The throat and nose, and their diseases

Front matter

YALE MEDICAL LIBRARY

=t

*=

CHAPTER I. Anatomy and Physiology of the Throat and Nose - - 6

The larynx, cartilages of, 6 ; Divisions of, 14 ; Ventricular bands, 15 ; Vocal cords, 15 ; Ventricles, 16 ; Muscles of, 17 ; Vessels and nerves, 21 ; Mucous membrane, 22 ; Trachea, 23 ; Functions of larynx, 23 ; Palate, 26 ; Uvula, 27 ; Tonsils, 28 ; Pharynx, 28 ; (Esophagus, 32 ; The nose, 33 ; Eustachian tube, 35.

CHAPTER IT.

Examination of the Throat and Larynx — The Laryngoscope - - 37

Sources of light, 37 ; Reflector, 45 ; Mirrors, 46 ; Laryngoscopy, 47 ; in children, 52.

CHAPTER III. Inspection of the Mouth, Fauces, and Pharynx - - 55

The teeth, 58 ; Gums, tongue, buccal cavity, 58 ; Soft palate, fauces, and uvula, 59 ; Tonsils, 60 ; Pharynx, 60.

CHAPTER IV. The Laryngoscopic Image - - - - - - 61

Description of the various portions of larynx as seen in mirror, 64 ; In production of tone, 68 ; The soft palate in ditto, 70 ; Auto-laryngoscopy and photo-laryngoscopy, 72.

CHAPTER V. Examination of the Nasal Passages — Rhinoscopy — The Rhinoscopic

Anterior Rhinoscopy, 76 ; Anterior rhinoscopic image, 79 ; Posterior rhinoscopy, 80 ; Digital examination, 84 ; Posterior rhinoscopic image, 85 ; Nasopharynx, 87.

viii CONSENTS

PAGE

CHAPTER VI. General Semeiology of Throat diseases - 88

A. Functional or subjective symptoms, 91 ; Voice and respiration, 91 ; Cough, 92 ; Deglutition, 93 ; Nasal respiration, 94 ; Senses of smell, taste, and hearing, 95 ; Pain, 96 ; B. Physical or objective, 96 ; Colour and form, 96 ; Mobility, position, and secretion, 97 ; C. Miscellaneous, 97 ; Stethoscope, sphygmograph, ophthalmoscope, pulse, history, weight, temperature, spirometer, q8.

CHAPTER VII. Therapeutics of Throat Diseases, Medical, Surgical, Dietetic, and

Hygienic - - - - - - ioo>

Gargles, 101 : Lozenges, 103 ; Inhalations. 104 ; Vapour, 104 ; Dry hot, 107; Cold, 108; Oro-nasal, 109; Cold air, 109; Compressed air, ill; Atomized, 112; Sprays, 112; Fuming, 116; External applications, 117; External pigments, 119; Douches or Collunaria, 121; Tampons, 125; Internal applications, 126 ; Insufflations, 129 ; Caustics, 130 ; Bleeding and scarification, 131 ; Laryngeal snares and forceps, 132 ; Laryngeal electrodes, 135 ; Massage, 135 ; Galvano-cautery. 135 ; Removal of foreign bodies, 143 ; Tracheotomy, 143 ; Anaesthetics, 147 ; Dietetics and Hygiene, 148 ; Artificial feeding, 149 ; Respiratory, 150 ; Respirators, 151 ; Balneo-therapeutics, 154 ; Vocal. 155.

CHAPTER VIII. The General Etiology and Pathology of Throat Diseases - 156

In relation to the connection of throat and nose, 157 ; To the tonsils, 158 ; To hyperemia, anaemia, and catarrh, 163 ; To constitutional states, 166 ; To anatomical facts, 167 ; To respiration, 169 ; To deglutition and mastication, 170; To voice production, 171 ; To atmosphere and climate, 173: To clothing. 175.

CHAPTER IX. Diseases of the Pharynx ------ ij6

Acute pharyngitis, 178; Common membranous sore throat, 180; Suppurating pharyngitis— hospital sore throat, 183 ; Chronic blennorrhoea, 184 ; Ulcerative septic pharyngitis, 186; Post -pharyngeal abscess, 186; Subacute pharyngitis, 189; Chronic pharyngitis — Clergyman's sore throat, 190; Pharyngitis sicca vel atrophica, 192, 196 ; Pharyngitis lateralis hypertrophica, 192 ; Tobacco pharyngitis, 193 ; Ulceration of the pharynx, 199 ; Syphilitic— Primary, 199 ; Secondary, 200 ; Tertiary, 204 ; Congenital and hereditary, 208 ; Scrofulous, 211 ; Tubercular, 212; Lupus and lepra of, 221 (see also p. 425) ; Neuroses of, 221 ; Anesthesia, 221 ; Hyperesthesia, 221 ; Paresthesia, 222; Lingual varix, 222 ; Hypertrophy of lingual tonsil, 223 ; Spasm of pharynx, 224 ; Neuralgia, 224 ; Motor paralysis, 225 ; Malformations, 226 ; Deformities, 226 : Morbid growths of, 227 ; Foreign bodies in, 227.

