A chronic form of the mild type of laryngitis is the cause of what is called clergyman's sore throat, which is considered under AFFECTIONS OF TIIE VOICE at page 390. Chronic forms of the disease, ending in ulceration, attend tuber cular consumption and syphilis, and are the cause of hoarseness and loss of voice in these affections.
Treatment.—Hot cloths and poultices should be applied directly over the front of the neck. If these fail to give relief, or if the case be urgent, mustard poultices or blisters may be applied. These, however, should not be placed directly over the larynx, but over the upper part of the breast-bone. The reason is, that if the blisters or mustard were placed directly over the larynx, the swelling they produce would extend to the larynx, because of its nearness to the surface. The person should be in bed in a room kept warm and free from cold draughts. Breathing steam will relieve the irritability of the throat, and to the same end a kettle should be placed on the fire and allowed to pour its steam into the room. For this the bronchitis kettle is best. (See APPLI ANCES FOR THE NURSERY, Plate XXXI.) Hot drinks are also beneficial ; and the bowels should be unloaded by a good dose of salts. In ordinary cases these measures will be sufficient. Persons of weak health must have their strength main tained by nourishing soups. Sometimes stimu lants are necessary. But cases of this kind ought to be in charge of a qualified physician. In cases where suffocation is threatened, instant relief may be given by the performance by a surgeon of tracheotomy. This consists in open ing the windpipe from the outside and insert ing a tube. The patient breathes through this new opening till the swelling has subsided, when the tube is withdrawn and the wound closed.
In chronic cases blisters may be applied out side, but the most effective treatment consists in the direct application to the membrane of astringent remedies in the form of spray, powder, or paint applied as mentioned in the paragraphs on AFFECTIONS OF Voica (p. 390).
Dropsy of the Larynx ((Edema) is a condition in which great swelling—sometimes threatening suffocation—is produced by the pouring out of fluid from blood-vessels in the loose tissue under the mucous membrane. It is due sometimes to the swallowing of scalding liquids, and sometimes comes on after erysipelas and scarlet fever. It may be caused by inflam mation, or be apart from it. It can best be relieved hi dangerous cases by tracheotomy, as above mentioned, or by a surgeon passing a lancet down the throat and scraping the part to permit the fluid to escape and the swelling thereby to subside. If scalding has been the cause, relief may be obtained by ice applied to the throat.
Inflammation of the Windpipe (Trache itis; Latin, trachia, the windpipe) is very similar to inflammation of the larynx. It also may be a
mere accompaniment of a common cold. Croup is a special kind of inflammation of the wind pipe, and is considered in Section XXIV, p. 538. The ordinary form is accompanied by fever, some pain in the windpipe, spasmodic cough ing, &c., as in the affection of the larynx. There is not the same pain ill swallowing, however, nor need the voice be affected if the inflammation is confined to the windpipe.
Treatment is the same as for laryngitis.
Bronchitis is a catarrhal inflammation of the bronchial tubes. In it, as in the ordinary catarrh, the lining membrane of the tubes is congested, dry, and swollen. Thereafter fluid is poured out from the gorged vessels, and the secretion becomes, in the later stages, thick and containing matter.
Its causes are chiefly exposure to cold, or the inhalation of irritating substances, or it is due to some fever, whooping-cough, &e.
Symptoms.—There is fever, preceded pro bably by chills. The pulse is quick, the breath ing hurried, and the tongue furred. Appetite is lost; the bowels are confined ; there are thirst, headache, and weariness. The special symptoms are due to the condition of the bronchial tubes. They are pain, a sense of tightness in the chest, difficulty of breathing, and a dry, irritable cough. These are due to the congestion and swelling of the mucous membrane of the tubes. The cough is occa sioned by the air passing over an irritable surface; and sometimes the patient has a feel. ing as if a tract within the chest and down the line of the breast-bone were raw. At this time, if one listens with the ear to the chest, whistling, cooing, or piping sounds are heard with the movements of breathing, caused by the air rushing along narrow tubes. By and by the cough is accompanied by a spit of clear mucus, the secretion from the inflamed mem brane. The spit soon grows more abundant, and becomes yellowish. The sounds heard in the chest are now not so musical, but more of a bubbling character, called crepitation, occa sioned by the air passing through the fluid in the tubes. The bubbling is coarse or fine as the inflammation is in larger or smaller tubes. As the case progresses the cough becomes less and the discharges diminish in amount. The sounds in the chest gradually become replaced by the fine rustle of ordinary breathing. The attack may last only a few days, or may go on for some weeks. In what is called capillary bronchitis the disease attacks specially the finer tubes. The very young or old are par ticularly liable to it. Breathing is in this form very difficult and laboured. The patient's skin is livid, and the blue veins are well marked over it, while the distress may be excessive. The spit is not so profuse as in the bronchitis of the larger tubeS. It more readily tends to death from suffocation or exhaustion.