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present areas of both dulness and tympanites, the case is pretty clearly tubercular.

Of the various forms it is important to distinguish the fibrous alone since this is the only one in which recovery may be looked for without operation.

Of the chance of survival with operative treatment, the least sanguine opinion gives a mortality of 25 per cent.

This includes all cases which die within a few weeks, whose demise may reasonably be regarded as hastened by the operation. The direct mortality of the operation itself is only about three per cent. Of the seventy-five per cent. of recoveries about one-fourth may be regarded as permanent, so of all operative cases we may look for nearly twenty per cent. of permanent cures.

The operation consists in opening the abdomen by a rather long incision, admitting air and light freely and draining with gauze wicks for a few days. Drainage may be preceded in some cases by flushing out the cavity with a normal salt solution, but not in those cases in which, by so doing, a localized peritonitis may become general.

ACUTE LARYNGITIS.

BY N. H. HOUGHTON, M.D., BOSTON, MASS.

[Read before Boston Hom. Med. Society.]

It is not within the scope of this paper to include all acute diseases of the larynx, but to limit the subject to a consideration of Acute Catarrhal Laryngitis.

In this disease the inflammation may be vivid in character and involve only the mucous membrane of the larynx, giving rise to slight hoarseness and cough, or it may reach the deeper tissues, be more severe, and become dangerous to life, especially in children.

The causes of acute catarrhal laryngitis are such as favor

inflammation of mucous surfaces in general. It is very frequently a continuation of an inflammation existing some. where in the upper portion of the respiratory tract, or a rhinitis, or a noso-pharyngitis. Diseases of the stomach and intestines may predispose one to attacks of laryngitis. Individuals, especially children, who are kept in doors much of the time, and those in whom the general health is poor, are susceptible to the disease. Cold and exposure, wetting of the feet, wearing damp clothing, improperly ventilated rooms, alcoholic drinks, excessive use of tobacco, and straining the voice in speaking, or in singing, are not uncommon causes. Obstructive lesions of the nose and noso-pharynx, causing mouth-breathing, inhalations of dust, irritating fumes and vapors, and foreign bodies in the larynx may induce the disease. Acute catarrhal laryngitis may accompany the eruptive fevers, especially measles, scarlet fever, small-pox, typhoid and typhus fevers, erysipelas, also influenza, hay fever, and rheumatism.

Usually the earliest symptom is impairment of the voice, which may be hoarse or completely lost, dependent largely upon the amount of inflammation present. Dryness, tickl ing and cough are nearly always to be found. A sensation of roughness and constriction in the throat, and in children sensitiveness to palpation may exist. In the second stage. the secretion of mucous considerably relieves the dryness. and cough, which becomes less metallic. An examination by the laryngoscopic mirror reveals the extent of the inflammation which may include the whole mucous membrane lining the larynx, or the hyperacenia may be confined to a certain portion, as the epiglottis or the ventricular bands. At times the ventricular bands may be so swollen as to nearly occlude the vocal bands from view. Children may appear during the day to have no serious illness but at night may be awakened with violent suffocative attacks of coughing. The respiration is embarrassed and efforts to breath are marked by an audible, stridulous sound. These attacks are probably occasioned by the drying of the accumulated

mucus in the larynx. The child is compelled to breathe through the open mouth, with the result that the inspired air is not moistened by the secretion of the nose, as in normal respiration, consequently the dry air causes rapid evaporation of the water of the laryngeal secretions with the effect of causing them to dry upon the vocal bands until they become a positive obstacle to the inspired air. However, this mechanical explanation is not satisfactory to all for there are some authors who consider these attacks due to a spasm of the adductors of the vocal bands. Edema occurring in the course of a laryngitis constitutes a grave complication since it may give rise to a fatal stenosis. Acute catarahal laryngitis though not always a serious condition yet from the location of the inflammation and the tendency to oedema with subsequent dyspnoea, calls for prompt and energetic treatment. Here the laryngoscope is an important factor, not only as an aid to the diagnosis, but in ascertaining the extent and severity of the inflammation, and whether oedema is present or absent. The examination with the mirror should be made if possible, and almost always is successful in adults, but in children it is often attended with difficulty and sometimes impossible.