CHAPTER X. Diseases of the Uvula - - - 229.'

Inflammation, acute, of, 229 ; Subacute, 230 ; Elongation of, 230 ; Malformations and new growths of, 235 ; Malignant, 236.

CONTENTS. ix

PAGE

CHAPTER XL

Diseases of the Tonsils - - - - - - 237

Histology, 237 ; Inflammation, acute, of— Tonsillitis, 238 ; Chronic— Enlarged tonsils, 250 ; Tonsillotomy, 254 ; Atrophy of, 257 ; Mycosis, 258 ; Benign growths of, 258 ; Cancer of, 259.

CHAPTER XII. Diseases of the Larynx - - - - - 268

Histology of larynx, 268 ; Anaemia, 269 ; Hyperemia and hemorrhages of, 270 ; Classification of laryngeal inflammations, 272.

CHAPTER XIII. Inflammation of the Mucous Membrane of the Larynx - 275

Acute, 275 ; Infantile, 280 ; In measles, 280 ; In variola, 280 ; In scarlatina, 280; In typhoid and typhus, 281 ; Subacute, 287 ; Chronic, 287 ; Granulosa vel follicular, 289 ; Phlebectasis laryngea, 291 ; Laryngitis sicca, 295 ; Subglottic, 296.

CHAPTER XVII. Diphtheria ... - -332

Etiology — Nature of contagium, 333 ; The Germ theory, 333 ; Ptomaine theory, 334 ; Inoculability, 336 ; Mode of origin, etc., 337 ; Insanitary causes, 338 ; Season, 338 ; Age, 339 ; Constitution, 339 ; Social status, 340 ; Pathology — Anatomical, of, 341 ; Histological, 342 ; Symptoms— Functional, 345 ; Physical, 347 ; Miscellaneous, 348 ; Varieties, 349 ; Complication and sequela_\ 350; Differential diagnosis, 350; Prognosis, course, and termination, 353 ; Recurrence, 354 ; Treatment — General, 355 ; Local— Internal, 359 ; Externa], 364 ; Dietetic, 365 ; Operative, 366 ; Tracheotomy, 367 ; Intubation, 369 ; Hygienic and prophylactic, 375.

Chapter XVIII

Secondary, 378 ; Relapsing, 380 ; Tertiary, 382 ; Tracheotomy, 388 ; Stenosis, 389 ; Congenita], 394.

x CONTENTS.

PAGE

Chapter XIX

Etiology, 400 ; Pathology, 401 ; Symptoms— Functional, 407 ; Physical, 410 ; Miscellaneous, 412 ; Diagnosis, 412 ; Prognosis, etc., 416 ; Treatment, 417 ; Tracheotomy, 422.

Chapter XX

Lupus of the Mouth, Pharynx, and Larynx — Leprosy - - - 424

Literature of, 424 ; Etiology, 429 ; Symptoms, 432 ; Diagnosis, 436 ; Treatment, 438 : Lupus-like disease, 438 ; Leprosy, 441.

CHAPTER XXL

Etiology, 446 ; Pathology, 450 ; Symptoms, 451 ; Treatment, 453 ; Thyrotomy, 462 ; Tracheotomy, 463.

Chapter XXII

General Pathology, 465 ; Etiology, 475 ; Symptoms, 478 ; Prognosis, 485 ;

Treatment, 486 ; Endo-laryngeal, 487 ; Tracheotomy, 488 ; Laryngectomy

— complete, 490 ; Partial, 491 ; Thyrotomy and erasion, 495 ; Sub-lingual

pharyngotomy, 496 ; Hygienic and dietetic, 496.

CHAPTER XXIII. Neuroses of the Larynx - - - - - - 498

Neuroses of sensation, 498 ; Of motion, 501 ; Paralysis in domain of superior laryngeal nerve, 503 ; Ditto of inferior laryngeal nerve, 504; Bilateral paralysis of adductors, 506 ; Unilateral ditto, 508 ; Bilateral paralysis of abductors, 509; Unilateral ditto, 511 ; Paralysis of sphincters, 514; Spasmodic affections, 513; Spasm of tensors, 515; Spasm of adductors, 516; Nervous laryngeal cough, 519 ; Epileptiform neuroses, 520.

