhaps, among the most common of the immediate causes to which colds may be attributed. Let us look a little more particularly into these and other causes, and as we mean to go to the bottom of this subject, let us begin with the feet. Everybody knows that getting the feet wet on a cold day, when they are likely to become chilled thereby, is a dangerous accident ; and yet, how few people take the pains to avert a possible catastrophe by adopting the necessary preventives, such as taking a hot foot-bath, dry- ing the feet before a fire until warm, etc. ! Pei haps it has not occurred to many that a cold may be contracted from having the feet damp, even without (±4) Exciting Causes of Nasal Catarrh. 45 any of the ordinary causes of wetting, such as walking in the snow or the rain, or in the grass after the dew has fallen, without rubbers. It is quite possible that a per- son may take cold through dampness of the feet due to perspiration. Profuse sweating of the feet is a symptom which very frequently accompanies some forms of nervous disease. Many persons are much troubled with sweating of the feet whenever vigorous exercise is taken. Such per- sons are just as likely to take cold if the feet are allowed to become chilled, as if they had been made damp by any other means. All persons who wear rubbers, over- shoes, or rubber boots, are exposed to the same danger, unless the rubbers are frequently removed, so as to give the feet an opportunity to dry, and great pains taken to keep them constantly warm. Persons who consider themselves particularly careful of their health, frequently take cold unawares, by getting their feet damp, though not positively wet. This is most apt to be the result of walking in the damp or wet with shoes or boots having thin soles. Sometimes, indeed, the feet will be chilled when not made either wet or damp, from walking on a cold pavement with thin foot-gear. Any- thing which chills the soles of the feet, is sufficient to pro- duce a cold, whether the chilling is due to the evapora- tion of moisture, or to prolonged contact with some cold body without a good non-conductor intervening. It should be remembered that leather is by no means the best of non-conductors ; it is much inferior to rubber, though bet- ter for a foot-cover than rubber, on account of being slightly pervious to air. The insertion of a layer of rub- ber in the soles of shoes and boots is an improvement in their manufacture which we are sure is of real value. Imperfect protection of the lower extremities, such as the wearing of thin shoes, thin stockings, and thin under-cloth- ing, is an exceedingly common practice, and one which is unquestionably productive of a vast number of colds. All the colds resulting from this practice do not affect the nasal cavity, or respiratory tract, or at least their ill effects are .46 Fifth Lecture. not confined to these regions. Colds contracted by expos- ure of the lower extremities, frequently result in catarrh of the bowels, bladder, and urinary passages, and sometimes, especially in women, in violent inflammation of the delicate organs of the pelvis, including cellulitis and peri- tonitis, two very dangerous maladies. Women are the greater sufferers from this cause, because the greater of- fenders. If there is anything a woman really admires, it is a small shapely foot ; and the idea of dressing the foot with thick stockings and thick warm shoes, is one not to be en- tertained for a moment by most women. Thousands have sacrificed their lives to their vanity. There are many persons whose condition of body is such that chilling of the feet and legs is a hazard almost as great as that in- curred by soldiers under a heavy fire from the enemy. The congestion of the internal organs set up by the sud- den chilling of the surface of the lower extremities, may ignite an inflammatory fire which will only be extinguished with the patient's death. People must be taught that these exposures are highly dangerous, and that thus incurring danger to life, is little short of criminal. Probably more colds are taken in spring and fall than at other seasons of the year, particularly in early spring and late fall. There are many persons who lay off their under-garments, or exchange them for thin cotton under-clothing, at a certain date in the spring, as the first of April or the first of May, for instance, taking account only of the time of the year, without reference to the weather. These same persons have a set time in the fall for putting on the winter under-clothing. These two changes constitute about the only modifications of cloth- ing which they consider necessary for health. In conse- quence, they are constantly taking cold during the seasons of the year mentioned ; in the spring, because the warm winter under-clothing is laid off too soon ; in the fall, be- cause the warm under-garments are not put on soon enough. We heartily indorse the remark of the famous English Exciting Causes of Nasal Catarrh. 47 physician who, when asked the question, "When should under-clothing be laid off?" remarked, "Lay aside under- garments on a midsummer's day, but be careful to put them on the next day." The fact is, under-garments are needed the year round, and we are strongly inclined to believe that for the great majority of people, they should be made of some woolen ma- terial, and worn almost the entire year, at least in this cli- mate. In summer, on hot days, the thick woolen under-gar- ment may be exchanged for lighter garments of the same material. On the very hottest days, thin cotton garments may be worn with safety, but the arrival of a cool day, even if it be in midsummer, demands that thicker garments should be worn. Under-clothing should be adapted to the weather, with but little or no reference to the season of the year, ex- cept that it should be remembered that a cool day in summer is relatively much cooler than a day of the same temper- ature in the winter-time, since the vital functions of the body have become adjusted to the higher temperature, and hence are not so well prepared to stand exposure to cold. The influence of weather upon health is a subject which every person suffering from catarrh, either affecting the nose or any other portion of the respiratory tract, should thoroughly understand ; and on another occasion we will devote a half-hour to the discussion of the influence of the weather upon health. Exposure of the arms and chest is even more likely to occasion a " cold in the head," or a " cold on the lungs," than is exposure of the lower extemities. Many a vain woman has sacrificed her life by exposing these portions of the body in a decollete dress, at a fashionable ball or party. The rule should be considered an inviolable one, that portions of the body which are accustomed to protection must be protected. Simply cutting the hair, thus exposing the neck, not infrequently gives a person a severe attack of acute nasal catarrh, or cold in the head. Wetting the hair, and neglecting to dry it properly, fre- quently occasions the same result, as does also exposing 48 FiftJi Lecture. the head without proper covering, by one who has been accustomed to protect the head. It is noticeable that this more frequently occurs in men than in women. It is probably because a woman's head-gear is worn for orna- ment, and not for protection. At least, one could hardly imagine that the tiny combination of ribbons and feathers perched on the top of a thick mass of hair surmounting the back part of the head, would be of any value as a pro- tection for this part of the body against atmospheric changes. We have often seen a fashionable woman wear- ing this sort of a hat upon the streets, and with no other protection for her head, face, and ears, although the mer- cury stood close to zero, and all the men in sight had on fur caps, and were vigorously rubbing their ears, if those members were not protected by mufflers or ear-pieces ; and yet the lady seemed to feel no discomfort, and perhaps suffered less from the cold and its consequences than did the men, who were accustomed to protecting their heads with warm fur coverings. Nevertheless, we ca'nnot indorse fashionable feminine head-gear which affords no protection to the head. Women are much in-door, and hence, when out-door, really require more protection for the head than do men. Another of the causes of cold which we will briefly men- tion, is sudden cooling of the body after perspiration in- duced by vigorous exercise. A person may take cold from this cause in midsummer as well as at any other season of the year. We have known violent colds to be con- tracted by sitting down in the shade after working or ex- ercising in the hot sun. A breezy place, under such cir- cumstances, is particularly dangerous, as it increases the chill by promoting evaporation. Even a mackintosh, which one wears on a damp day to protect himself from taking cold, by keeping his clothing dry, may itself become a cause of cold. The impervious rubber covering retains in the clothing the moisture which is constantly es- caping from the body, and thus, after the garment is worn some time, the clothing may become quite damp. When Exciting Causes of Nasal Catarrh. 49 one returns home, and the mackintosh is removed, rapid evaporation takes place, and chills and cold may be the result. Exposure to cold air after perspiration induced by a hot bath, is frequently the cause of colds. Another deadly cause of colds, to which clergymen and school-teachers are particularly exposed, is the spare bed. The damp sheets and musty mattresses usually found in these death-traps, not infrequently induce colds from which the victims never recover. Lastly, we may mention as a producer of cold in which disturbance of the circulation is the leading factor, one of the most potent of all causes, viz., a cold. When a per- son has' taken a cold, even if it be a slight one, he is al- most certain to add to it. The condition of the system produced by a cold, occasions a most distressing suscep- tibility to influences which would have no effect upon a healthy person. The slightest draught, the least degree of chilliness, even seemingly unimportant changes in cloth- ing, are sufficient to bring on all the symptoms of an acute cold — coryza, sneezing, etc. I have known invalids who were likely to take cold from simply wetting the hands, or from slight changes in the bed-clothing. In- deed, it almost seems as though turning over in bed is sufficient to give one of these unfortunate persons a cold. The unhappy experiences of such persons leads them to form the habit of such elaborate protection of the body that this susceptibility is intensified and perpetuated. This is exceedingly mischievous, as it cultivates a delicate habit of body which not only exposes the individual to constant danger from causes which do not affect a healthy person, but becomes, after a time, a constitutional peculiarity, which may be transmitted. The children of such parents are an easy prey to catarrh and consumption. Contagious Colds. — It has long been suspected that some colds, at least, are contagious. It is a matter of com- mon observation that in many instances' when one mem- ». 