ENLARGED TONSILS.
Chronic enlargement of the tonsils, as shown in Fig. 17, _A A_, is an exceedingly common affection. It is most common to those of a scrofulous habit. It rarely makes its appearance after the thirtieth year, unless it has been imperfectly cured. Both tonsils are generally, though unequally enlarged. A person affected with this disease is extremely liable to sore throat, and contracts it on the slightest exposure; the contraction of a cold, suppression of perspiration, or derangement of the digestive apparatus being sufficient to provoke inflammation.
CAUSES. Repeated attacks of quinsy, scarlet fever, diphtheria, or scrofula, and general impairment of the system, predispose the individual to this disease.
SYMPTOMS. The voice is often husky, nasal or guttural, and disagreeable.
When the patient sleeps, a low moaning is heard, accompanied with snoring and stentorian breathing, and the head is thrown back so as to bring the mouth on a line with the windpipe, and thus facilitate the ingress of air into the lungs. When the affection becomes serious it interferes with breathing and swallowing. The chest is liable to become flattened in front and arched behind, in consequence of the difficulty of respiration, thus predisposing the patient to pulmonary disease. On looking into the throat, the enlarged tonsils may be seen, as in the Fig. 17. Sometimes they are so greatly increased in size that they touch each other.
[Illustration: Fig. 17.
_A. A._ Enlarged Tonsils. _B_. Elongated Uvula.]
TREATMENT. The indications to be carried out in the cure of this malady are:
(1.) To remedy the constitutional derangement.
(2.) To remove the enlargement of the tonsilar glands.
The successful fulfillment of the first indication may be readily accomplished by attention to hygiene, diet, clothing, and the use of Dr.
Pierce's Golden Medical Discovery, together with small daily doses of his "Pleasant Pellets." This treatment should be persevered in for a considerable length of time after the enlargement has disappeared, to prevent a return.
To fulfill the second indication, astringent gargles may be used.
Infusions of witch-hazel or cranesbill should be used during the day.
The following mixture is unsurpassed: iodine, one drachm; iodide of potash, four drachms; pure, soft water, two ounces. Apply this preparation to the enlarged tonsils twice a day, with a probang, or soft swab, being careful to paint them each time. A persevering use of these remedies, both internal and local, is necessary to reduce and restore the parts to a healthy condition.
Sometimes the enlarged tonsils undergo calcareous degeneration; in this case, nothing but their removal by a surgical operation is effectual.
This can be readily accomplished by any competent surgeon. We have operated in a large number of cases, and have never met with my unfavorable results.
The method we adopt at the Invalids' Hotel and Surgical Institute for the removal of diseased tonsils is, like other minor operations, painless. The patient is not required to take chloroform or ether. When the enlarged gland is once thoroughly removed the disease seldom returns.
ELONGATION OF THE UVULA.
Chronic enlargement, or elongation of the uvula or soft palate, as shown at _B_ in Fig. 17, may arise from the same causes as enlargement of the tonsils. It subjects the individual to a great deal of annoyance by dropping into or irritating the throat. It causes tickling and frequent desire to clear the throat, also change, weakness and loss of voice, and often gives rise to a very persistent and aggravating cough.
Constriction of the throat, cough and difficult breathing are more prominent symptoms in complicated cases.
TREATMENT. The treatment already laid down for enlarged tonsils, with which affection, elongation of the uvula is so often associated, is generally effectual. When it has existed for a long time, and does not yield to this treatment it may be removed by any competent surgeon.
CHRONIC LARYNGITIS.
This is of much more frequent occurrence than the acute form, and is often associated with tubercular affections, and constitutional syphilis. It is characterized by an inflammatory condition, ulceration, or hardening of the mucous membrane of the larynx, most frequently the latter. There is also a chronic form, known as _follicular laryngitis_, or _clergymen's sore throat_, to which public speakers are subject.
THE CAUSES of chronic laryngitis are various, as prolonged use of the vocal organs in reading or speaking; using them too long on one pitch or key, without regard to their modulation; improper treatment of acute diseases of the throat; neglected nasal catarrh; the inordinate use of mercury; syphilis; repeated colds which directly cause sore throat, injuries, etc. It is also frequently due to tubercular deposits, and in these cases it generally terminates in consumption.
SYMPTOMS. The affection often comes on insidiously. There is soreness of the throat, noticeable particularly when speaking, and immediately thereafter; a "raw" and constricted feeling, leading to frequent attempts to clear the throat, in order to relieve the uneasy sensation.
The voice becomes altered, hoarse, and husky, and there is a slight, peculiar cough, with but little expectoration. At first, the matter expectorated is mucus, but as the disease advances, and ulceration progresses, it becomes muco-purulent, perhaps lumpy, bloody, or is almost wholly pure pus. The voice becomes more and more impaired, and is finally lost. In the latter stages, it resembles consumption, being attended with hectic fever, night-sweats, emaciation, cough, profuse expectoration, and sometimes hemorrhage.
TREATMENT. The patient should avoid using his voice as much as possible.