CHAPTER XXIV. The General Etiology and Pathology of Nasal and Naso-Pharyngeal

The nasal mucous membrane, 530 ; Olfactory region, 531 ; Respiratory region, 533 : Normal physiological functions, 536 ; Rhinitis hypertrophica, 539 ; Rhinitis atrophica, 541 ; Polypi, 541 ; Reflex neuroses, 542 ; Epileptiform neuroses, 543 ; Mania, etc., 544 ; Stammering, aprosexia, etc., 545 ; Eye diseases, 546 ; Asthma, 547 ; The accessory cavities, 549 ; Naso-pharyngeal disease — Tornwaldt's disease, 550 ; Adenoid growths, 550 ; General characteristics of nasal obstruction, 551.

Chapter XXV

Diagnosis and Treatment of Nasal and Naso-Pharyngeal Diseases - 554 Classification, 554 ; Diseases of mucous membrane — Rhinitis, acute, 555 ; Subacute, 560; Neurotic — Hay-fever, etc., 561 ; Chronic hypertrophic rhinitis, 67 ; Rhinoscleroma, 572 ; Atrophic rhinitis, 573 ; Lupus, 579 ; Lepra, 579 ;

CONTENTS. xi

PAGE

Rhinitis Caseosa, 580 ; Diseases of Septum — Hematoma of, 581 ; Abscess of, 581 ; Perforations of, 581 ; Deviations and deformities of, 583 ; Necrosis and caries, 598 ; Synostosis, 599 ; New Growths— Polypi, 600 ; Fibromata, 606; Cystomata, 607 ; Papillomata, 607 ; Enchondromata, 608 ; Osteomata, 608 ; Exostoses, 608 ; Sarcomata, 608 ; Carcinomata, 609 ; Schirrus, 609 ; Epistaxis, 609 ; Neuroses — Anosmia, 611 ; Parosmia, 612 ; Foreign Bodies — Rhinoliths, 612 ; Larva?, Fungi, etc., 613 ; Diseases of Accessory Cavities — Catarrh of antrum, 613 ; Empyema of ditto, 613 ; Diseases of frontal sinus, 617; Of ethmoidal cells and sphenoidal sinuses, 617 ; New growths, 618 ; Naso-pharyngeal Cavity— Catarrh, post-nasal, 618 ; Hypertrophy of pharyngeal tonsil, 620 ; New growths, 629.

CHAPTER XXVI. Aural Maladies associated with Naso-Pharyngeal Disease. — Part I

How to Examine an Aural Case - 630

Functional and subjective symptoms, 631 ; Hearing power — Conversation, 631 ; Watch, 632 ; Discharge, 632 ; Pain, 633 ; Tinnitus, 633 ; Tuning-fork, 634 ; Vertigo, 634 ; Physical and objective signs, 637 ; Membrana tympani, 637 ; Tympanic cavity, 640 ; Mastoid process, 640 ; Eustachian tube, 640 ; New growths, 641 ; P^ye affections, 641 ; Aural case form, 642.

CHAPTER XXVII. Aural Maladies associated with Naso-Pharyngeal Disease. — Part II

General Etiology and Therapeutics - 64S

Eustachian tube, 648 ; Causes of obstruction of, 650 ; Treatment of chronic non-suppurative catarrh, 652 ; Valsalvan inflation, 652 ; Politzer inflation, 653 ; Eustachian catheter, 654 ; Vapours, 655 ; Suppurative catarrh and its consequences, 656.

Formulae - - - 657 xii CONTENTS.

PAGE

Coloured Plates, with Descriptive Letterpress - - 675

PLATE

I. Varieties in Form of the Normal Larynx as seen in the Mirror- 677 II. Acute, Subacute, and Chronic Pharyngitis - - - - 679

III. Syphilitic Disease of the Pharynx - 681

IV. Diseases of the Uvula and Tonsils - 683

V. Acute Tonsillitis — Pharyngitis Sicca — The Rhinoscopic Image

and Diseases of the Posterior Nares — Diphtheria - - 685

VI. Simple Inflammations of the Larynx — Traumatic Laryngitis —

VII. Syphilitic Laryngitis ------ 689

VIII. Anaemia of the Larynx — Tubercular Laryngitis — Disease of the

Laryngeal Cartilages - - - - - - 691

IX. Benign Neoplasms in the Larynx — Malignant Disease of the

Pharyngo-Larynx and Larynx ----- 693

X. Neuroses of the Larynx - 695

XL Tuberculous Laryngitis - - - - - 697

XII. Tuberculous Laryngitis, etc. ----- 699

XIII. Syphilitic and Scrofulous Ulceration of the Pharynx — Pharyn-

gitis Sicca — Epithelioma of the Palate and Tonsil - - 701

XIV. Diphtheria — Lupus— Sarcoma — Epithelioma, etc. - - 703 XV. The Lymphatic Vessels of the Base of the Tongue, Tonsils,

Larynx, and Pharynx — Photo-lithograph (after Sappey) - 705

LIST OF ENGRAVINGS.