50 Fifth Lecture. ber of a family catches a cold, all the other members eventually suffer from it. Sometimes a cold of this sort afflicts an entire school or community. The explanation of the contagion is found in the " germ theory" of disease, which has furnished a rational explanation for so many mysteries in relation to common maladies, and has also furnished the means for their prevention. It is indeed more than probable that germs play an important part in the origin of all colds, ordinary colds as well as those which are distinctly known as contagious. It is well enough known that germs or microbes are present in the air at all times in immense numbers. What is termed pure air> •contains a smaller number of germs, while bad air con- tains these enemies of life in great numbers. Doubtless, •some of these germs are much more active as agents in the production of catarrhal disease than are others. These may be those which give rise to what are termed conta- gious colds. But it is well known that the most common mi- crobes of the air, and those which are always present, are exceedingly active as agents in the production of catarrh of the mouth, and of the intestinal tract, under favorable conditions. Why, then, may not these same agents be equally efficient as a cause of catarrh of the nose ? My the- ory of the matter is this : The congestion occasioned by the disturbance of the circulation consequent upon expos- ure to some of the recognized causes of taking cold, occasions the coryza, or watery discharge, while the thicker discharge which follows a few hours later, and the continuation of the disease, is occasioned by the microbes which are al- ways present in the nose in large numbers. This theory may be somewhat novel, but it seems to me to present the merit of plausibility, at least. The congested vessels fill the tissues, and render them less able to defend them- selves against the attack of microbes, while the serum poured out in such abundance, affords the most favorable condition for the development of the germs. The recent studies of specialists in diseases of the eye, seem to have iproven that all diseases of the lids which are accompanied Exciting Causes of Nasal Catarrh. 5 r b>y a mattery discharge, are due to microbes ; and why may not the same explanation hold for the nose as well ? Future experiments will undoubtedly settle this question, and at no distant day. A curious example of the contagion of colds is afforded by a disease which has attracted considerable attention, and which is known as the " stranger's cold." This disease occurs on a small bit of land known as St. Kilda's island, lying off the coast of Scotland. For more than two hun- dred years it has been known that the natives of the island of St. Kilda are subject to an attack of influenza immedi- ately upon the arrival of a new vessel. There seems to be nothing improbable in the account of this curious disease. Indeed, travelers have reported a parallel observation regarding the islands of Tonga and Sa- moa, in the Pacific Ocean. Some months since, the writer was told by a traveler who had visited Pitcairn Island, that almost the only sickness upon the island for many years, had been an influenza which appeared after the ar- rival of a ship. Imaginary Colds. — There are many persons who live in such terror of the causes of colds that merely the suggestion of a draught, the sight of an open window, or the whistling of the wind through the trees, is sufficient to produce a spinal shiver, a nervous chill, and like enough a genuine sneeze. I have known such persons to be fright- ened into a cold a score of times ; and they suffer far more from their constant anxiety, and their unhealthful coddling, than they would be at all likely to suffer from colds if they took no precautions to prevent them. If a man can take the cholera or the yellow fever as the result of fear, cer- tainly he may contract a cold from the same cause. These persons often make themselves and their friends very miser- able by their constant fussiness about everything that can have any possible relation to a cold. They are a class of hypochondriacs, who ought to be turned over to the mind-cure doctors, shut up in a Turkish bath, or hermet- ically sealed in an air-tight case. SIXTH LECTURE. QLl)c ty$%unz of Nasal Glatarrl). HAVING considered at some length the nature and causes- of catarrh, let us now give our attention to the practical side of the subject — the proper treatment of the disease. The Curability of Nasal Catarrh.. — First of all, let us ask the question, Can nasal catarrh be cured ? Before I undertake to answer this query, I must ask another, What is meant by "cured"? If it is meant that one who has had nasal catarrh shall be made so well that he will never have the disease again, I must say most emphatically, " No." It is certainly impossible, by any course of treatment or regimen, to make a person better than he was before he contracted the disease. It is obvi- ous that if a man was born with a tendency to this dis- ease, and if this tendency has been strengthened by ex- posure to exciting causes to that degree that the disease has developed and become chronic, — I say, it is evident that in the treatment of such a case, we cannot hope to make the patient so well that he cannot contract the dis- ease a second time, or a third time, or an indefinite num- ber of times, if he is so fortunate as to get rid of the active symptoms so many times as that. Nevertheless, this disease can be cured in the same sense in which any disease can be cured. A man may be cured of dyspepsia, and yet he may easily abuse his stomach until it again revolts in indiges- tion. On the other hand, a man who has once been cured of indigestion, may learn how to care for his stom- ach, what to eat, how much to eat, and when to eat, and how to conduct himself in relation to his digestion that he may not again suffer from the disease. This is what (52) The Hygiene of Nasal Catarrh. 53 may be done in cases of catarrh. The man whose stom- ach has been injured by bad eating to that degree that it has broken down with dyspepsia, can never hope to be able to abuse it as he once did, without a speedy visita- tion of punishment ; and a man who has once had nasal catarrh, must be admonished that he must not suppose that when cured of his malady he is made invulnerable to its re-attacks, but that he must learn what have been the predisposing and exciting causes in his particular case, and then faithfully carry out the system of regimen which may be required ; and he must make up his mind to do this as a part of his daily routine. In the majority of cases, one who will do this may enjoy almost complete immu- nity from the disease, even after having suffered from it so long that it seemed incurable. YVe must, of course, except from the curable cases those who have suffered from the malady to that extent that the bones of the nose have become diseased or greatly distorted in shape, and cases in which the disease has reached that stage in which the natural tissues of the mu- cous membrane have disappeared. In these cases, the dis- ease can only be palliated. The patient may be made more comfortable, his sufferings may be greatly lessened, but little more than this can be done. This fact should be a most emphatic admonition to all who may be af flicted with this malady, even in a moderate degree, to give it attention at once, and not put the matter off until the opportunity for getting the most satisfactory results from treatment has passed by. Of first importance in the treatment of nasal catarrh is regimen. Nasal catarrh must not be regarded as simply a local disorder. It is not a disease of the nose merely, but a malady which affects the entire body. Everything, therefore, which pertains to the health of the body, is of importance in relation to the curing and prevention ot this disease. Let us consider the essential features ot what may be termed the hygiene of nasal catarrh. 54 Sixth Lecture. Clothing. — The clothing of a person who is suffering or has suffered from this malady, is of first importance. As remarked on a previous occasion, the under-clothing should always be of wool, heavy in winter, and lighter in summer, and always adapted, not only to the season of the year, but to the weather. In very cold weather, suscep- tible persons may with advantage wear two or three suits of under-clothing. It is especially important that the limbs should be thoroughly clothed. Stout shoes with thick soles, sufficiently roomy to allow the wearing of thick woolen stockings, are essential. Felt shoes and thick woolen anklets or leggings should be worn when necessary for comfort. The feet must be kept warm by some means, and preferably by clothing rather than by artificial heat. Probably a good share of the colds contracted are due to going out into the frosty air from an over-heated room, without proper protection. The suicidal practice of wear- ing decollete dresses at balls and parties, added to the other harmful associations of these occasions, dancing, eating of ice-cream and other indigestibles, is unquestionably re- sponsible for a vast number of the colds which result not only in catarrhs, but far more fatal maladies. Outer wraps should always be taken off upon entering a warm room from a walk out of doors in cold weather. Rubbers, overshoes, and the mackintosh should never be worn for a greater length of time than is absolutely re- quired, and if they have been worn for so long a time that the stockings or under-clothing have become moist from retention of the exhalations of the skin, the entire cloth- ing should be changed. This is quite as necessary under such circumstances as if one had been out in the rain with- out proper protection. Diet. — The best diet for a person subject to the disease which we are considering, will consist chiefly of fruits, grains, milk, and a few vegetables. Flesh meats should be used sparingly, if at all, certainly not more than once a day. Flesh food always contains more or less elements of The Hygiene of Nasal Catarrh. 55 a clogging nature, — the excretory substances which are present in the tissues at the death of the animal, and allied matters formed during the first few hours after death. These add fuel to the flame in a system already clogged with impurities, and hence exercise an unfavorable influ- ence in regard to this disease. Sugar and sweet foods are also to be avoided. Grains supply starch in abundance, which, by the process of di- gestion, is converted into sugar, thus supplying the wants of the body in this respect to the fullest extent. Certainly, any further demand for saccharine material will be readily furnished by sweet fruits. By the use of sugar in its ordi- nary concentrated form, the system becomes charged with unusable material, which must be eliminated as so much waste matter. When sugar is taken freely, it also inter- feres with the action of the saliva upon the starchy ele- ments of the food, by producing a free secretion of mucus in the stomach, and occasioning acid fermentation, which hinders gastric digestion. The liver is overtasked, and is called upon to eliminate saccharine material which can- not be used. The subjects of nasal catarrh are almost always persons whose nutritive organs are deficient in ac- tivity ; hence, every article of food which may add to the burden of the excretory organs, should be rigidly excluded, or at least taken in the most moderate quantities. Butter and other animal fats must also be condemned, — because of their clogging influence, and their interference with digestion. Cooked fats are particularly harmful. Cheese is an article of food fit only for the stomach of a scavenger, and should be an abomination in the eyes of a catarrhal patient. Rhubarb and onions must also be dis- carded on account of the oxalic acid which they contain. The urinary secretion of persons suffering from this disease, very generally shows the presence of this poisonous sub- stance, in combination with lime. This fact certainly con- demns the use of all substances likely to introduce the poison into the system. The whole list of condiments, including mus- tard, pepper, pepper-sauce, ginger, and all hot and irritating 56 Sixth Lecture. sauces, must be stricken from the dietary of the subject of nasal catarrh. Tea and coffee must also be interdicted, as well as beer, wine, cider, and all alcoholic beverages. Water, the only proper drink, should be taken freely, as it encour- ages elimination, although the patient should avoid drink- ing freely of hot water or hot drinks of any sort in quan- tities sufficient to induce perspiration, when likely to be exposed to cold draughts, or just before going out of doors. Ice-cream, iced water, iced tea, and all frozen or iced foods, are exceedingly harmful in this disease. As we have previously learned, the chilling of the surface of the body is the most potent of all exciting causes of nasal catarrh. This is due to the fact that while cold applications at first excite a contraction of the blood-vessels, a reaction speedily follows in which the blood-vessels are greatly re- laxed, a condition which remains for a longer or shorter period, according to the intensity of the impression made by the cold application, or its duration. Through reflex influence, a similar condition is excited in some internal area, usually that of the respiratory tract. The intimate nervous relation between the stomach and the air-passages, both being supplied with branches from the same cranial nerve, renders it apparent that the same reflex relation may exist between these parts. Meals should be taken with regularity, and it is decid- edly better that but two meals should be taken daily, or, at most, two meals and a light lunch. TobaCCO-TJsing in any form must be condemned, be- ing one of the most common causes of this disease. The tobacco-user who is suffering from this disease, must abstain from the weed entirely. An occasional smoke or other indulgence in the poison, will prove sufficient to maintain the diseased condition, and neutralize all the curative ef- forts which nature, aided by the most skillful physician, will be able to put forth in his behalf. Swift sung the praises of tobacco as a remedy for colic and toothache. He him- The Hygiene of Nasal Catarrh. 