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as in hooping-cough, accompanied by stitches in the chest, sore throat and fever."
Nux moschata. In Hull's large Jahr (1848), we see "bright-red shining elevations resembling mucous glands below thefrcenum lingua, somewhat larger than millet-seeds." Three symptoms of " coryza."
The seven cough symptoms do not resemble hoopingcough; they point more to the dry, brassy, ringing, reflex cough of the hysterical subject.
Phosphorus gives "pain and prickling in the franum," apparently subjective sensations. This drug has "vomiting" connected with "cough," but it is "sourish vomiting during the cough," whereas the vomiturition of pertussis occurs at the close of the paroxysm.
Our old friend, Drosera, gives "whitish ulcer on the tip of the tongue."
A disease of an adjacent organ, to the consideration of which I will next ask your attention. The literature of the new faith teems with examples of the cure of chronic disease, but of follicular inflammation of the pharynx we see little, and, excepting in the more recent serials, nothing; indeed, I am not aware that any of our body, besides Hughes and Meyhoffer, has honoured this prevalent and persistent pathological condition with distinct notice.
Kleinert, in vol. xx of the British Journal of Homoeopathy, in a paper distinguished by originality of thought and disfigured by a perfectly paradisiacal innocence of pathology, relates some interesting cases of follicular disease under the comprehensive title "Laryngeal Catarrh." His remedies are Acid, nitric., Ambra, Argentum, Carbo veg., Causticum, Eupion, Hepar, Mangan. acet., Merc, Phos., Selenium, Stram., Verb* Hartmann does not condescend to recognise the existence even of this disorder.
* Oddly enough Dr. Kleinert did not appear to employ Kali lich., though that drug had been even then figuring in English clinical literature for fourteen years.
The reason of this remarkable neglect is twofold : On the one hand physicians are rarely consulted for this symptom when it stands alone, and if graver signs coexist, the pharyngeal complication is lost sight of in the melange of phenomena, more urgent or at the least more interesting. On the other hand, the disorders of the pharynx received little attention before the researches of Garcia, Turck and Czermak, initiated in the year 1855,* shed upon an adjacent region such a flood of new light, light both literal and figurative.
As far as my own experience goes, I have encountered this affection most frequently in two classes of the community, viz., in clergymen and in nursing mothers. The association is apparent—debility.
In Meyhoffer's admirable work on The Chronic Diseases of the Organs of Respiration, treating of follicular laryngitis (which I have never myself seen without accompanying and probably antecedent pharyngitis), he gives as causal agents: "over-exertion of voice, oral respiration, local irritants as tobacco-smoke, alcoholic drinks, spices and the inspiration of chemical vapours." To these I will add such predisponents as dyspepsia, starvation and depressing mental emotions, in fact every debilitating circumstance; but above all these we must place those constant catarrhs which ever afflict the resident in a humid and fickle climate.f
As evidence of the prevalence of pharyngeal lesions even in a sheltered valley noted for the dryness of its air, I will give you the result of some careful observations recorded by myself in the March of the year that has just passed (1873).
I had the curiosity, during one week, to scrutinise the pharynges of all the patients who came to my consultingroom.
* I do not here speak of Liston's earlier use of the laryngeal mirror in 1840, because that is a matter of historic rather than of clinical interest.
t Conversation in a carriage has a peculiarly irritating effect on the voice of follicular subjects, and it is not easy to append any satisfactory explanation to this.
From the 23rd to the 29th of March, both days inclusive, I examined forty-nine throats ; of these thirteen were males.
Now, I think, gentlemen, you will be surprised when I tell you that in so enormous a proportion as forty-two to seven there was some distinct deviation from the standard of health! In nearly every instance that deviation took the form of engorged follicles. It is interesting to note that though this disorder formerly enjoyed a masculine designation, Angina Clericorum, as a matter of fact it is divided with remarkable impartiality between the two sexes; for whilst |j, or 85 per cent., of men suffered, |g, or 86 per cent., of the women were victims; showing even a slight preponderance on the female side.*
One sixth only of all patients enjoyed the possession of a typically sound pharynx.