[The figures of instruments and those descriptive of the anatomy are printed from ^drawings on wood. Those representing diseased conditions are, with a few exceptions,

facsimile reproductions of the author's pen-and-ink sketches, by the process known as Direct Photo-engraving.]

FIG. PAGE

I. Side View of Larynx - 7

II. Front View of Larynx - - 8

III. Side View of Larynx, showing the Interior - - 9

IV. Side View of Larynx, showing the Left Interior Muscles - 10 V. Side View of Larynx, showing the Left Ventricle - -n

VI. View of Larynx Opened from Behind - - 12

VII. The Larynx in Gentle Breathing - - 16

VIII. The Larynx in Tone Production - - 16

IX. The Larynx in Deep Breathing - - - - 16

X. The Muscles of the Larynx seen from Behind - - 18

XL Side View of the Larynx, showing the Right Crico-thyroid

XII. View of a Horizontal Section of Larynx from Above - -22 XIII. A. Glottis in Repose. B. In Deep Inspiration. C. In Tone

Production - - - - - 24

XIV. The Muscles of the Soft Palate and Pharynx - - 26

XV. Sectional View of the Pharynx - - - 29

XVI. Side View of Muscles of Pharynx - - - 30

XVII. Anterior Section of the Nostrils {after Luschka) - $5

XVIII. Vertical Section of Head, showing Cavity of Nose - - 34

XIX. Standard Gas Lamp - - - 3S

XX. Laryngeal Mirror with Incandescent Lamp - 40

XXI. Coxeter's Water-wheel Motor - - 41

XXII. The Lennox- Broume Limelight Apparatus - 42

XXIII. Laryngeal Reflector - - - - 45

XXIV. The Laryngeal Mirror - - - - - 46 XXV. Diagram illustrating the Principle of the Laryngoscope - 47

XXVI. Diagram of Laryngeal Mirror, illustrating Reversion of

Reflected Image - 7 xiv LIST OF EXGRA VINGS.