57 self suffered from one of the worst forms of catarrhal di- sease of the ear. Exercise. — Muscular exercise, either in a well-regu- lated gymnasium or out-door, or, better, both combined, constitutes one of the most important curative as well as preventive measures applicable to this disease. Exercise is not simply a means of developing the muscles. It de- velops the nerves as well, improves the nerve tone, aids digestion, and stimulates the action of the nutritive or- gans. The increased amount of oxygen taken in by the lungs, vitalizes and invigorates every vital action. The action of the liver is particularly invigorated by active ex- ercise. The increased vigor of the muscles of the dia- phragm, aids the circulation of the liver in such a way as to greatly facilitate its blood-purifying processes. The sufferer from catarrh should lay down for himself a regu- lar routine of vigorous muscular exercises which will bring into play the entire muscular system. These exercises should be taken with the same regularity as should the meals, and should be sufficient to develop the full powers of the body, although extreme fatigue or exhaustion should be avoided, as this condition is one which particularly favors the contraction of a cold upon slight exposure. Horseback exercise, mountain climbing, boating, and, in fact, all out- door recreations, are to be commended to persons suffering from this disease. Poor air and artificial heat, the inevitable results of the common method of heating, are greatly productive of catarrhal disease. Tfie stove-heating and furnace-roast- ing which prevail in most civilized homes, cannot be too strongly condemned. A room heated by a stove is cer- tain to be badly ventilated, and to expose the feet of the occupants to chilling from the layers of cold air which are invariably found near the floor. The upper part of the room, where the least warmth is really needed, is usually over-heated, while at the floor, the air may be fifteen or twenty degrees below the proper point. Furnace-heated 58 Sixth Lecture. houses are generally poorly ventilated, the common ar- rangement being to supply the furnace with air from the basement, or from a vestibule or hallway, so that the same air is used over and over. This secures a great economy in fuel, but a great waste of health. A constant fresh-air supply, direct from out-doors, heated by a furnace, steam coil, or a jacketed stove, is essential, and the foul air should be removed by means of ventilating shafts or ducts so arranged as to direct the foul and cold air from the floor. This will insure perfect circulation of air, and air of the maximum degree of purity, provided the openings are of the proper size. At least one square foot of regis- ter surface should be supplied for every three persons occu- pying dwelling-houses. When ventilating ducts alone are used, without a fresh-air supply, the result is a constant influx of cold air through the doors and windows. Cold air even enters through the walls of a dwelling. Brick, mortar, wood, and sandstone are pervious to air to a de- gree seldom appreciated. Cold draughts, which are so mischievous for persons sus- ceptible to colds, are often encountered in a room which is not properly heated and ventilated, and that without any opening for draught being apparent. For instance, a person sitting by a window will feel a draught upon the head or neck when there is no perceptible opening through which air can enter. The same will sometimes be experi- enced when sitting near an outside wall. These draughts are simply downward currents occasioned by the contact of the air of the room with the cold windows of the outer walls. Sleep. — In this, as in all other chronic diseases, abund- ance of sleep is essential. Sleep is nature's sweet restorer, not only from the results of the natural wear and tear of the body from labor, but from the ravages of disease. Both repair of natural waste and the restoration of diseased or disabled parts, take place during sleep almost entirely ; hence the importance of a sufficiency of this natural heal- The Hygiene of Nasal Catarrh. 59, ing agent. The conditions during sleep are also of great- est importance. Sleeping-rooms should be well ventilated, the fresh air being admitted warm, and in such a manner that draughts will not fall upon the patient. That a draught may be avoided, however, the bed should be placed so that the entire body, and not a single part only, will be in the current. For some reason, perhaps not easily explicable, one seldom takes cold out of doors, even, though exposed to very cold winds, while a pencil of cold air striking upon the back of the neck, through a crack, may be the starting-point of a severe cold in the head, or of a violent sore throat. Persons who are particularly sus- ceptible to draughts, and we cannot avoid them altogether, may protect themselves against their harmful influence by wearing a woolen night-cap. By all means run no risk. The sleeping-room, as well as the body, must receive consideration. A damp bed has not infrequently proved to be a death-bed. A bed in an unheated chamber is al- ways damp in the winter-time. Vapors distilled from the kitchen and laundry are dispersed through the dwelling, and are condensed in unheated rooms, so that an ordinary house having some rooms heated and others unheated, is a veritable distillery. This is why the sheets of a bed in a cold bedroom are always damp. To sleep in such a bed is about equivalent to an old-fashioned cold wet-sheet pack, with the refrigeration continually re-enforced by applications of cold water ; for it is not simply the sheets that are damp ; the mattress, the blankets, the pillows, — everything about the bed, — possesses the same deadly quality of chilly dampness. Look out for damp beds. If away from home, dodge the spare bed as you would the lock-up or pest-house. Every article of clothing worn during the day should be laid aside at night. Night-clothing should consist of a long woolen gown reaching from neck to wrists and an- kles. If the feet are habitually cold, warm woolen bed- socks, and, if necessary, leggings in addition, should be worn. Natural heat is much to be preferred to artificial SEVENTH LECTURE. Qtt)e treatment of Nasal Catarrt). We have now come to the most important and prac- tical part of this subject. The treatment of nasal catarrh has afforded a rich field for quacks, and has been a source of almost infinite annoyance to physicians. It is only re- cently, and since the subject has been taken up by scien- tific specialists, that the disease has been treated in anything like a successful manner. We have no universal panacea. The disease is one which possesses marked in- dividual peculiarities, and can be. successfully treated only by a careful adaptation of remedies to individual cases. In the first place, we must condemn utterly the use of any of the popular catarrh specifics, inhalants, etc. These rem- edies are usually such as have proven successful in a few instances, and will benefit a certain proportion of cases, but are quite as likely to do harm to a greater number. The various popular nostrums advertised for the cure of catarrh, are composed of substances which have been well known to the medical profession for years, and pos- sess none of the specific virtues which are attributed to them. The successful treatment of nasal catarrh includes — 1. Proper hygiene. 2. Measures addressed to the system in general. 3. Measures addressed to the local disease. The hygienic management of the disease we have al- ready dwelt upon at sufficient length. Incidentally, also, in our consideration of the hygiene of catarrh, we have considered some of the most general measures of treat- ment, and perhaps need not dwell further upon this, ex- cept in connection with the treatment of special condi- tions; so to make our subject of as much practical value (60) The Treatment of Nasal Catarrh. 61 as possible, we will proceed at once to the consideration of — How to Treat a Common Cold. — As has been remarked, a "cold in the head" is simply an acute ca- tarrh of the nasal mucous membrane. The things to be accomplished by curative measures are — 1. The removal of exciting causes, and the taking of spe- cial precautions against further exposure. 2. A restoration of the balance of the circulation, the disturbance of which, through the influence of chill upon the nervous system, is the usual exciting cause of a cold. 3. Local treatment for the relief of the local affection. The best means for the accomplishment of these ob- jects, are so simple that they may generally be found at hand ready for use. I. If the feet have been wet or chilled, take a hot foot- bath, or dry the feet and rub them until warm. If the whole body has been, chilled, the circulation should be stimulated by means of hot drinks, such as hot water, hot lemonade, or any of the simple domestic " herb teas, " omit- ting from the category such irritating substances as gin- ger, capsicum, and lobelia. Extra wraps should also be added. If possible, the patient should go to bed, place a hot brick to his feet, and wrap himself with woolen blankets. When these conveniences are not at hand, vig- orous exercise, either in the open air or in-door, may be substituted with entire success by persons in robust health. Sneezing, which many persons regard as a danger-signal, indicating that a cold is likely to be contracted, is, as has been previously remarked, really nature's first effort of resistance against the encroaching disorder which we com- monly call a cold. A hearty sneeze agitates the whole body, and is usually accompanied by a convulsive jerk of a large portion of the five hundred muscles which com- pose the muscular system. A sneeze is, in short, a vigor- ous kind of muscular exercise, which is intended by na- ture to restore the balance of the circulation, and thus an- 62 S event J i Lecture. tagonize the cold. A walk or run in the open air, or any other kind of vigorous exercise, will operate bene- ficially in the same way. 2. The measures already mentioned are to some degree preventive as well as curative in character, acting not only to remove the cause of a cold, but the evil effects which may have been already produced. There are, how- ever, other efficient measures which act still more vigor- ously upon the nervous system, and aid in the restora- tion of an even balance in the circulation. Among these may be mentioned a hot bath, which may consist of a simple hot full bath, a vapor or a hot-air bath, a Turkish or a Russian bath, a wet-sheet or a dry pack. What is desired, is that vigorous perspiration should be induced. Here are some of the most convenient ways for accom- plishing this result in an ordinary household: — A Vapor Bath. — Seat the patient upon a wet towel in a cane-seated chair, with a pail or a small tub of hot water placed beneath. Wrap him with blankets, and care- fully place in the tub, one by one, heated flat-irons or bricks, which may be conveniently handled by means of a string or a wire attached. The bricks should not be plunged suddenly into the tub, as that would produce too large a volume of steam, but should be slowly let down into the water, that the generation of the steam may be properly regulated. A vapor bath may be given while in bed, by placing hot bricks wrapped in moist Cloths alongside the patient, being careful not to place them against the body, and elevating the bed-clothing by means of a frame-work made of bent hoops or wires. Still another method of giving a vapor bath, is to place a perforated wooden board in a full bath-tub, resting it three or four inches above the bottom of the tub. Place the patient on this, and allow the hot water to run along the bottom of the tub and out at the discharge pipe. By covering the tub with a blanket, a very effective vapor bath may be obtained. The Treatment of Nasal Catarrh. 