All applications which are made to so delicate an organ as the larynx should be administered in such a way as to do the least possible harm, Direct local applications of powders and solutions should be avoided as their mechanical irritation does more harm than good. Throat and cough lozenges in numberless variety which laden the counters of the drug stores, and which are so indiscriminately used, should be condemned. Most of them contain opium and are made of sugar and candy, are of large size, and are not only inapplicable to inflammation but cause impairment of digestion and appetite. It must also be remembered that gargles do not reach the larynx and are only beneficial where there is some pharyngeal involvement. Any diseased conditions of the upper respiratory tract should receive proper treatment. Strumuous, lymphatic children should be toned up by the

use of cod-liver oil and by the indicated remedy, such as one of the calcareas. Another prophylactic measure is the employment of the cold sponge bath combined with brisk rubbing. In treating the disease in children, the patient should be put in bed in a well-ventilated room of a temperature of about 70 degrees. The air should be kept moist by generating steam or slaking lime. The croup tent should be used in severe cases. Nightly exacerbations should be anticipated by using every means to soften and expel the dried mucus, and to moisten and soothe the dry, irritable membrane by the use of the hot bath, hot fomentations and steam inhalations, and failing in these excite free emesis by tickling the fauces with the finger or brush. Early in the attack. benefit may result from wrapping the throat in a towel, the end of which has been dipped in cold water. In people, other than small children, inhalations of steam medicated with oil of pine, oil of tar, oil of eucalyptus, and compound tincture of benzoin are highly beneficial. The use of oil sprays, such as liquid vaseline, one ounce, oil of sandal wood six drops and oil of tar three drops, or a three per cent. solution of camphomenthol in albolene, or Neorgan's sabalal spray which consists of saw palmetto, eucalyptus and menthol oily menstruum, may be of great help when inhaled. from ambulizer. These preparations are not astringent, but stimulating, and thus they promote secretion and relieve the congested blood vessels. For the relief of the dema the swollen tissue must be punctured and the watery fluid. allowed to escape. Rarely intubation and tracheotomy may be demanded. For the early symptoms, such remedies as aconite, belladonna, ferrum phos. and ammonium muriate will give prompt relief, while later iodine, bromine, spongia, calciiod, hepar sulph., guiac, phosphorus, sanginaria and apis should be consulted.

in an

EDITORIAL.

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in the Gazette. They should be typewritten if possible. To obtain insertion the following month, reports of societies and personal items must be received by the 15th of the month preceding.

THE HAHNEMANN ASSOCIATION.

The annual meeting of the Hahnemann Association was held at Young's Hotel on January 14, and was enthusiastic enough to encourage us all. Addresses were made by Dr. Horace Packard, secretary of the Association, setting vigorously forth the needs of the medical school and the reasons why the necessities are more pressing than ever at this time; by Col. Chas. R. Codman concerning the Massachusetts Homœopathic Hospital and its dependence on the medical school; by the Hon. Alden Spear, chairman of the Board of Trustees of the Westboro Insane Hospital, showing the inter-dependent relations existing between that institution and the School of Medicine; while Mr. W. M. Dickinson spoke most eloquently on the necessity of endowment of medical schools, and showed that of all professional schools, those pertaining to the study of medicine were least often and indeed very rarely endowed.

The Association has already been of very material assistance to the school, and already has plans under way whereby it will be of still further help, but this work should not be left to the Association alone, it should be the duty of every homœopathic physician in New England to do what little or what much he can, not by his purse, but by his influence to raise sufficient endowment to place the medical school beyond financial embarrassment.

What are the problems with which we are confronted today and how are they to be solved?

First. The standards both for admission to and gradua

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