FIG. PAGE

XXVII. Position of Observer's Hands in making a Laryngoscopy

Examination - - - - - - 49

XXYIII. Hill's Folding Tongue Depressor and Retractor - - 56

XXIX. Author's Tongue Spatula and Finger-guard - - 57

XXX. The Soft Palate - -59

XXXI. Sectional View showing Position of Mirror for giving

Minimum of View of Larynx - - - - 62

XXXII. The same for giving a Full View - - - - 65

XXXIII. Side View of Larynx, showing Right Ventricle Open - 64

XXXIV. Laryngeal Image— Lower Thick Register - - - 68 XXXV. Laryngeal Image — Upper Thick Register - - 69

XXXVI. Laryngeal Image — Lower Thin Register - - 70

XXXVII. Laryngeal Image — L'pper Thin Register - 70

XXXVIII. Laryngeal Image — Small Register - 7c

XXXIX. Soft Palate in Tone Production 1 F | - - 71

XL. Soft Palate in Tone Production (A) - - 71

XLI. Soft Palate in Tone Production (C pure) - - - 71

XLII. Soft Palate in Tone Production (C nasal) - - 71

XLIII. Auto-Laryngoscope of Foulis - - - 73

XLIV. Stein's Photo-Laryngoscope - - 75

XLV. Stein's Photo-Laryngoscope - - 75

XLVI. Duplay's Xasal Speculum - - - 77

XLVII. Fraenkel's Nasal Speculum - - - 77

XLVIII. Thudichum's Xasal Speculum - - - - 77

XLIX. Elsberg's Xasal Speculum, with Author's Rack Movement 7S

L. The Lennox Browne Xasal Speculum - - 78 LI. Curve of Shank of Mirror, and Position of Hand necessary

for Rhinoscopy - - - - - - 81

LII. Fraenkel's Rhinoscopic Mirror - - - - 81

LIII. Section showing Position of Mirror and Patient's Head

for obtaining a Rhinoscopic Image - - - 82

LIV. The Posterior Rhinoscopic Image - - - 85 LV. View of the Posterior Nares, the Pharynx being laid Open

from Behind (after Luschka) - - - - 86

LVI. Outlines of (A; Fauces, (B) Posterior Nares, (C) Section

of Nares, and (D) Larynx - - - - 90

LVII. Sectional View of Corbyn's Double-Valve Inhaler- - 105

LVJII. The Murch Hospital Inhaler - - - - 106

LIX. Lee's Steam Draught Inhaler - - - 107

LX. The Ammuriagen (A//eu and Hanbiiry) - - 109

LXI. Kerr's Chloride of Ammonium Inhaler - - - 11c

LXII. The Burroughs Chloride of Ammonium Inhaler - - in

LXIII. Pharyngeal Spray Producer - - - - 113

LXIV. Double Handball Throat Spray Producer- - - TIS

LIST OF EXGRA VIXGS.

xv

FIG.

LXV. Siegle's Atomizer, in the Original Form LXVI. An Improved Siegle's Atomizer LXVII. Laryngeal Syringe

LXVIII. Hamilton's Fumigator and Atomizer - LXIX. Leiter's Pliable Metal Temperature Regulators LXX. The Anterior Syphon Xasal Douche - LXXI. Harrison Allen's Apparatus for Anterior Xasal Douche LXX 1 1. Author's Posterior Xasal Syringes LXXIII. The Lejferts Coarse Spray LXXIV. The Lennox Browne X'asal Hand Syringe LXXV. Laryngeal Sponge-Holder LXXVI. Ditto with Catch to secure the Sponge - LXXV II. The same with Catch closed - LXXVIII. Smyly's Cotton-wool Brush LXXIX. Terminals of Cotton-wool Brushes LXXX. Author's Laryngeal Brush LXXXI. Rauchfuss's Laryngeal Insufflator LXXXII. Labiersky's Laryngeal Insufflator LXXXIII. Simple Caustic Holder- -

LXXXIV. Jarvis's Laryngeal Porte-Caustique

LXXXV. Laryngeal Lancet -

LXXXVI. Gibb's Laryngeal Snare LXXXVII. Carmalt Jones's Laryngeal and Xasal Snare LXXXVIII. Voltolini's Laryngeal Sponge Probang -

LXXXIX. Varieties of Fauvel's Laryngeal Growth Forceps XC. Laryngeal Electrode - XCI. Author's Galvano-Caustic Battery (Mayer) XCII. Author's Galvano-Caustic Battery (Downs) XCIII. Author's Galvano-Caustic Points and Loops (Mayer) - XCIV. E. P. S. Galvano-Cautery Accumulator with Rheostat (Coxeter) ------

XCV. Instruments for Securing Xasal Polypi - XCVI. Wilde's Snare for Xasal Polypus XCVII. Hamilton's Instrument for the same Purpose - XCVIII. Long Forceps for Xasal Polypus

XCIX. Lund's Ring Forceps for the same Purpose CI. Author's Improved (Esophageal Ramoneur CII. Acute Pharyngitis, with Exudation OIL Chronic Pharyngitis Lateralis Hypertrophica - CIV. Secondary Syphilis in the Fauces CV. Multiple Tertiary Ulcerations of Soft Palate, etc. CVI. Central Tertiary Perforation of Hand and Soft Palate - CVILandCVIII. Syphilitic Adhesion of Uvula to Faucial Pillars CIX. Hereditary Syphilitic Laceration of Pharynx

PAGE

114 "4

ir5

117 119

133 134 134 135 136

137 138

141 142 142

142 142

200 204

LIST OF ENGRA VINGS.

CX. Tuberculous Ulceration of Velum and Fauces - - 216

CXI. Larynx of the same Patient - - - - 216

CXII. Varix of Base of the Tongue - - - - 222

CXIII. Uvula Forceps and Scissors in Position for Operating - 233

CXIV. Congenital Double Uvula, with Relaxation - - 235

CXV. Magnified Section of a (slightly) Hypertrophied Tonsil 238

CXVI. Tonsil Guillotine, in Position for Operating on the Left

CXVII. Wire-Loop Ecraseur for Enlarged Tonsils - 255

CXVI 1 1. Calcareous Formation extruded from the Tonsil - 259

CXIX. Lympho-Sarcoma of the Tonsil - - 261

CXX. Primary Epithelioma of the Tonsil - - - 263

CXXI. Epithelioma of Anterior Pillar of Fauces - 264

CXXII. Section of Vocal Cord and Ventricle, Magnified - 269

CXXIII. Paralysis of Thyro-arytenoidei in Laryngitis - - 283

CXXIV. Paralysis of Arytenoideus in Laryngitis - 283

CXXV. Imperfect Approximation from Swelling in Laryngitis - 283

CXXVI. Primary Perichondritis of Larynx - - - 310

CXXVII.^

CXXVIII. Primary Perichondritis of Larynx. Various Views

CXXIX. J under different Stages of Treatment - - - 312

exxx..