At the same time, attention should be paid to the diet, the bathing, and the clothing. Every thing should be done that is calculated to build up and improve the general health. Dr. Pierce's Golden Medical Discovery is well adapted to remove morbid states of the disease, in consequence of its direct action on the mucous membranes of the air-passages, and its efficacy in allaying irritation of the laryngeal, pharyngeal, and pneumogastric nerves. It should be perseveringly employed. Iodine inhalations, administered with the pocket inhaler, illustrated by Fig.
3, and the application of tincture of iodine to the forepart of the neck, are efficacious in many cases. Inhalations of chloride of ammonia, administered with a steam-atomizer, Fig. 11, in the form of spray, are frequently of great benefit. _Perseverance_ is necessary, and the afflicted are cautioned against discontinuing the treatment too soon, for the disease is very liable to return.
CONSUMPTION.
PHTHISIS PULMONALIS.
By this we understand a constitutional affection, characterized by a wasting away of the body, attended by the deposition of tubercular matter into the lung tissue. Hence the appellations, _Phthisis Pulmonalis; Pulmonary Tuberculosis; Tubercular Consumption_. Tubercles may form in other organs and result in a breaking down of their tissues, but the employment of the term _Consumption_ in this article is restricted to the lungs. The general prevalence, the insidious attack, and the distressing fatality of this disease, demand the special attention and investigation of every thinking person. It preys upon all classes of society. Rich and poor alike furnish its victims.
Some idea of its prevalence may be formed when we consider that, of the entire population of the globe, one in every three hundred and twenty-three persons annually dies of consumption. It may not be definitely known just what proportion of all the deaths in this country and Europe occurs from this one disease. Those who have gathered statistics differ somewhat, some claiming one-fourth, while others put the ratio at one-sixth, one-seventh, and even as low as one-ninth. A fair estimate, and one probably very near the truth, would be one-sixth or one-seventh of the whole number. In New York City, for five consecutive years, the proportion was three in twenty. In New England, about twenty thousand annually succumb to this destroyer, and in the State of New York as many more. These figures may appear to be exaggerations, but investigations of the subject prove them to be the simple truth. Epidemics of cholera, yellow fever, and other diseases of similar character, so terrible in their results, occasion wide-spread alarm, and receive the most careful considerations for their prevention and cure, while consumption receives scarcely a thought. Yet the number of their victims sinks into insignificance when compared with those of consumption. Like the thief in the night, it steals upon its victim unawares. In a large proportion of cases, its approach is so insidious that the early symptoms are almost wholly disregarded; indeed, they excite but little, if any, attention, and perhaps for a time disappear altogether. Thus the patient's suspicions, if they have been aroused, are allayed and appropriate measures for his relief are discontinued.
This may be the case until renewed attacks firmly establish the disease, and before the patient is fully aware of the fatal tendency of his malady, he is progressing rapidly towards that "bourne from which no traveler returns."
As has already been stated, consumption is a constitutional disease, manifested by feeble vitality, loss of strength, emaciation--symptoms which are too often classed under the name of _general debility_, until local symptoms develop, as _cough, difficult breathing_, or _hemorrhage_, when examination of the chest reveals the startling fact that tubercular deposits have been formed in the lungs. Invalids are seldom willing to believe that they have consumption, until it is so far advanced that all medicine can do is to smooth the pathway to the grave.
Another characteristic of this disease is _hope_, which remains active until the very last, flattering the patient into expectation of recovery. To the influence of this emotion, the prolongation of the patient's life may often be attributed.
NATURE OF THE DISEASE. It is an error to suppose that the disease under consideration is confined to the lungs. "Pulmonary Consumption," as has been remarked, "is but a _fragment_ of a great constitutional malady."
The lungs are merely the stage where it plays its most conspicuous part.
Every part of the system is more or less involved, every vital operation more or less deranged; especially is the _nutritive_ function vitiated and imperfect. The circulation is also involved in the general morbid condition. Tubercles, which constitute a marked feature of the disease, are composed of unorganized matter, deposited from the blood in the tissue of the lungs. They are small globules of a yellow, opaque, friable substance, of about the consistency of cheese. After their deposition, they are increased in size by the accretion of fresh matter of the same kind. They are characteristic of all forms of scrofulous disease.
The most plausible theory in regard to them is, that they are the result of imperfect nutrition. Such a substance cannot be produced in the blood when this fluid is perfectly formed. It is an unorganized particle of matter, resulting from the imperfect elaboration of the products of digestion, which is not, therefore, properly fitted for assimilation with the tissues. The system being unable to appropriate it, and powerless to cast in off through the excretory channels, deposits it in the lungs or other parts of the body. There it remains as a foreign substance, like a splinter or thorn in the flesh, until ejected by suppuration and sloughing of the surrounding parts. It might be supposed by some that when the offending matter was thus eliminated from the lungs, they would heal and the patient recover; but, unfortunately, the deposition of tubercular matter does no cease. Owing to the morbid action of the vital forces, it is formed and deposited as fast or faster than it can be thrown off by expectoration. Hence arises the remarkable fatality of pulmonary consumption.