It is difficult to follow numerical values mentally, so I will briefly tabulate thus:
The remedy from the use of which I have seen the greatest amount of success is the Yellow Iodide of Mercury; the salt containing two equivalents of Iodine has not appeared to me to be followed by results so favorable. The next medicinal agent in order of clinical value is Kali bichromicum.
I have seen good effects from Hamamelis V in the subacute, from Capsicum 3X in the chronic venous congestion so frequently seen in conjunction with follicular lesion. Nux is useful when the mucous membrane is brick-red, and the mouth is sore, or when pelvic congestion complicates the case.
* Follicular pharyngitis is nearly always present in the subjects of pulmonary, vesicular emphysema. Dr. Henry Bennett has pointed out how frequently pelvic congestion in women is associated with a relaxed state of the pharyngeal mucous membrane.
Insolatio and Hay-fever.
We will now, gentlemen, pass to the consideration of two diseased conditions which, widely separated as they may be in their manifestations, are yet at times allied as to their aetiology—I speak of sunstroke and hay-fever.
It would be no novelty to assert that both these morbid states may be induced by the impinging, under certain circumstances, of the rays of the sun on the surface of the body. They have been said to owe, in some instances, a common origin to the Heat of the sun; but I ask you, have we not rather ignored the share that another factor concerned may claim in the production of these phenomena?
We must not forget that the solar beams contain pencils of yellow or light rays as well as pencils of blue or chemical rays.
Why may not over-stimulation by light be accredited as the cause, knowing as we do that no amount of heat* without light will so disturb the economy?
In an exhaustive monograph, composed in a truly scientific spirit, and displaying peculiar powers of patient investigation, one of our body has recently given to us the valuable results of years of thought and observation on the subject of hay-asthma. When I had the pleasure of perusing this classic contribution to the scant literature of hay-fever, with a feeling of extreme admiration for the minute care, the patient research, betrayed by its style, came a sensation of surprise that its author should have dropped into the beaten track of attributing this disease to the heat rather than to the light of the sun.
* There is a disease induced by over-stimulation with chemical or blue rays, viz. the moon-stroke of India. It is characterised by hepatic congestion and an impaired state of the memory. I have under my care a lady who, after a moonlight walk, experiences diminished heart-action and marked muscular prostration—nicotism minus the nausea.
At p. 677 of vol. xxx of the British Journal of Homoeopathy Mr. Blackley says :—" Many patients have thought that exposure to the heat of the sun has made their attacks more severe." Again, "Dr. Bostock had the symptoms more severely developed whenever he ventured into the open air whilst residing at Ramsgate" (whose atmosphere is likely to be as free from pollen as any in great Britain); and again, "Dr. Phoebus notices that exercise, especially that of a fatiguing nature (in other words, outdoor exercise), causes exacerbations." Dr. Smith, p. 258, loc. cit., thinks that great heat and strong light induce or aggravate the symptoms.
Mr. Blackley explains all these by the fact that when patients are in the open air they inhale more pollen. This May be so; but another explanation perhaps lurks behind. They are certainly more exposed to the direct rays of light emanating from the sun. Mr. Blackley does, indeed, at p. 253, take up the question of light as a causative agent, but he dismisses it so summarily as nearly to amount to a putting out of court.
Whilst Bostock, George Moore, Pirrie, and Smith have supported the heat theory, Phoebus alone definitely advocated the view that light might be the chief disturbing cause.
May not the whole question of hay-asthma be condensed and formularised thus?—Given a hyper (Esthetic condition of the nerves distributed to the skin or to the ophthalmo-respiratory tract, then any irritant, local or reflex, its nature determined by the special idiosyncrasy of each particular individual, shall induce an attack.
We shall never discover which is the precise sinner, because All in turn are sinners, because every patient has his own peculiar bUe noire always ready to pounce on him in seasons when his resisting power stands at a minimum.
For convenience we class all under the comprehensive, but incorrect, terms "hay-fever," and "hay-asthma;" there is no doubt that even in the same individual
VOL. XXXII, NO. CXXV1II. APRIL, 1874. T