63 A Hot- Air Bath. — Seat the patient in the chair as for a vapor bath, placing underneath the chair a saucer con- taining an ounce or two of alcohol. Before lighting the alcohol, set the saucer in a pan containing a small amount of water, so that any overflow of alcohol will not result in damage. A Pack. — The method of giving a wet-sheet pack, is too well known to require description. A dry pack is taken by wrapping the patient in blankets, placing hot bottles at the feet and sides, and giving hot drinks. Hot drinks should be copiously given in connection with all the baths described, both before and during the bath. If a vigor- ous effect is desired, the sweating begun in the vapor or the hot-air bath, may be continued by means of a dry pack. After taking a bath of this sort, the patient should go directly to bed, and should remain there until the cold is substantially cured, being careful to keep warmly cov- ered, maintaining, if possible, a sufficient degree of per- spiration to keep the skin slightly moist. As has been pointed out, the essential morbid condition in a cold, is a dilation of the blood-vessels of the affected part, the immediate cause of which is a disturbed state of the nerve centers of the spinal cord, which control them. It is thus evident that the real disease is located in the spine, hence it is proper that treatment should be addressed to this part. Among the most important meas- ures of treatment for a cold of the head, throat, or lungs, is the application of heat to the upper portion of the spine. Heat may be applied in the form of fomentations of flan- nel cloths wrung out of hot water, bags filled with hot water, heated bags of sand or salt, hot bricks or bottles, or other similar means. The effect of the heat is intensi- fied, and to some degree prolonged, by the addition of mustard to the water from which the cloths are wrung, in the proportion of a tablespoonful of mustard to a quart of water. A very light mustard plaster, allowed to re- main on just long enough to cause redness of the skin 64 Seventh Lecture. without blistering, may be advantageously used, although, on the whole, the continued application of heat is to be preferred to any other form of counter-irritant. The re- lief afforded by this measure of treatment, is often very prompt and very remarkable. The pain at the back of the head, stiffness of the neck, and similar symptoms which frequently accompany a cold, quickly yield to these ap- plications. If a hot bath or other means by which perspiration is induced, is not sufficient in its first application, it may be repeated once or twice; but it should be distinctly un- derstood that the application of hot baths day after day, is not a proper mode of treatment for the relief of a cold. The effect of such a course is usually to ag- gravate the malady, by keeping the system of the patient in a constant state of susceptibility to abnormal disturb- ances of the circulation. The skin is relaxed, rendered sensitive, and unable to defend itself against changes of temperature; hence if the cold is not subsequently "broken" by one or two hot baths, accompanied by the other treat- ment mentioned, the sweating should be discontinued, and the spinal applications, combined with measures calculated to harden the skin, should be employed. Among the best of these are the salt-rub, which consists in rubbing the whole body vigorously with moist salt ; a saline sponge- bath, — sponging the body with a tepid solution of salt, a tablespoonful to the quart; — and a vinegar sponge-bath. Cold bathing has very much the same effect, though less intense. After a bath of any sort, the body should be well rubbed with olive or cocoanut oil, or fine vaseline, as a protection. This, indeed, is a precaution which person's subject to colds should always take after a warm bath. Local Treatment for a Cold. — The most disagreeable local symptoms attending an acute cold in the head, are coryza, or a watery discharge from the nose, obstructed nasal breathing, and distressing pain just below the eye- brows. These symptoms may be greatly ameliorated, and the cure of the disease expedited, by the employment of The Treatment of Nasal Catarrh. 6$ some local measures, only a few of the most effective of which, we have room to mention. Inhalants. — The inhalation of the vapor of strong am- monia water, strong spirits of camphor, the vapor of bal- sam of benzoin, tar, oil of eucalyptus, and especially of menthol, which is ' now sold at nearly all drug-stores,, placed in convenient inhaling tubes, frequently gives great relief to the coryza and the stuffed feeling of the nasal passages, by stimulating the dilated blood-vessels. to contract. See page,i2oand Nos. 42, 4.7. These meas- ures are not effective, however, unless employed at an early stage, and should then be frequently repeated, per- haps once or twice every hour during the first fofty-eight hours after the cold has been contracted. Snuffs. -7— We do not recommend the taking of snuff of any sort, as a habit. There is, nevertheless, some effi- ciency in the insufflation of certain substances in the form of powder, especially in the early stages of a cold. Among the best preparations of this sort are Nos. 26, 31, 32, jj y 34, 35- Solutions. — On the whole, medicated solutions are, per- haps, less useful in the treatment of the first stages of a cold than the powders or vapors which have been de- scribed. Nevertheless, there are a few solutions which are of real service, and should be mentioned first of all, because of their efficiency. A spray of a four-per-cent solution of cocaine, thrown into the nostrils every hour, is the most efficient of all remedies, if we except the powder prepared from the same drug, in relieving the local symptoms of an. acute cold. A solution of listerine, one part to eight or ten of wa- ter, used as a spray, is also an efficient remedy. What: the mucous membrane requires, when acutely congested, is mild stimulation, but not irritation ; hence, everything of an irritating character should be avoided. A solution of common salt, two drams to a pint of water, used as a: spray, will sometimes afford relief. E. <56 Seventh Lecture. Heat applied to the face and forehead by means of a sponge dipped in hot water, affords great relief to head- ache and faceache, and undoubtedly to some degree les- sens the congestion of the nasal mucous membrane. Diet. — It is important that something should be said respecting diet, in the treatment of this condition. For the first twenty-four hours, the staple article of diet should be hot water. A' little milk or gruel, or better yet, a few bunches of grapes or other juicy fruit, may be allowed, but hot water is certainly to be preferred, and the more the better It is hardly probable that the patient will take too much of this efficient detergent. In a cold, there is an obstructed condition of the emunctories, or cleans- ing organs, of the body. Hot water greatly aids the elim- ination of the effete products which are accumulated in the system, and thus hastens the termination of the abnormal effort made to eliminate waste products from the nose. Two or three quarts of hot water may be swallowed every two or three hours during the first stages of a cold, with great advantage. Meat, and all rich and stimulating arti- cles, should be scrupulously avoided. Milk in moderate quantity, with fruits and grains simply prepared, should constitute the diet. As has previously been remarked, it is important that a person suffering from an acute cold should protect him- self from exposure. On this account, he should remain in bed for the first twenty-four hours. We have endeavored to sketch in the foregoing what long experience and observation has taught us to be the rational method of treating an ordinary cold. That there is no other means by which it can be successfully man- aged, we will not say. We have known, in fact, of. in- stances in which persons engaged in out-door employ- ments, have effectually cured a cold by a long drive in a bracing wind, or a vigorous day's work in a keen atmos- phere. It is not to be questioned that the inhalation of • cold air acts as a local stimulant, and the dense oxygen inhaled under such circumstances, together with vigorous The Treatment of Nasal Catarrh. 6j exercise, stimulates both the circulation and the process of elimination, and thus the very measure which would seem likely to aggravate a cold, operates as a cure ; but only persons of vigorous constitution, and those accus- tomed to an out-door life, are likely to succeed by this method. Most certainly unsuccessful will be any method of treatment which combines out-door exposures with sweat- ing baths and other eliminative treatment commonly em- ployed. We have known persons to sweat themselves into a state of great debility and weakness, in the at- tempt to cure a cold, thus constantly augmenting the malady by their ill-advised procedures. Again, we wish to emphasize the statement that if a cold is not substan- tially relieved, or broken, within the first forty-eight hours by the application of two or three hot baths, these meas- ures of treatment will not prove effectual, and if continued, will probably only aggravate the cold. Hardening- — As previously remarked, one of the most potent causes of nasal catarrh is what might be termed coddling. The hardy denizen of the forest," living almost in a state of nudity, exposed to extreme heat and cold, winds and storms, and but scantily protected from either by his rude hut, has no use for a specialist in the treatment of nasal catarrh. A naked Indian was once asked by a white man, who was uncomfortably cold, al- though clad in thick woolen garments, fur cap and gloves, whether he was not cold. The Indian asked in reply, "Is your face cold?" Receiving a negative answer, he said, " Indian all face. " He saw no reason why his naked arms and thighs should suffer from the cold more than his face; and they did not, simply because, by constant exposure, all parts of his body had become accustomed to maintaining their own warmth without artificial heat. While we are not prepared to advocate the savage ex- treme in clothing, or no clothing, as a remedy for catarrh; yet we would say that without doubt one of the primal 68 * Seventh Lecture. causes of this malady is weakening of the resisting forces of the body by excessive warmth. The woodman seldom takes cold, notwithstanding some conditions which would hazard the life of those accustomed to ordinary modes of living. The log-driver of the lum- ber woods is wet to the skin the most of the time, and at night lies down in his cold shanty, without removing his garments, yet does not take his " death cold," neither does he get rheumatism, but to all appearance suffers little from his amphibious life. To the sufferer from nasal catarrh, I do not say, Subject yourself to like exposures ; for very likely should you undertake this, you would either kill yourself outright, contract hopeless deafness, or bring: on a rheumatic attack which might cripple you for life ; but, I do recommend the subject of catarrh to avoid over- coddling, and to endeavor to educate himself out of his ex- treme susceptibility. In other words, he should subject himself to a species of discipline which might be consid- ered a sort of hardening process. This ought to consist particularly in the education of the skin, teaching it to properly regulate its circulation under adverse circum- stances. This involves the education of the nervous sys- tem as well. I would say to the subject of this disease, when winter approaches, do not shut yourself up in stove, steam, or furnace heated rooms, but, instead, go out of doors a portion of every day. Go out in all kinds of weather, taking care, of course, to protect yourself with proper clothing, thus keeping yourself accustomed to out- door air. By this means, you may acquire the ability to withstand exposure to cold, without injury. Do not run away to Florida or California, or some other much- vaunted climate, to escape Jack Frost. Cold air is a friend, often in disguise, perhaps, but nevertheless one of the very best of friends to health. Bathing, particularly in cool water, if practiced daily or tri-weekly, will do much to educate the skin in the di- rection desired. Sea-bathing is on this account advanta- The Treatment of Nasal Catarrh. 