CXXXI. Syphilitic Perichondritis - - - - 313

CXXXII. Laryngeal Chondro-Sarcoma and Perichondritis - 314

CXXXIII. Post-mortem Appearance of Throat with Diphtheria - 344

CXXXIII^. Diagram illustrating Curve for introducing Intubator.

(Misprinted CXXW.) - 372

CXXXIV Tertiary Syphilitic Ulceration of Larynx - 388

CXXXV. The same after five weeks' Treatment - - 388

CXXXVI. Whistler's Cutting Dilator - 390

CXXXVII. Cicatricial Stenosis of Larynx - - - - 391

CXXXVIII. The same after Treatment - - 391

CXXXIX. Author's Hollow Laryngeal Dilator with Cutting Blade 391

CXL. Tuberculous Inflammation of Larynx - - 408

CXLI. Tuberculous Infiltration of Larynx - 410

CXLII. Carious Ulceration, etc., of Tuberculous Laryngitis - 411

CXLIII. Tuberculous Ulceration of Pharynx, etc. - - 421

CXLIV. Laryngoscopic Appearance of the same Case - - 421

CXLV, Lupus of the Nose and Upper Gums - - 427

CXLVL Condition of the Pharynx in the same Case - - 427

CXLVII. Condition of the Larynx in the same Case - 427

CXLVIII. Lupus of the Soft Palate - - 432

CXLIX. Palatal Appearance of Lupus - - 434

LIST OF EXGRA VINGS.

CL. Laryngoscopy Appearance of the same - 434

CLI. Early Lupous Infiltration of Uvula - - 434

CLII. Early Lupus of Uvula and Velum - - 434

CLIII. Early Lupous Ulceration of Anterior Faucial Pillar - 435

CLIV. Lupus of Soft Palate and Uvula - 435

CLV. Lupus of the Larynx - - - 435

CLVI. Thickening of Epiglottis in Lupus - - - 435

CLVII. Inflammatory Thickening and Nodulation of Epiglottis

CLVI1I. Laryngeal Appearance in (so-called) Lupoid Inflammation - - - - - - 439

CLVIII*. The same eleven months later - - 439

CLIX. Faucial Appearance in the same Case - - 439

CLX. Laryngeal Appearance, Syphilis simulating Lupus - 440

CLXtf. Leprosy of Larynx - 443

CLXI. Cystic Growth on Epiglottis, Polypi on Right Cord - 447

CLX II. Multiple Papillomata of Larynx - - - 448

CLXIII. Mucous Polypus on Vocal Cord (Respiration and

CLXIV. Papillomata on Vocal Cords - - - 448

CLXV. Cystic Growth on Left Vocal Cord - - - 449

CLXVI. Papilloma at Anterior Insertion - - 449

CLXVII. Papillomata on Epiglottis and Left Vocal Cord - 451

CLXVIII. Small Fibroma on Left Vocal Cord - - 454

CLXIX. Multiple Papillomata of Larynx - - - 455

CLXX. Papilloma at Anterior Insertion of Cords - - 455

CLXXI. Papillary Growths on Right Vocal Cord (Respiration

and Phonation) ----- 459

CLXXIL Papilloma on Right Vocal Cord - - 460 CLXXIII. Symmetrical Papillary Growths on Vocal Cords - 460 CLXXI V. Multiple Papillomata of Larynx, Three Views (Respiration and Phonation) - - - - 460

