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Catarrh of the Larynx.
By catarrh, we understand an inflammation; the blood vessels of the part increase in size, there is an increased flow of liquid, and sooner or later a casting off of some part of the membrane itself, causing a thick, ropy discharge. This is the history of a catarrh, no matter where it appears - that is, no matter what mucous membrane be affected. The liability to catarrh varies extremely among different persons; a slight exposure to cold, or rapid transition from one temperature to another, is quite sufficient to excite a catarrhal inflammation somewhere in many individuals, while other persons exposed to the same influences suffer from no such inconvenience. Then, too, among those who are liable to catarrh there is considerable diversity as to the part most easily affected; in some, exposure to cold is followed by discharge from the nose ; in others bronchitis and cough occur ; while still others are apt to suffer from inflammation of the lungs or of the kidneys. All these things may result from " taking cold," though the catarrh inflammation more frequently affects the mucous membranes situ ated nearest the surface, among them that of the larynx. We may say in general, that poorly-nourished people are more prone to a catarrh as a result of exposure to cold, than healthy and robust individuals; and those who are constantly exposed to the weather in the performance of their usual avocations are less easily affected than those whose pursuits are sedentary. Another factor is im portant in determining the liability to catarrh; namely, that after repeated attacks a mucous membrane becomes more readily affected; it is a weak spot, and yields most readily to any influences tending to derange the individual's health.
Among the exciting causes of catarrh of the larynx are the breathing of very cold air, or dust; excessive efforts at singing, shouting, screaming, and violent coughing. But, in addition, agents which do not affect the larynx directly, may also cause a catarrh of this organ; thus, chilling of the skin, especially that of the feet, is frequently the direct cause of the catarrh. Then, again, a catarrhal inflammation may spread through the larynx from adjacent organs; thus it not infrequently occurs that an inflamma tion of the throat, such as diphtheria, will, in the course of a few days, spread through the larynx. Another familiar example is the catarrh of the larynx, almost invariably found in habitual drinkers, in whom the disease usually begins first in the pharynx, and sub sequently extends to the larynx.
Beside these various causes which may induce a catarrh of the larynx in any individual, there are certain other factors which fre quently induce the disease. Some very obstinate cases of catarrh of the larynx are due to constitutional taints, such as syphilis; and finally there are numerous instances of the disease in which the cause is to be found in the growth of a tumor in the larynx. Symptoms.-Acute catarrh of the larynx does not usually cause serious constitutional symptoms ; though in some instances slight shiverings mark the onset, and some fever accompanies the disease. The patient complains of a sensation in the throat, which he describes usually as tickling, or, in more severe cases, as burn ing or soreness; this sensation is aggravated by coughing or speaking. At the same time, the voice is changed in character, grows deeper, hoarse, perhaps cracked, and, finally, may be lost altogether. This change in the voice indicates that the mucous membrane covering the vocal cords is in a state of inflammation or catarrh. Another constant symptom is a violent cough, due to the irritation in the inflamed mucous membrane. There may be also a spasm of the muscles of the larynx, whereby the passage for the air is so much diminished in size as to cause a wheezing sound during the breathing.
If the catarrh affect the larynx only, - a somewhat rare occur rence- there is but little matter expectorated. The cough is hard, dry, ringing. It often happens that a child who has coughed somewhat during the day, and has been rather hoarse though not ill, wakes up suddenly in the night with great difficulty in breathing. The little patient seems suffocated ; gasps for breath, and throws himself about in the bed in terror, perhaps clutching anxiously at his throat. The cough is loud and hoarse-" barking. " These are the cases commonly called croup by mothers, and are really merely attacks of slight catarrh of the larynx. So soon as the child has cleared his throat of the mucus which has collected there during his sleep, the breathing becomes again easier, the cough subsides, and the patient falls asleep.
Acute catarrh of the larynx usually terminates, if uncompli cated, within a week ; though if neglected, or if the patient be in poor health, it may last for several weeks.
Chronic catarrh of the larynx is marked by hoarseness, obsti nate cough, and finally permanent change in the character of the voice. This difficulty may result from an acute attack, but more commonly appears only after frequent catarrhs.
Treatment.- Since the acute attack usually subsides spon taneously within a week, treatment with medicines is usually unnecessary. It will suffice to direct the patient to remain so far as possible in a uniform temperature, and not expose himself to sudden changes of atmosphere ; he should avoid the effort to talk, so far as possible, and should especially resist the inclination to cough. He will of course say that he can't help it, but he must help it. The irritation of the larynx, and hence the tendency to cough, can be much diminished by one of the following prescrip tions:
Hydrocyanic acid (dilute) - - Half a drachm.
Sulphate of morphia "-" Half a grain.
Syrup of tolu - One ounce.
Water - - - - - One ounce.
Mix and take a teaspoonful every two hours.
Or relief may be obtained from the following :
Syrup of wild cherry - One ounce. -
Syrup of squills - One ounce.
Camphor water ----- One ounce.
Mix and take a teaspoonful every two hours.
At the very first indication of " taking cold," whether the mucous membrane affected be that of the larynx, or elsewhere, it is often possible to cut the matter short by promoting free perspi ration. This can be easily accomplished by soaking the feet in hot water for fifteen minutes, the patient being meanwhile enveloped in a quilt or blanket; at the expiration of this time the feet should be well dried, the patient tucked snugly in bed, and ten grains of " Dover's powder " may be administered. The throat may be wrapped in flannel, though it is not necessary to apply petroleum or hog's fat, or any of the other popu]ar domestic remeàies. If the individual be constipated, a saline laxative may be administered with advantage.
The treatment of chronic catarrh of the larynx must consist of local applications, which are best made by means of a brush. This requires especial manual skill, and must, therefore, be entrusted only to professional hands. It sometimes happens that a long-con tinued catarrh results in the formation of ulcers in the larynx, even in those who are not afflicted with any constitutional taint, such as syphilis or tuberculosis. Such a complication - the formation of an ulcer - is not always indicated by additional symptoms ; per haps the most characteristic feature is pain upon swallowing ; in such cases, too, the matter expectorated is often streaked with blood.
The ulcers of the larynx consequent upon a syphilitic or tubercular taint, will be described in connection with these diseases respectively.
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