69 geous, and a sea-bath may be taken at home at any time, by the addition of a tablespoonful of salt to a quart of water. The body, well sponged with this solution at a tempera- ture of about 75 , and afterward briskly rubbed with a rough towel to secure thorough reaction, is protected in a most efficient manner against any evil effects of cold air. Sudden changes of temperature, rather than the degree of exposure to severe cold, is one of the most exciting causes of nasal catarrh ; but the system may even become accus- tomed to changes of this sort. The cold-air bath, taken in increasing degrees, first exposing an arm, then an arm and a shoulder, then both arms, then one leg, then both, and thus portion by portion, until the entire surface of the body is uncovered, first for a few seconds, then for half a minute, next for a minute, and finally for five minutes or longer, combining the exposure with exercise sufficient to keep the blood circulating, is an excellent preventive against taking cold. Dr. Brown-Sequard has suggested that the back of the neck, perhaps the most vulnerable portion of the body, may be thus anti-catarrhally disciplined, by means of a pair of bellows, with which an air-current is blown upon the neck, first for a few seconds, then for longer periods, increased from day to day, till finally any amount of ex- posure of this sensitive part to cold draughts, will fail to produce sore throat or a cold in the head. The feet, also, may be accustomed to being wet with cold water, and their susceptibility to this kind of expos- ure overcome. All animals go about with wet feet with- out harm resulting, and the Indian wears his wet mocca- sins a week or more without change, and takes no cold. Dip the feet in cold water for a few seconds at first, then for longer and longer periods, until they can endure a cold bath for half an hour, and this source of danger will be overcome. When one considers the fact stated by an eminent his- torian, that for a thousand years not a man, woman, or child in all Europe took a bath, he does not wonder that yo Seventh Lecture. scrofula in multitudinous forms, and various kinds of plagues were so prevalent during that period as to destroy more than one third of the entire inhabitants of the Old World. Prevention Of Contagion. — Contagious colds may be prevented by avoiding contact with persons suffering from this form of disease. Perhaps it will be safe to re- gard all colds as contagious. Probably they are, to some degree. Hence, a person suffering from a cold should be quarantined to a sufficient extent to confine the handker- chief, towel, and allied articles to his exclusive use. The use of a towel or a handkerchief in common, not infrequent in families in humble circumstances, is unquestionably a cause of the extension of catarrhal diseases of the nasal cavity, and of grave forms of disease of the eye, which sometimes result in blindness. It is possible that inflam- mation of the eyes may be occasioned by wiping the eyes with a handkerchief soiled by discharges from a catarrhal nasal cavity. Kissing may be another means by which contagious colds are communicated. Promiscuous kissing is intolerable under any circumstances ; and a person suf- fering from a cold or catarrh may be the means of com- municating the disease to children. Catarrhal diseases may sometimes be occasioned by the fondling of lap-dogs and other animals, which are subject to this affection, as well as are human beings. Hygiene VS. Heredity. — One of the most benefi- cent gifts of modern medical studies, is the development of the fact that hereditary tendencies may be stamped out by a proper regimen, begun at a sufficiently early period of life. Parents who are themselves the subject of catarrhal disease, should recognize the tendency which they have transmitted to their children, and begin at the very earliest period of infancy a course of hygienic care, which, perse- vered in, may be relied upon to eradicate inherited dis- position to catarrhal disease. EIGHTH LECTURE. ®l)e Cocai treatment of QII)ronk ^asal Catarrl). WHEN catarrh has existed for such a length of time that it has become a constant condition, it is said to be chronic. In many cases of chronic catarrh, the most prominent feature of the disease in its simplest form, — a profuse discharge, — is not always present, but often dis- appears almost entirely under favorable conditions. The discharge returns, however, whenever there is the slight- est exposure to the exciting causes of cold. In other cases, the discharge is constant and abundant. In still another class of cases, there has never been any great amount of discharge present, and an examination will show that the mucous membrane is unnaturally dry. The passages, instead of being obstructed, are larger than those of a healthy person. In all of these cases, there will be found some abnormality of secretion. 'If not pro- fuse, it is likely to be thick and viscid, adhering in small quantities to various parts of the nasal cavity, or forming- dry plugs, which obstruct the nasal passages. These cases all require thorough daily cleansing of the nasal cavity. How to Cleanse the Nasal Cavity.— There are various methods by which the cavity of the nose may be cleansed. The first essential is a proper solution. Alka- line solutions are most suitable for this purpose, for three reasons : First, they best dissolve the viscid or hardened mucus ; Second, alkaline solutions, when brought in con- tact with the mucous membrane, stimulate the contraction of its blood-vessels ; Third, solutions of this character are also less irritating to the mucous membrane than any other. Pure water possesses none of these advantages. The (71) Eighth Lecture. " diphtheria, renders it important that it should be treated as contagious ; that is, a person suffering from acute tonsilitis should be isolated, small children, in particular, being kept away from the patient, and the same precautions being taken g6 Tenth Lecture. as are necessary in cases of other contagious diseases. I have met very severe cases of diphtheria which originated in contagion from persons who were suffering from what was supposed to be only a mild attack of tonsilitis. Treatment. — The general pain and distress is best relieved by a hot bath or a hot-blanket pack. At the outset of the disease, ice-compresses or ice-bags should be applied to the throat constantly, with hot fomentations every two or three hours. The patient may be given small bits of ice to hold in the mouth and swallow, to control the local inflammation. The steam inhaler is of great service in these cases (Fig. 5). Steam alone is of great value as a remedy. No. 46 may also be used with benefit. The inhaler should be employed as long and as often as it is found comfortable. After the fever accom- panying the disease has subsided, Nos. 4.3 or 44 may be used, three or four times daily, with the inhaler. The patient should also be encouraged to drink water freely. Hot water is to be preferred to cold, and he should drink at least three or four pints during the course of the day. Great relief is afforded by the hot gargle, which should be taken every fifteen or twenty minutes, a half glass of water being used each time. The water should be as hot as can be borne. It is well to add to the water a little chlorate of potash, a dram to the pint of water; but this is not essential. The application, with a swab, of a solution of cocaine,. No. 34, often gives great relief in these cases. I have also seen great relief from the use of a solution of nitrate of silver. No. 42. If suppuration of the tonsil occurs, it should be lanced as soon as the condition is indicated. Extreme swelling, accompanied by a throbbing pain, with great redness and tenderness of the tonsil, are indications of suppuration. It is, of course, necessary to call a physician to attend the patient in cases of this sort. Acute Inflammation of the Larynx^ Chronic Inflammation of the Larvnx. Ill Diseases of the Throat, Etc., Due to Nasal Catarrh. 97 Chronic Inflammation of the Tonsils — En- larged Tonsils. — Repeated inflammations of the ton- sils finally result in permanent enlargement of these glands. The appearance of the tonsils in this condition is well shown in Plate III. Usually little depressions will be ob- served in the tonsils. These are the enlarged and dilated follicles of the tonsils, which are the source of the small masses of foul-smelling cheesy matter frequently expelled from the throat by persons with enlarged tonsils. These cheesy particles are often mistaken for tubercles. The mischiefs which arise from enlarged tonsils ' are very great ; and what is most unfortunate, the general public are not aware of this fact. Aside from the injury to the voice, the presence of these glands in the throat is often the cause of deafness, by producing disease in the middle ear. The frequent inflammations which are set up by the slightest exposure to cold, are a constant menace, and a serious detriment to the general health. Treatment. — The only radical measure of treatment is removal, by a competent surgeon. Unfortunately, there is so great a prejudice against this perfectly harm- less procedure, that it is often neglected. It is claimed that the removal of the tonsils injures the voice, is likely to cause the disease to go to the lungs, prevents proper sexual development, causes consumption, and produces no end of mischief, — all of which is totally at variance with the facts of experience. I have removed not less than half a bushel of tonsils, and have never seen other than the most desirable results. The only danger is from hemorrhage, and this is not a serious danger, only when the operation is done by inexperienced and incompetent persons. There is no longer any question among well- informed physicians, as to the advisability of removal of the tonsils in cases requiring the operation. It is possi- ble to remove the tonsils without a surgical procedure, in cases in which the patient will not allow the operation to> be done, although an operation is much to be preferred as a means of getting rid of these annoying growths. G. •98 Tenth Lecture. Astringent preparations applied once or twice a day, are also of service, as are applications to the tonsils of the ■galvano-cautery ; but the latter can only be made by a skillful surgeon. The question is sometimes asked, "If the tonsils can be removed without injury, why were they made." I reply, The question is not concerning the removal of healthy ton- sils, but diseased ones. A healthy tonsil is of service. It secretes a fluid which is able to convert starch into sugar, and so is an important aid to digestion. It is said, in- deed, that the secretion of the tonsils is even more pow- erful than that produced by the salivary glands, in digest- ing starch ; but a diseased tonsil, one which is enlarged and hardened, is no longer of service for this purpose. It is merely a mischievous obstruction, and should be re- moved ; and the sooner this is done, the better for the patient. Acilte Sore Throat. — This disease, properly termed acute pharyngitis, is often confounded with tonsilitis, which it usually accompanies, although it often occurs alone. The appearance of this disease is well illustrated in the colored cut at the top of Plate IV. The mucous mem- brane is everywhere swollen and red, and will be seen to to be covered with a tenacious mucus. Treatment. — The treatment of this condition is essen- tially the same as that which has been recommended for tonsilitis. It is also important in this disease, as well as in tonsilitis, to remember that it may readily be con- founded with diphtheria. On this account, the patient should be kept away from others, particularly small chil- dren. For treatment, see page 97, under head of treat- ment for tonsilitis. Nos. 34, 42. The inhalation of steam with the steam inhaler is also of great service, as in cases ..of acute tonsilitis. ;Diseases of the Larynx. — Among the most com- imon results of chronic nasal catarrh, is disease of the The Larynx, Vocal Cords Closed. The Larynx, Vocal Cords Op« II Diseases of the Throat, Etc., Due to Nasal Catarrh. 