CLXXV. Multiple Papillomata of Larynx, July, 1885 - - 461

CLXXVL The same Case, January, 1886 - - 461

CLXXVIII. M „ n February, 1887 - - - 461

CLXXIX. Growth on Right Vocal Cord (Two Views) - - 462

CLXXX. Guarded Wheel Ecraseur - - - 462

CLXXXI. Lymphatics of the Larynx and Trachea in the Adult

{after Sappey) - - 468

CLXXXIL Laryngopharyngeal Epithelioma - 473

CLXXXIII. Pharyngo-Laryngeal Sarcoma- - - - 477

CLXXXIV. Epithelioma of Posterior Wall of Larynx - - 480

CLXXXV. Lympho-Sarcoma of Tonsil, Pharynx, and Larynx - 482 xviii LIST OF ENGRA VIXGS.

FIG. PAGE

CLXXXVI. Fauces fourteen days after Operation - - 482

CLXXXVII. Larynx fourteen days after Operation - 482

CLXXXVIII. Sarcoma of Larynx, October 14, 1876 - 484

CLXXXIX. Sarcoma of Larynx, December 6, 1877 - - 484

CXC. Intra-Laryngeal Epithelioma before Operation - 493

CXCI. Intra-Laryngeal Epithelioma sixteen weeks after

Operation ------ 494

CXCII. Intra-Laryngeal Epithelioma (Internal Aspect of

Removed Portion) - - - 495 CXCIII. Intra-Laryngeal Epithelioma (Microscopic Appearance of Surface) ----- 495

CXCIV. Intra-Laryngeal Epithelioma (Microscopic Appearance of Deeper Section) - 495 CXCV. Nasal Secretion from Hay-fever - - - 562 CXCVI. Coronal Section showing Deviation of Septum - 584

cxcvir. Ditto - - 585

CXC VIII. Dundas Grant's Splint for Deviated Septum - - 590

CXCIX. Hewetson's Nasal Dilator with Author's Modifications 590

CC. Hill's Nasal Dilator and Septum Straightener - 590

CCI. to CCXX. Diagrams representing Anterior Rhino- \ 592

scopic Appearance of Septal Deflections and to

CCXXI. Mucous Polypus of Nose - - 602

CCXXII. Microscopic Section of Adenoid Hypertrophy - 622

CCXXIII. Author's Finger-guard, with Extension Curette, Spoon,

CCXXIV. Hovell's Soft Rubber Finger-guard - - - 626 CCXXV. Schutz's Antero- Posterior Forceps for Adenoid

CCXXVI. Gardiner Brown's Tuning-Fork - 635

CCXXVII. Membrana Tympani (after Politzer) - - 638

CCXXVIII. Diagrams of Membrane for Case-taking - 643 and 647

CCXXIX. Author's Politzer Bag for Patient's use - - 653

CCXXX. Keene's Form of Politzer Bag , - 653

CCXXXI. Ward Cousins' Instrument for Tinnitus - 654

Preface To The Third Edition

The rapid sale of the second edition of this work may be accepted as sufficient evidence that it satisfactorily meets a demand ; and the fact that the reviewer ot a leading medical journal has pronounced it to be ' one of the completest treatises on diseases of the throat in any language,' might be pleaded as an excuse for a simple re-issue.

At the time, however, of the appearance of this flattering notice the book was already out of print, and I had far advanced in that thorough revision and extension which had been rendered necessary , not only because I recognised the justice of many kindly but pertinent criticisms, but also because the science of Laryngology and Rhinology is making such giant strides, that it is impossible for one who wishes to keep his work up to date to be content with what was written even so recently as two years ago.

Especial note has been taken of the circumstance that Laryngology, which formerly depended almost entirely upon the somewhat limited revelations of the laryngeal mirror, is in these later times assuming a new aspect, and opinion is each day becoming more indisputable that in the condition of the Nasal Fossae, which constitute the first avenues of the natural breathway, is to be found the key to a right understanding and successful treatment of the majority of Faucial, Pharyngeal, and Laryngeal diseases. The chief feature of this edition is, therefore, fitly emphasized by the expansion of that portion of the volume which treats of intranasal and naso-pharyngeal maladies. In this connection several new illustrations of the various forms of nasal obstruction, and of instruments for their relief, are added.

xx PREFACE TO THE THIRD EDITIOX.

In deference to this growing recognition of the important influence which diseases of the Nose exercise upon those of the Throat and Larynx, I have somewhat amplified my title ; but the arrangement of the work remains the same as in previous editions.

The functions of the Tonsils have long been a subject of speculation, and the general ignorance of their utility was well exemplified by the somewhat startling announcement made a few years since by an eminent physician recently deceased, that were he to play the part of a Frankenstein, he would make man without them. Possibly it was this remark that drew the attention of some of the more enthusiastic and younger members of the profession to the subject, as an unexplored field for their labours * but certain it is that within recent years much valuable work has been done, which has proved that these glands play important roles, the chief of which is probably that of the manufacturing of leucocytes, to act as ' scavengers ' for the clearing away of food debris, and for the holding in check micro-organisms in the upper respiratory and alimentary tract. It has also been shown that these lymphoid structures are not confined to the fauces or to the naso-pharynx, but that similar though smaller aggregations of adenoid tissue are to be found at the root of the tongue, in the ventricle of the larynx, in the nose, and other situations, constituting minor ' tonsils ' — lingual, laryngeal, etc. — with similar duties to those of their more important congeners of ordinary recognition. The subject has been expanded in this edition commensurately with its importance.

