Rhinology, laryngology, and otology, and their significance in general medicine

Front matter

Chap. Copyright No.

Shelf ."T^E^^Yq

UNITED STATES OF AMERICA.

Preface

In these days of specialism there is a laudable tendency to tighten the bonds that unite the daughter to the mother science. On every hand we see the publication of works destined to show the correlation between various branches of medicine, and to awaken the interest of representatives of the various specialties for one another's work by defining the lines where their respective provinces meet.

The present book belongs to this category, and the author's object has been to point out the interdependence between diseases of the entire organism and diseases of the nose, pharynx, larynx, and ears.

It is a somewhat hazardous experiment, this attempt to unite the three specialties rhinology, laryngology, and otology in a single treatise, and I am well aware of the opposition it is destined to meet from the extreme advocates of specialism. But let us examine the relation between these three specialties. A study of the history shows us that rhinology was added to laryngology in response to a practical demand, and that recent developments have shown that otology stands more and more in need of rhinology — so much so that a distinction might be made between rhino-laryngology and rhino-otology. But we ought rather to oppose this subdivision, since the study of rhinology is as important for the successful practice of laryngology, as a knowledge of nasal affections is indispensable in the practice of otology ; in other words, one specialty encroaches on the domain of another, and it is impossible to establish definite boundaries.

Whenever it becomes necessar>' to examine more carefully certain regions of the body, anatomically and physiologically distinct, the natural result is the growth of a specialty.

As experience shows that certain portions of the organism

5 PREFACE.

which, owing to their position and function, can not be reached by ordinary methods of examination practised in general medicine, demand the development of special methods to enable us to examine new regions both in the healthy and in the diseased state, and as with the growth of our knowledge additional facts are discovered, the field gradually widens, and new departments spring into existence, which are only too often regarded by both physicians and laymen as isolated domains of the general science.

There must, of course, be a period in the development of a specialty during which those who practise it devote their entire energy to the study of the anatomy and physiology of the new regions, and to the creation of a special pathology and method of treatment adapted to the peculiarities of the parts concerned. Once this foundation is established, however, it becomes important to incorporate the new discoveries in the scheme of general medicine. A specialty should not be regarded as a thing apart and a kind of appendage ; it should take an active part in all the problems with the solution of which general medicine is concerned. To do this an active cooperation between general medicine and every one of the various specialties is indispensable. Whenever it is lacking, the specialty is in danger of becoming a mere source of revenue and of losing its scientific significance ; while, on the other hand, the general practitioner will fail to recognize special symptoms which might have been of the greatest importance to him in the recognition and treatment of his cases.

In taking this standpoint and in describing the relations which manifest themselves as disturbances of the general organism in disease of special parts, or as disturbances of special parts in general disease, I lay no claim to originality, for several works on our specialties have appeared with a special reference to general medicine. Moritz- Schmidt, in his excellent book on " Diseases of the Upper Air-passages," has followed the same Hues, "writing from practice for practice" ; Lori discusses "Alterations of the Pharynx, Larynx, and Trachea due to Other Diseases " ; while Moos and Haug discuss " The Diseases of the Ear in their Relation to General Diseases," one in his chapter on the Etiology of the Diseases of the Ear in Schwartze's " Handbuch der Otologic," the other in a special monograph.

My undertaking a new work on this theme merely shows the abundance of material accumulated during the last few years, and the development of new points of view that justify the publication of another book on the subject. It has been my endeavor to confine myself to the positive, and, disregarding speculation, to present to the reader nothing but exact and well-established information.

The treatment of the subject is purposely succinct, especially the description of the commoner diseases. A detailed description of special symptomatology is not within the scope of this book, which does not pretend to be a special text-book in the ordinary sense, being intended to awaken the interests of both the general practitioner and the speciaUst in certain matters which appear to me to demand special attention and further elaboration. As I have drawn freely from the entire literature, bibliographic notes seemed to me indispensable. They do not pretend to anything like completeness, but I have, I hope, cited the most important works, a reference to which will enable the reader to elucidate any doubtful questions that may present themselves.

E. P. Friedrich.

Contents

I. DISEASES OF THE RESPIRATORY ORGANS.

PAGE

General Remarks on the Relations Existing between the Nose,