99 throat. The experience of specialists in the treatment of diseases of the nose and the throat, has led to the gen- eral conclusion that in the majority of cases catarrh of the throat has its origin in the nose, and is propagated down- ward by means of the discharges from the nasal cavity, which naturally find their way in this direction. It is evident, then, that in the treatment of this class of dis- orders, the place to begin is the nasal cavity. Remedies applied to the throat will prove of little value unless the disease of the nasal cavity is successfully treated. Hence it should be understood in reference to the treatment of the several diseased conditions of the throat of which we have spoken, that the nasal cavity is to be treated as well, according to the indications which may be present in each individual case. Hoarseness. — This common accompaniment of a cold is due to thickening of the vocal cords. If the swell- ing of the vocal cords is but slight, the voice may be only husky, as is common when a person has contracted a slight cold. A great amount of swelling produces hoarseness with inability to utter high-pitched sounds. A very great amount of swelling may occasion entire loss of voice. The condition of the larynx in cases of this sort may be seen in the upper figure shown on Plate II. Sometimes this condition becomes chronic, the voice is permanently impaired, weak, uncertain, husky, or otherwise changed in quality. This form of throat disease is often found in beer-drinkers, auctioneers, and clergymen who " in- tone" in speaking. In this condition, there is permanent thickening of the vocal cords and the cartilages of the larynx, an extreme case of which is illustrated in Plate II. Treatment. — For acute inflammation of the larynx, the chief requisite is rest of the voice, which in severe cases should be absolute, the patient not trying to speak above a whisper. The steam inhaler should be used at least every two or three hours, and such other measures should be adopted as have been recommended for the 100 Tenth Lecture. treatment of an acute cold, page 59. A solution of com- mon salt, carbonate of soda, or chlorate of potash, one dram to a pint of water of either one of the substances mentioned, may be advantageously used with the steam atomizer. One half ounce to an ounce may be used with the atomizer every two or three hours. A moist pack should be worn about the throat night and day, well covered, to prevent chilling. Fomentations about 'the throat and neck may also be applied with advantage two or three times daily. Mustard fomentations may be used if hot water does not give relief. The chronic form of this disease requires attention to all the general preventive and curative measures recom- mended for nasal catarrh. Especial attention must be given to the clothing. The disease is probably not wholly curable, though great improvement may be secured in most cases. Relief of the nasal catarrh which usually accompanies the disease is the most effective of all means of cure. In very chronic cases, a cold pack applied at night should be employed habitually, and as follows : Out of cold water, wring sufficiently dry so that it will not drip, a towel long enough to reach twice around the neck. Cover with several thicknesses of flannel, so as to keep warm during the night. Remove in the morning, rub the neck thoroughly with the hand dipped in water contain- ing salt, a tablespoonful to the quart, or with alcohol or distilled extract of witch-hazel. Afterwards, apply a little oil or vaseline, and wrap about the neck one or two thicknesses of flannel to be worn during the day through cold weather. Nos. io y 11, 18, 19, 20, are also of service in cases of this sort, used with the steam atomizer. Catarrhal Cough. — One of the most annoying symp- toms of this disease, especially when it has extended to the throat, is a throat cough. A cough does not always indicate disease of the throat, much less disease of the lungs, though most frequently it is due to chronic disease Diseases of the Throat, Etc., Due to Nasal Catarrh. 101 of the tissues of the throat, follicular hypertrophy, elonga- tion of the palate, enlarged tonsils, dryness, or some other morbid condition. In not a few instances, it is merely a habit. A slight tickling in the throat sets up the dispo- sition to cough, which being yielded to, increases the irri- tation, and produces more coughing ; and thus the symptom is perpetuated. Treatment. — The various cough mixtures advertized in the newspapers, should be most studiously avoided. Most of these compounds contain opium, which is a most per- nicious drug in these cases, as it not only does not cure the cough, nor relieve it, except very temporarily, but aggravates the disease. Internal remedies of all sorts, that is, those that must be swallowed, should be avoided. The disease, so far as the cough is concerned, is local in char- acter, and should receive local treatment. It is a very un- wise thing to swallow a powerful drug, or such unwhole- some mixtures as sirup and whisky, which are often recom- mended in these cases, and send the medicine the whole length of the alimentary canal, and throughout the whole system, simply to secure its contact with the mucous mem- brane of the throat for a few seconds during its passage. The remedies elsewhere recommended for disease of the throat, are all excellent for use in the treatment of throat coughs, each being applied in conditions to which it is applicable, and which we need not here recapitulate. Simply drinking a glass of hot water, or gargling half a glass of water hot as can be borne, will often relieve a cough in a most magical manner. When there is dry- ness of the throat, a bit of licorice, or of any sapid sub- stance which will cause a flow of saliva and hence moisten the mucous membrane, will give relief. For a cough re- sulting from a hard cold in which the lungs are involved, a fomentation applied to the chest is a very effective meas- ure of treatment. A little mustard added to the water will increase the effect of the fomentation. Mouth-breath- ing' is a frequent cause of throat cough, and must of course be corrected before the cough can be permanently relieved. 102 Tenth Lecture. When expectoration is copious, no remedy should be used to stop the cough, as it is necessary to remove the mor- bid secretion. If internal remedies must be used, as in cases of dry, harsh, irritable cough, we recommend the fol- lowing as effective, and not likely to do harm, as do the common cough mixtures which contain opium or some other narcotic : Nos, 61, 62, 63. Chronic Sore Throat. — There are two forms of this disease, or more properly, two stages, which are shown in the colored engravings at the bottom of Plate IV. and the top of Plate V. The proper name of the disease is chronic pharyngitis. It is sometimes called " clergyman's sore throat." In the first stage of the disease, there is general thickening of the tissues of the throat. The uvula is often enlarged and elongated. There is much secretion, and the patient complains of a wooden feeling in the throat, a stiffness of the muscles of the throat, weakness and lack of flexibility of the voice. In speaking, the throat becomes tired soon, and there is a constant and most unpleasant hawking, hemming, spitting, and other efforts to clear the voice. In the more advanced stage of the disease, some of these symptoms are relieved. There is no swelling, the secre- tion is less in quantity, though more tenacious, but there is a most uncomfortable dryness, which is only very tem- porarily relieved by swallowing water or other fluids. On looking into the throat, it will be noticed that the unnat- ural swelling and redness have given place to the very op- posite conditions. There is an unnatural paleness of the mucous membrane. In some cases, it is almost white, either over the 'entire surface, or in patches. The uvula is often thinned, shortened, and pointed. The mucous mem- brane is sometimes so thin as to be almost transparent, and one can readily see the bony surfaces beneath. Here and there will be seen a red patch, or an enlarged follicle, which is frequently covered with a very tenacious mucus. Acute Pharyngiti Chronic Pharyngitis. V. Diseases of the Throat , Etc., Due to Nasal Catarrh. 103 The patient complains of a constant itching, or other dis- agreeable sensations. Treatment, — The two forms of this disease require very different treatment. When there is redness, swelling, and much secretion, astringent applications should be made twice daily, by means of a swab. Nos. 38, 39, 40, 4J> are to be most highly recommended for this purpose. The use of the steam inhaler, two or three times daily, the temperature of the steam being made as high as can be borne, is also of advantage. Nos. 43, 44, may be used with the inhaler. Gargle a pint of hot water in the throat several times daily. Treat the nasal cavity for any exist- ing catarrh, giving special attention to the back part of the nose, which is usually most affected in these cases. The balsam bottle, No. 48, may also be used with advantage, several times a day. The constant complaint of persons suffering from this disease, is the great susceptibility to taking cold on very slight exposure. An excellent means of overcoming this susceptibility, to some degree at least, is the daily applica- tion to the throat of the fumes of ammonium chloride. No. 47. ^ The diet in this disease, is a matter of great importance. Tea, coffee, beer, and all narcotic drinks, condiments, ice- cream, ice-water, and all unwholesome and irritating foods, must be avoided. This form of sore throat is very com- mon among users of tobacco, It is quite impossible for a cure to be effected without a complete renunciation of the weed. Chronic pharyngitis is a common accompaniment of dyspepsia. In such cases, it is of course essential that the stomach disorders should be cured. The advanced stage of chronic pharyngitis requires very different treatment from that of the earlier stage of the disease. The general hygiene, as relates to food, clothing, etc., is the same, but in the use of local remedies, astringents should be carefully avoided. Applications which we have found of great service in cases of this sort, are Nos. 41, 42, 46, 48, 4p, 30. In the majority of cases, the disease 104 ' Tenth Lecture. cannot be wholly cured. The condition of the mucous membrane of the throat is one in which the glands have disappeared by degeneration. The normal tissues are de- stroyed, and cannot be reproduced. In both forms of chronic sore throat, there is often a disagreeable tickling of the throat, due to an elongation of the uvula. In the early form of the disease, the swollen uvula will often contract under the use of astringents. In some cases, especially of the later stage of the disease, the uvula is not only swollen, but over- grown, and relief can only be obtained by clipping off the redundant portion. The whole uvula should not be removed, as is sometimes done, as this organ is necessary to the perfect exercise of the voice. An operation of this sort should in all cases be performed by a competent sur- geon. By the application of a four-per-cent solution of cocaine, in the form of a spray, the operation can be done without pain. Bleeding, if troublesome, may be readily checked by gargling hot water, or by applying a solution of cocaine. False Or Spasmodic Croup.