I deem it a pleasurable duty to once more acknowledge the kindness of those colleagues and friends who assisted me in the preparation of the last edition, for similar help in that of the present.

36, Weymouth Street,

Portland Place. W.

May, 1890.

Preface To The Second Edition

The first edition of this work was published in May, 1878, just nine years ago, and was so well received as to be exhausted in less than eighteen months. My intention was to comply at once with the demands for a further issue, but many causes have prevented its accomplishment. Chief among them is the fact that the literature of the subject, in the shape of manuals, monographs, and more especially periodical contributions, has increased in such a full and constant flow as to convince me, on each fresh attempt at revision, that nothing less than an entire re-writing of the book would suffice to do justice to the growing importance of the theme. The calls of practice and literary claims in other directions have combined to impede the completion of this project.

Now that the task is finished, no one is more sensible of its imperfections than myself. I nevertheless venture to express the hope that my readers will be the gainers by the delay.

Claiming an experience of twenty years of uninterrupted and exceptional clinical opportunities, I have in this volume endeavoured to tell unreservedly everything I have learned, both in Consulting-room and Hospital-ward, which is likely to be helpful in the diagnosis and treatment of that class of diseases with which my professional life has been almost exclusively occupied.

The work has no pretensions to be considered exhaustive. It will have fulfilled its aim if it is accepted as containing so much information on the subject as may be required for all needs of the general practitioner, and as, at least, a solid basis for more extended research to those who may elect to practise as specialists.

Some of the changes and additions made in this new volume are indicated in the introductory remarks following this preface : to detail all would be tedious and unnecessary. It is sufficient to say that my endeavour to give an accurate reflection of the vast

Nxii PREFACE TO THE SECOND EDITION.

progress of the specialty since the former edition was published has involved extension of the letterpress to something like treble the length of the earlier work. The engravings have been quadrupled, and twenty new coloured illustrations have been added. Attention may also be drawn to the much fuller consideration given to diseases of the Nasal passages., as well as to the suggestions concerning such Aural affections as are more especially connected with morbid conditions of the Throat.

The practical character of the treatise necessarily makes it somewhat personal in its tone, but there is neither thought nor wish to appropriate all that is taught as original. On the contrary, short of encyclopaedic reiteration of references, credit is always duly accorded to other labourers in the same vineyard.

The many obligations I am under to my Hospital colleagues for their interest and assistance in my labours are acknowledged, though inadequately, in the dedication and in the body of the book ; but I cannot refrain from more particular mention of Dr. Dundas Grant and Mr. William Hill.

The former, since he joined us as Registrar in 1878, and later as one of the Surgeons, has never failed in his enthusiasm to prosecute any fresh inquiry suggested to, or emanating from him, and has been always an original and sympathetic fellow-worker.

Mr. Hill, our present Registrar and Pathologist, has rendered me much willing and valuable aid in histological investigations, in compilation from contemporary literature, and in revision of the proofs generally.

It is a pleasure also to acknowledge the great assistance rendered me in the relation of cases, by the zeal and efficiency with which former Surgical Registrars — Messrs. J. D. Arnold (now of St. Francisco), Carmalt Jones, Percy Jakins, and W. Cant — have performed their duties.

;6, Weymouth Street,

Portland Place, W.

June, 1887.

DISEAS ES

OF THE

TH ROAT AN D NOSE

INTRODUCTORY.

A few words with regard to the aims and plan of this work may be useful to the reader.

Necessity no longer exists for enforcing the value of the laryngoscope. By its means, not only are many special local maladies, otherwise invisible during life, brought directly under the eye of the observer, but in many serious general diseases, such as phthisis, cancer, and syphilis, as well as in cases of aneurismal or glandular tumours, the local condition of the larynx thus revealed will at a very early period enable us to form a diagnosis and prognosis, which without such knowledge would be often erroneous, or at least doubtful.

^iemssen* . has proposed, and 2Elsberg has also insisted, that courses on laryngoscopy and laryngological technics, as well as other methods of diagnostic and therapeutical procedures, should precede attendance on general clinical instruction, the argument being based on correct appreciation of the fact that unless the student is already in possession of the technical ability required, the mere looking on the performances, or listening to the words, of the best clinical teacher is comparatively valueless for his own doings in practice. Until some change in this direction is effected, practical skill in technical specialties, such as laryngology, ophthalmology, and otology must be confined to the minority of students conscientiously desirous to equip themselves at all points for their