CLINICAL NOTES'ON DISEASES OF THE

THROAT,

NOSE AND EAR.

By Surgeon-Major R. H. WHITWBLL, m.b., b.s.c., Officiating Civil Surgeon, Mozufferpore,

(Continued

from page

229.)

Nahrd?As understood iti Tirhoot?means a of the nose. In other parts of Bengal,

polypus

however, the name is an expression for a severe form of rhinitis, accompanied by fever, depression, brow-ache, and a pain along the line of the nasal nerve. There is a copious acrid secretion

from the nostrils, which are occluded from turgescence of the inferior and middle turbinateds 011 each side. Rhinoscopic examination causes pain. I have seen altogether five cases of this disease, which is closely allied to the rare socalled croupous or membranous form of rhinitis. In one of my cases, that of an Uriya boy, there was a thin white deposit covering the septum and inferior turbinated bodies. Removal by a probe caused bleeding, and there was no recurrence after exfoliation. In the only case of true croupous rhinitis, I was fortunate enough to see, the membrane was similar, but reformed when shed. This specific peculiarity apart, the other symptoms are referable to a general inflammation of the mucous membrane covering the erectile tissue over the septum and turbinated bodies, and of several of the cavities communicating with the nose, particularly of the frontal sinuses The discharge is first and ethmoidal cells. mucous, then muco-purulent, never pus. By two of my patients, who by the way were all in their youth, the attacks were said to recur The throat in all was at irregular intervals. more or less congested, and the voice of course nasal and harsh. The treatment is to temporarily reduce the congestion and pain with cocaine so as to admit of the application of any of the alkaline sprays. A mixture ot borax and glycerine is as useful Dover's powders with quinine should as any. be given at night during the acute stage. Later lactic acid or menthol may be tried. When all inflammation has subsided, the inferior 44

334

INDIAN MEDICAL GAZETTE.

turbimvteds on each side must be thoroughly burnt with a galvano-cautery, and all irregularities of the septum pared down. AmerHypertroplnj of the lingual ican authors were among the first to assert that all morbid sensations about the throat, vaguely ascribed to a nervous or hysterical origin, were invariably due to pathological changes in one or other of its structures. Lennox Browne in the last edition of his work on the Throat and Nose supports this. One of the commonest little though suspected causes of these morbid sensations is anaemia of the pharynx, and another to which I am about to draw attention is hypertrophy of the lingual tonsil. This condition is more frequent among women than men, and is not, as a rule, seen in subjects under 18 years of age. My experience is that it is invariably associated with varix. Varix, 011 the other hand, may exist at the base of the tongue without hypertrophy of its adenoid tissue. One very well marked case of this disease which came under my care, was that of a lady who suffered from exacerbations of pharyngitis, and complained of a fullness in the throat with a tired feeling after speaking or singing. There was some local congestion with a few granules 011 the back wall of the pharynx. These were burnt, but it was not till the whole of the hypertrophied lingual tonsil had been repeatedly scored with the porcelain point of the galvano-cautery that any permanent relief was secured. It is now eighteen months since this was done, and she has not had any return of her attacks of sore throat; and her voice, she states, is quite

strong again.

A second instructive case was that of a Bengali Civilian of melancholy temperament. Varix and hypertrophy of the lingual tonsil were both marked. He complained of a lump rising and falling in his throat, which he was quite sure was due to cancer. He went away with this delusion unshaken, nor would lie consent to operative interference of any kind.

[Nov.

1892.

Clinical Notes on Diseases of the Throat, Nose and Ear.

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