CAUSES. The causes of consumption are numerous and varied, but may all be classed under two heads, viz: _Constitutional_, or _predisposing_, and _local_, or _exciting_. Of just what tubercular matter consists, is still a subject of controversy, but that its existence depends upon certain conditions, either _congenital_ or _acquired_, is generally conceded; and one of these conditions is impaired vitality.
Constitutional predisposition must first give rise to conditions which will admit of the formation of tubercular matter, before any cause whatever can occasion its local deposition. It must modify the vitality of the whole system, when other causes may determine in the system thus impaired, the peculiar morbid action of which tubercular matter is the product. The general division of causes into predisposing and exciting, must ever be more or less arbitrary. Individuals subject to predisposing causes may live the natural term of life and finally die of other disease. Indeed, when predisposing causes are known to exist, they should constitute a warning for the avoidance of other causes. Again, among the so-called exciting causes, some may operate in such a manner, with some individuals, as to predispose them to consumption, and the result will be the same as if the disposition had been congenital. The causes which in one individual are _exciting_, under other circumstances and in other individuals, would be _predisposing_, because they act so as to depress the vitality and impair the nutritive processes.
THE PREDISPOSING CAUSES, then, are hereditary predisposition, scrofula, debility of the parents, climatic influences, sedentary habits, depressing emotions, in fact, _anything_ which impairs the vital forces and interferes with the perfect elaboration of nutritive material.
THE EXCITING CAUSES are those which are capable of arousing the predisposing ones into activity, and which, in some instances, may themselves induce predisposition; as dyspepsia, nasal catarrh, colds, suppressed menstruation, bronchitis, retrocession of cutaneous affections, measles, scarlatina, malaria, whooping-cough, small-pox, continued fevers, pleurisy, pneumonia, long-continued influence of cold, sudden prolonged exposure to cold, sudden suspension of long-continued discharges, masturbation, excessive venery, wastes from excessive mental activity, insufficient diet, both as regards quantity and quality, exposure to impure air, atmospheric vicissitudes, dark dwellings, dampness, prolonged lactation, depressing mental emotions, insufficient clothing, improper treatment of other diseases, exhaustive discharges, tight lacing, fast life in fashionable society, and impurity and impoverishment of blood from any cause. This list might be greatly extended, but the other causes are generally in some manner allied to those already named.
SYMPTOMS. The symptoms of consumption vary with the progress of the disease. Writers generally recognize three stages, which so gradually change from one to the other that a dividing line cannot be drawn. As the disease progresses, new conditions develop, which are manifested by new symptoms. Prior to the advent of pulmonary symptoms, is the latent period, which may extend over a variable length of time, from a few months to several years; and, indeed, may never be developed any farther. Until sufficient tubercular matter has been deposited in the lungs to alter the sounds observed on auscultation and percussion, a definite diagnosis of tubercular consumption cannot be made, even though there may have been hemorrhage. Nevertheless, when we find _paleness, emaciation, accelerated and difficult breathing, increased frequency of the pulse, an increase of temperature_, and _general debility_ coming on gradually without any apparent cause, we have sufficient grounds for grave suspicions. These are increased if tenderness under the collar-bone, with a slight, hacking cough is present. These symptoms should be sufficient to warn any individual who has the slightest reason to believe that he is disposed to consumption, to lose no time in instituting the appropriate hygienic and medical treatment, for it is at this stage that remedies will be found most effective. Unfortunately, this period is too apt to pass unheeded, or receive but trifling attention; the patient finds some trivial excuse for his present condition, and believes that he will soon be well. But, alas for his anticipations! The disease goes onward and onward, gradually gaining ground, from which it will be with great difficulty dislodged.
The cough now becomes sufficiently harassing to attract attention, and is generally worse in the morning. The expectoration is slight and frothy; the pulse varies from ninety to one hundred and twenty beats in a minute, and sometimes even exceeds this. Flushes of heat and a burning sensation on the soles of the feet and palms of the hands are experienced. A circumscribed redness of one or both cheeks is apparent.
These symptoms increase in the afternoon, and in the evening are followed by a sense of chilliness more or less severe. The appetite may be good, even voracious; but the patient remarks that his food "does not seem to do him any good," and, to use a popular expression, "he is going into a decline." As the strength wanes the cough becomes more and more severe, as if occasioned by a fresh cold, in which way the patient vainly tries to account for it. Expectoration increases, becomes more opaque, and, perhaps, yellow, with occasionally slight dots or streaks of blood. The fever increases, and there is more pain and oppression of the chest, particularly during deep respiration after exercise.
Palpitation is more severe. There may now be night-sweats, tire patient waking in the morning to find himself drenched in perspiration, exhausted, and haggard. Bleeding from the lungs occurs, and creates alarm and astonishment, often coming on suddenly without warning. The hemorrhage usually ceases spontaneously, or on the administration of proper remedies, and in a few days the patient feels better than he has felt for some time previously. The cough is less severe, and the breathing less difficult. Indeed, a complete remission sometimes occurs, and both patient and friends deceive themselves with the belief that the afflicted one is getting well.