— This disease some- what resembles true croup in many points, and is often mistaken for it. Its chief points of difference are, little or no fever, spasmodic difficulty in breathing, with intervals of entire relief from the croupy symptoms, sudden appear- ance of the affection, usually at night, and as sudden dis- appearance. It generally begins with a cold. Treatment. — Hot and cold applications or fomentations to the throat, and hot and cold applications to the upper part of the spine. A sponge wrung out of hot water is a ready means of fomenting the throat. In the absence of hot water, the moist sponge may be heated by placing it upon a hot stove. An emetic of salt water, or a half 'tea- spoonful of powdered alum given in syrup or honey will often aid in cutting short an attack. Chronic Pharyngitis, Advanced Stage. Diphtheria. VI Diseases of the Throat, Etc., Due to Nasal Catarrh. 105 Diph.th.eria. — I shall not undertake to describe this disease, nor to dwell at length upon its treatment, as it is a malady which always requires the supervision of an intelligent physician. In the treatment of cases of acute sore throat, whether the case is one of acute phar- yngitis or of tonsilitis, the possibility of the development of diphtheria in a severe form should always be consid- ered ; and whenever there is the slightest ground for sus- picion that the dread disease is present, thorough precau- tions should be taken to prevent its spread. The general treatment of the disease should be essentially the same as that recommended for acute tonsilitis ; in addition, how- ever, germicides must be applied to the throat, as strong as possible without injury. One of the best remedies of this class is alcohol, which should be applied with absorb- ent cotton, used as a swab. Chlorinated soda, one part to three of water, is also an excellent remedy for use in the same way. The steam inhaler used for ten or fifteen min- utes every hour or two, is a useful measure of treatment. Recent experiments have shown that a solution of papa- yotin, applied with a brush, is a most effective means of re- moving the false membrane formed in this disease. No. 54- One of the most distressing accompaniments of this disease, is paralysis of the throat, which frequently exists for some weeks after other symptoms have been recov- ered from. Paralysis also not infrequently appears in other parts of the body. This symptom, fortunately, usually disappears without treatment in the course of a few weeks. Recovery may be expedited by the proper employment of electricity. Hay-Fever. — My observation has been that persons who suffer the most from hay-fever, are invariably those who suffer from catarrh, usually in a chronic form, during other seasons of the year, as a result of which the mucous membrane of the nose is in a swollen and thickened con- dition, obstructing the nasal passages to a greater or less io6 Tenth Lecture. degree. A slight additional irritation, such as the cause of hay-fever creates, is sufficient to produce almost com- plete obstruction of the nose, and through reflex action, spasm of the air-tubes of the lungs is produced, making breathing difficult, and occasioning great distress. Experience with a large number of cases of this sort, has convinced me that hay-fever is a curable affection, notwith- standing the general belief to the contrary. There are al- ways to be found in these cases certain sensitive points in the nasal cavity, which may be treated by applications of the galvano-cautery, in such a manner as to overcome the hyper-sensitiveness which gives rise to the distressing symptoms of the disorder. FIG. 7. — THE EYE. n. The Nasal Duct, by which the tears are carried to the nose. Disease of the Eye Due to Catarrh. — There is an important relation between diseases of the nasal cavity and of the eye, which ought not to be overlooked. A vio- lent cold is usually accompanied by redness of the eyes. This generally passes off in a few days or a few weeks. Sometimes, however, the inflammation becomes chronic. Many cases of chronic conjunctivitis have their origin in this way, and a large proportion of cases of nasal catarrh are accompanied by redness of the lids, granular lids, and other difficulties. A very annoying difficulty, which fre- Diseases of the Throat, Etc., Due to Nasal Catarrh. 107 quently arises from nasal catarrh, is obstruction of the nasal duct (Fig. 7), in consequence of which the tears are not able to escape into the nose, and so run out over the lids and down the cheeks. In many cases, the duct is not entirely closed, so that the difficulty is not experienced ex- cept when the patient is out of doors in the wind, or when the eyes are overtaxed, or otherwise irritated. Treatment. — The mild form ; of inflammation which attends an ordinary cold, requires no further treatment than simply bathing the eyes with hot water two or three times a day ; but when the inflammation is more severe, or does not readily pass away with the cold, some mildly astringent lotion may be used with advantage. A solution of boracic acid or borax, in proportion of two or three grains to an ounce of water, No. 59, is almost always of service, and in mild cases no other remedy is required. No. 60 is also useful. For more obstinate cases, employ Nos. 55, 56, 58. Lotions may be applied to the eye by means of a dropper, or with a bit of absorbent cotton twisted into a roll, or a strip of absorbent paper rolled into the form of a small tube. A few drops of a medicated so- lution are usually sufficient for an application. A solution of tannin, one dram to an ounce of glycerine, is effective in chronic cases in which there is much red- ness and thickening of the mucous membrane. Whenever the last-named remedy is used, it should be applied only to the everted lids, and the solution should be at once washed off with warm water. It is much better to consult a competent oculist in these cases, than to run the risk of harm to so delicate an or- gan as the eye, or to suffer injury from neglect to apply the proper remedy. Cases in which there is obstruction of the nasal duct, causing the tears to flow out over the lid, must be treated by a skillful oculist, as they often require a surgical op- eration, and great skill is necessary in their treatment. It is also important in these cases, as well as in cases of throat trouble dependent upon nasal catarrh, that the nasal cavity 108 Tenth Lecture. should receive thorough treatment at the same time as the eye ; otherwise the disease is certain to return. G-ramilar Lids. — One of the most common eye affections accompanying- chronic catarrh, is chronic gran- ular conjunctivitis, or what is commonly known as gran- ular lids. The inner lining of the eyelid is red and roughened, and there is frequently a profuse secretion, which causes the lids to adhere together during sleep. The successful treatment of this condition requires : ( I ) The cure of the catarrhal condition of the nasal cavity, in which it probably originated 5(2) The daily application of hot water to the eye in the form of a spray. This application should be made with thoroughness and with some force, and about as hot as can be borne. It should be made three times a day, and continued for about fif- teen minutes each time. By the employment of this remedy alone, I have relieved cases which for several years had resisted all other methods of treatment. The cure may be expedited by the application of sulphate of cop- per, alum, and other astringents, to the lids. These rem- edies however, should be employed only by a competent physician. Diseases of the Ear, Resulting from Nasal Catarrh.. — Catarrh of the middle ear is the cause of at least nineteen-twentieths of all cases of deafness. In the majority of cases, the catarrhal diseases begin in the nose and extend to the ear. The patient feels, at first, only an uncomfortable sensation in the ears or in the Eu- stachian tubes. (Fig. 8.) Perhaps he observes a peculiar sensation in the ears only when he swallows, especially just after a fresh cold has been contracted. Occasionally, ear ache is experienced. After a time, the discovery is made that there is very decided deafness in one or both ears. Perhaps there is a peculiar sound in the ears. It may be a chirping, as of a cricket or other insect. Often Diseases of the Throat, Etc., Due to Nasal Catarrh.- 109 the sound is a roar, as of the sea, or a beating or singing- sound like the rumble of a train of cars. It is useless to treat these cases without giving atten- tion to the disease of the nasal cavity ; and when the disease has existed for some time, it is necessary that treatment should be applied directly to the ears as well as to the nose. One of the most effective means of treatment is inflation of the ears through the FIG. 8. — THE EAR. Ear Drum ; 2. Eustachian Tube. nose. This may be done in three ways : The simplest method is that of Valsalva. The patient closes the nos- trils tightly with the thumb and finger so that no air can pass out, closes the mouth tightly, takes a long breath, and then blows as though trying to clear the nose, but keeping both nose and mouth tightly closed. The effect of this is to open up the Eustachian tubes, and force a quantity of air into the ears. A better method is that used by the ear specialist. It consists in the inflation of the ears by means of a strong rubber bag made for the purpose (Fig. 9). The air is blown into the nose as the patient is swallowing water or speaking the word hook, or some other word ending in k. FIG. 9. — POLITZER'S BAG FOR INFLATING THE EARS. In a few cases, the specialist finds it necessary to employ a tube called a Eustachian catheter (Fig. 10), which is passed into the nose and carried back to the opening of IO TentJi Lecture. the Eustachian tube. By means of the bag, air is made to enter the silver tube, and is forced into the ear. The long FIG. IO. — EUSTACHIAN CATHETER." rubber tube shown in Fig. 1 1, is an otoscope, with which the surgeon is able to hear whether or not, his treatment is effective, one end of the tube being placed in his own ear, while the other is in the ear of the patient undergo- ing" treatment. FIG. ii. OTOSCOPE. The sufferer from catarrh who finds his hearing becom- ing impaired, should lose no time in placing himself under the care of a thoroughly competent specialist in diseases of this sort. Earaclie. — A most common accompaniment of nasal catarrh, especially in children, is earache. Contrary to popular opinion, also, this common affection is by no means of little moment, except as it is a source of pain and inconvenience. It has happened in more than one instance that a neglected earache has resulted in the death of the little sufferer after weeks of most acute an- guish. In some cases, death results from inflammation of the brain at a period many years removed from the first attack of the malady, an acute attack being the occasion of inflammation of the delicate membranes of the brain which lie in close contact with certain portions of the ear. 'Diseases of the Throat, Etc., Due to Nasal Catarrh. 1 1 1 It is important that every case of earache, no matter how slight, should receive immediate and efficient atten- tion, as the pain is often a precursor of deafness, if not of something more serious. Space will not allow of a com- plete treatment of this subject, but it may be useful to the reader to know that the hot-water douche is one of the most effective means of relieving pain in the ear aris- ing from acute inflammation. The douche can be best ad- ministered with a fountain syringe, or its equivalent. In the absence of this useful device, the hot water may be poured into the ear, the patient placing himself in a reclin- ing posture, with the ear in such a position that the wa- ter can easily run off. Still another method is to fill the ear with warm water, then place in the opening a small mass of absorbent cotton, also saturated with w r ater, and over this apply fomentations. These methods of treatment are vastly superior to the old-fashioned onion poultices and similar applications, and if thoroughly employed, will not only give great relief from pain, but will also prevent a great share of the mis- chief which usually results from inflammations of this sort. Discharge from the Ear. — A discharge from the the ear is usually occasioned by acute inflammation of the middle ear, as the result of which the drum membrane is ruptured, and the products of suppuration are discharged. In cases in which the opening is small, and the suppura- tion subsides within a short time, nature often repairs the injury to the membrane. In many cases, however, the opening remains, and the suppurative process becomes chronic. I have often met cases of this kind in which there had been a discharge more or less constant for ten or fifteen years. It should be understood that a condi- tion of this sort is always dangerous, as the bones may become affected at any time, and the inflammation may thus extend to the coverings of the brain, resulting in suppuration and death. Treatment.- — Carefully cleanse the ear by means of the U2 Tenth Lecture. syphon syringe, employing a solution of carbonate of soda, one dram to a pint of water. The water should be as warm as can be borne without discomfort, and should en- ter the ear with only sufficient force to cause the water to flow freely. After the ear has been cleansed in this way, it should be carefully dried by means of a bit of ab- sorbent cotton wound around the end of a wooden tooth- pick, taking care to extend the cotton well beyond the end of the tooth-pick, so that the tissues of the ear shall not be injured. Finally, fill the canal of the ear with finely powdered boracic acid. It will ordinarily hold at least a thimbleful of the powder. A small portion should be in- troduced at a time, and crowded down to the bottom of the canal by the use of the cotton-wrapped tooth-pick. A bit of cotton should be placed in the opening of the ear to retain the powder. In a few days, or as soon as the pow- der becomes softened by the discharge, another ear douche should be taken, and a fresh supply of powder introduced. I have sometimes succeeded, by the aid of this simple remedy, in curing, within a week, cases of chronic dis- charge from the ear which had resisted other measures for many years. In some cases, the discharge is due to a poly- pus in the ear, when it is usually necessary to remove the foreign growth, although the method suggested will some- times effect a cure without an operation. Valuable Prescriptions FOR NASAL CATARRH. Cleansing Qolntions. The following solutions are for the purpose of cleansing the nasal cavity, preparatory to the application of other medicated solutions. They are to be applied with an air atomizer. If nec- essary or advisable to employ the anterior or posterior nasal douche, or the sponge instead of the atomizer, three times the quantity of water indicated in the prescriptions should be added to the solution. 1 Soda Carbonate, dr. 2. Soda Chloride (common salt), dr. 2. Water, pt. 1. 2 Soda Carbonate, dr. 2. Borax, dr. 2. Water, pt. 1. 3 Borax, dr. 2. Soda Carbonate, dr. 2. Glycerine, oz. 1. Water, pt. 1. 4 Cleansing Solution, No. 2, 8 parts. Listerine, 1 part. EHsinfrrtant Hemettes. The nasal cavity of a person suffering from nasal catarrh is unquestionably a peculiarly favorable location for the develop- ment of various sorts of microbes, and this is doubtless one of the most potent causes of the very obstinate nature of this dis- ease. This renders important the application of germicides. These solutions should be used freely, after the application of other medicated preparations to the nasal cavity, especially in cases in which the breath has an unpleasant odor. 5 Potass. Permanganate, grs. 16. Water, pt. 1. Use with atomizer, or a id three parts of water, and use with sponge. (113) H. dr. I. dr. I. dr. 2. oz. 2. dr. I. pt. I. dr. 2. dr. 2. oz. 2. oz. 8. dr. 2. dr. 2. dr. 2. oz. I. pt. I. 114 Valuable Prescriptions 6 Borax, Sodium Chloride, Soda Carbonate, Glycerine, Carbolic Acid, Water, Use with atomizer. 7 Borat, Salicylate of Soda, Glyce^'ne, Water, Use with atomizer. 8 Soda Carbonate, Borax, Liquor Chlorinated Soda, Glycerine, Water, Use with air atomizer. 9 Turpentine, Spirits of Camphor, Tinct. Benzoin, compound, ec 1 parts. Use with the steam inhaler, exhaling through the u^ e, or place on cotton wool, and inhale through a glass tube. 10 Listerine, oz. 1. Water, oz. 7. Use with atomizer. 11 Oil Eucalyptus, dr. }4. Oil Wintergreen, dr. 1. Menthol Crystals, dr. 1. Tinct. Benzoin, comp. dr. 3. Boro-Glyceride, oz. 1. Aquae, pt. 1. Filter through magnesia. This may be used as a substitute for the preceding, with equally good effect. 12 Oil Eucalyptus, drops 30. Oil Petrolina, oz. 4. Use with atomizer. 13 Oil Cubebs, drops 30. Oil Petrolina, oz. 4. Use with atomizer. For Nasal Catarrh. 115 14 Oil Sandal-wood, drops 30. Oil Petrolina, oz. 4. Use with atomizer. 15 Oil Scotch Pine, drops 30. Oil Petrolina, oz. 4. Use with atomizer. 16 Iodoform, dr. 1. Starch, oz. 1. A very disagreeable remedy, and to be used only in bad cases of offensive breath. Use as a snuff, or introduce by means of a blow- tube. 17 Iodoform, dr. 1. Ether, oz. 1. Use with an atomizer in same cases as the above. Astringent ttimifties. The following prescriptions are for use in cases of chronic ca- tarrh attended by thickening of the mucous membrane, with pro- fuse secretion. IS Tannic Acid, dr. 1. Water, oz. 4. To be used with air atomizer, for the nose ; with steam atom- izer, for throat or larynx, diluting in cases in which violent cough- ing is induced. 19 Fluid Extract Hydrastis, Water, Use same as preceding. 20 Distilled Extract of Witch-hazel, Glycerine, Water, Use same as preceding. 21 Zinc Sulphate, Water, Use same as preceding. 22 Potass. Alum, Water, Use same as preceding. 23 Ferric Alum, Water, Use with atomizer, same as preceding. dr. 2. oz. 4- oz. 2. oz. 1. oz. 3- dr. 1. pt. 1. dr. 1. pt. 1. dr. 1. pt. 1. Ii6 Valtiable Prescriptions 24 Alum, Listerine, Water, dr. oz. oz. 2. 2. IO. Use with atomizer. Miscellaneous. 25 Boracic acid, Starch, dr. oz. 2. I. Use as a snuff two or three times a day. 26 Menthol, Soda Chloride, Boracic Acid, Soda Carbonate, dr. dr. ' dr. dr. I. I. Use as a snuff, or blow into the nostrils se\ -eral time 27 Boracic Acid, finely powdered, Spirits Camphor, Starch, dr. dr. oz. i. 2. I. Use same as preceding. 28 Tinct. Benzoin, Spirits Camphor, Cocaine Muriate, Starch, dr. dr. gr- oz. 2. I. 20. I. Use as a snuff. 29 Alum, desiccated, dr. i. Starch, dr. 6. Use the snuff two or three times daily, after thoroughly cleans- ing the nasal cavity. 30 Gallic, or Tannic Acid, dr. 2. Starch, oz. 1. Use same as preceding. 31 Powdered Sanguinaria, dr. 1. Starch, dr. 10. Use as a snuff. 32 Zinc Oxide, dr. 1. Starch, dr. 6. Use same as preceding. 33 Sub-Nitrate of Bismuth, dr. 4. Starch, oz. 1. , Use same as preceding. For Nasal Catarrh. WJ 34 Cocaine Muriate, gr. 10. Boracic Acid, gr. 5. Water, oz. 1. Use with air atomizer. May be applied to the throat with a swab. 35 Cocaine Muriate, gr. 10. Sub-Carbonate of Bismuth, dr. 4. Use as a snuff, every two or three hours. 36 Cocaine Muriate, gr. 4. Hydrastin, gr. 8. Cacao Butter, dr. 2. Make into eight pencils, each about the size of a small lead- pencil ; introduce one into one or both nostrils at night. 37 Zinc Iodide, dr. 2. Listerine, oz. 2. Water, oz. 10. Especially useful in cases of post-nasal catarrh, accompanied by dropping of secretion in the throat. HemeMes to be ^pplieo to \\\z ®t)roat. The following are a few of the many prescriptions which we have used in cases of acute and chronic diseases of the throat, and which have proved to be of great service. 3.8 Ferric Alum, Glycerine, Apply with a swab, two or three times daily. 39 Tannin, Glycerine, Use same as preceding. 40 Fluid Extract Hydrastis, Glycerine, Use same as preceding. 41 Tinct. Iodine, Chloral, Glycerine, Use same as preceding. 42 Nitrate of Silver, Water, Bottle must be kept wrapped with blue or black paper. dr. I. oz. I. dr. I. oz. I. dr. 2. oz. I. dr. I. dr. I. oz. 2. gr. 4- oz. 2. Valuable Prescripti ens 43 Tincture Benzoin, comp., dr. i. Water, oz ' / Place in inner cup of steam inhaler ; inhale for ten minutes three or four times daily. Excellent in cases of chronic catarrhal cough. 44 Balsam Peru, dr. i. Water, oz [ u Use same as preceding. 45 Turpentine, dr. 4. Water > oz.' 1. Ten drops oil of cinnamon or wintergreen may be added to the turpentine if more agreeable. Use same as preceding. 46. Fluid Extract Lupulin, dr. 2. Water, oz [ 2 Use with steam inhaler. 47 Aqua Ammonia, Q z. 1. Hydrochloric Acid, oz. 1. Do not mix. Place the ammonia in a large, deep bowl. Place the hydrochloric acid in a small tea-cup; set the tea-cup con- taining the hydrochloric acid in a bowl containing the ammo- nia. White fumes will arise. Gather and inhale these fumes by means of a paper cone. The fumes will be given off until the strength of the ammonia is exhausted. By this arrangement, the air of a sleeping-room or living-room may be kept continually charged with the fumes of chloride of ammonia. 48 Oil Cubebs, dr. r. Oil Sandal-wood, dr. 1. Oil Scotch Pine, dr. 1. Oil Eucalyptus, dr. 1. Tinct. Benzoin, compound, dr. 4. Place in a bottle containing several dry sponges, and arranged with rubber cork and glass tubes, as shown in Fig. 6. Use sev- eral times daily, drawing the air through the bent tube, and ex- haling through the nose. By connecting an atomizer bulb with the straight tube, the air charged with balsam from the bottle, may be forced into the nostrils with good effect. 49 Tinct. of Benzoin, compound, dr. 4. Balsam Peru, dr. 2. Oil Eucalyptus, dr. 1. Oil Cubebs, dr. 1. Alcohol, oz> 2 . Put the mixture in a tea-cup, and place this in a basin of wa- ter, which should be kept simmering over a spirit-lamp. This For Nasal Catarrh. 1 19 will charge the air of a bed-room with balsamic odors, which are purifying and wholesome, and to some degree advantageous in diseases of the air-passages. 50 Tinct. of Benzoin, compound, oz. 1. Tinct. Tulu, oz. 1. Oil Sandal-wood, dr. 2. Oil Scotch Pine, dr. 2. Oil Eucalyptus, . dr. 1. Turpentine, dr. 1. Menthol, dr. 4. Alcohol, oz. 2. Make a thick pad of cotton wool, cover with cheese-cloth, and quilt loosely. Saturate this with the above mixture. Allow the alcohol to evaporate, cover with flannel, and place inside the pil- low at night. 51 Soda Bi-carbonate, dr. 1. Aquae, oz. 4. Use with air atomizer, hot as can be borne, in cases of coryza, or acute cold. 52 Place a dram of menthol crystals in a glass tube, with a little absorbent cotton in each end, to retain the crystals. This con- stitutes a menthol inhaler. A clay pipe may be used. 53 Potass. Bromide, dr. 2. Soda Carbonate, dr. 2. Aquae, pt. 1. Use hot, with an air atomizer, in cases of acute catarrh, every four to six hours. 54 Papayotin, gr. 75. Distilled Water, dr. 1^. Glycerine, dr. 4. Apply to diphtheritic membrane with a camel's-hair brush. EYE LOTIONS. The following lotions will be found of service in appropriate cases ; but it should always be remembered that the eye is a del- icate organ, and that it is far better to employ the services of a good specialist in diseases of the eye, than for one to try to treat even apparently simple maladies of this organ. 55 Zinc Sulphate, gr. 2. Water, oz. 2. 120 Valuable Prescriptions Apply a few drops, two or three times a day, with a dropper or bit of absorbent cotton twisted into a rolL 56 Nitrate of Silver, gr. 2. Water, oz. 2.. Apply same as preceding. 57 Cocaine Muriate, gr. 20. Boracic Acid, gr. 5. Water, oz. 1. Apply same as preceding. 58 Zinc Sulphate, gr. 2. Morphia Sulphate, gr. 2. Water, oz. 2. Apply same as preceding. 59 Boracic Acid, gr. 5. Water, oz. 2. Apply same as preceding. 60 Acetate of Lead, gr. 10. Water, oz. 8. Moisten a cloth with this solution, and lay upon the eyes on retiring at night. REMEDIES TO BE TAKEN INTERNALLY FOR COUGH. 01 Soda Brom., dr. 2. Syrup of Licorice, oz. 2. Take a teaspoonful in a glass of hot water every four hours to relieve a dry, harsh cough. 62 Lemon juice, Honey, Glycerine, A teaspoonful every two or three hours. 63 Fl. Ex. Pinus Candensis, Syr. Ipecac, Syr. Tolu, Take a teaspoonful three or four times a day. oz. , 2. oz. 2. oz. I. dr. 4- dr. #■ oz. 4- mmm. m m '45fe*v