Nose and Throat

Croup is an acute laryngitis of childhood, usually occurring between the ages of two and six years. The nervous element is more marked than in adults, so that the symptoms appear more alarming. The trouble frequently arises as part of a cold, or as a forerunner of a cold, and often is heralded by some hoarseness during the day, increasing toward night. The child may then be slightly feverish (temperature not over 102° F., usually). The child goes to bed and to sleep, but awakens, generally between 9 and 12 P.M., with a hard, harsh, barking cough (croupy cough) and difficulty in breathing. The breathing is noisy, and when the air is drawn into the chest there is often a crowing or whistling sound produced from obstruction in the throat, due to spasm of the muscles and to dried mucus coating the lining membrane, or to swelling in the larynx. It is impossible to separate these causes. The child is frightened, as well as his parents, and cries and struggles, which only aggravates the trouble. The worst part of the attack is, commonly, soon over, so that as a rule the doctor arrives after it is past. While it does last, however, the household is more alarmed than, perhaps, by any other common ailment.

This is an acute inflammation of the mucous membrane of the larynx. The larynx is that part of the throat, in the region of the Adam’s apple, which incloses the vocal cords and other structures used in speaking. Hoarseness is commonly due to extension of catarrh from the nose in cold in the head and grippe . It also follows overuse of the voice in public speakers and singers, and is seen after exposure to dust, tobacco, or other smoke, and very commonly in those addicted to alcohol.

Membranous croup is diphtheria of the lower part of the throat (larynx), in the region of the Adam’s apple. If in a case of what appears to be ordinary croup the symptoms are not soon relieved by treatment, or if any membrane is coughed up, or if, on inspection of the throat, it is possible to see any evidence of white spots or membrane, then a physician’s services are imperative.

The consideration of diphtheria will be limited to emphasizing the importance of calling in expert medical advice at the earliest possible moment in suspicious cases of throat trouble. For, as we noted under tonsilitis, it is impossible in some cases to decide, from the appearance of the throat, whether the disease is diphtheria or tonsilitis. A specimen of secretion removed from the throat for microscopical examination by a bacteriologist as to the presence of diphtheria germs alone will determine the point. When such an examination is impossible, it is always best to isolate the patient, especially if a child, and treat the case as if it were diphtheria. Diphtheria may invade the nose and be discoverable in the nostrils. A chronic membranous rhinitis should be treated as a case of walking diphtheria.

Quinsy is a peritonsilitis; that is, it is an inflammatory disease of the tissues in which the tonsil is imbedded, an inflammation around the tonsil. The swelling of these tissues thrusts the tonsil out into the throat; but the tonsil is little affected. Quinsy involves the surrounding structures of the throat, and usually results in abscess. The disease is said to be frequently hereditary, and often occurs in those subject to rheumatism and gout. It is seen more often in spring and autumn and in those living an out of door existence, and having once had quinsy the victim is liable to frequent recurrences of the disease. Quinsy is characterized by much greater pain in the throat and in swallowing than is the case in tonsilitis, and the temperature is often higher sometimes 104° to 105° F. When the throat is inspected, one or both tonsils are seen to be enlarged and crowded into its cavity from the swelling of the neighboring parts. The tonsils may almost block the entrance to the throat. The voice is thick and indistinct, the glands in the side of the neck become swollen, and the neck is sore and stiff in consequence, while the mouth can be only partially opened on account of pain. For the same reason the patient can swallow neither solid nor liquid food, and sits bent forward, with saliva running out of the mouth. The secretion of saliva is increased, but is not swallowed on account of the pain produced by the act. Sleep is also impossible, and altogether a more piteous spectacle of pain and distress is rarely seen. Having reached this stage the inflammation usually goes on to abscess (formation behind or above or below the tonsil), and, after five to ten days from the beginning of the attack, the pus finds its way to the surface of the tonsil, and breaks into the mouth to the inexpressible relief of the patient. This event is followed by quick subsidence of the symptoms. Quinsy is rarely a dangerous disease, yet, occasionally, it leads to so much obstruction in the throat that death from suffocation ensues unless a surgeon opens the throat and inserts a tube. Occasionally the pus from the ruptured abscess enters the larynx and causes suffocation.

Tonsilitis is a germ disease and is contagious. Exposure to cold and wet and to germ laden air renders persons more liable to attacks. It is more likely to occur in young people, especially those who have already suffered from the disease and whose tonsils are chronically enlarged, and is most prevalent in this country in spring. The disease appears to be often associated with rheumatism. Tonsilitis begins much like grippe , with fever, headache, backache and pain in the limbs, sore throat, and pain in swallowing. On inspecting the throat (with the tongue held down firmly by a spoon handle and the mouth widely open in a good light, preferably sunlight) the tonsils will be seen to be swollen, much reddened, and dotted over with pearl white spots.

The milder sore throat is commonly the beginning of an ordinary cold, although sometimes it is caused by digestive disorders. Exposure to cold and wet is, however, the most frequent source of this form of sore throat. Soreness, dryness, and tickling first call attention to the trouble, together with a feeling of chilliness and, perhaps, slight fever. There may be some stiffness and soreness about the neck, owing to swelling of the glands. If the back of the tongue is held down by a spoon handle, the throat will be seen to be generally reddened, including the back, the bands at the side forming the entrance to the throat at the back of the mouth, and the uvula or small, soft body hanging down from the middle of the soft palate at the very back of the roof of the mouth. The tonsils are not large and red nor covered with white dots, as in tonsilitis. Neither is there much pain in swallowing. The surface of the throat is first dry, glistening, and streaked with stringy, sticky mucus.

A small, shallow, yellow ulcer, appearing on the inside of the lips or beneath the tongue during some disorder of the digestion. It is very tender when touched and renders chewing or talking somewhat painful. Treatment consists of touching the ulcer carefully with the point of a wooden toothpick which has been dipped in pure carbolic acid (a poison) and then rinsing the resulting white spot and the whole mouth very carefully, so as not to swallow any of the acid.

There are various forms of inflammation of the mouth, generally dependent upon the entrance of germs, associated with indigestion or general weakness following some fever or other disease. Unclean nipples of the mother or of the bottle, or unclean bottles, allow entrance of germs, and are frequent causes. Irritation of a sharp tooth, or from rubbing the gum, or from too vigorous cleansing of the mouth, may start the disease. Some chemicals, especially mercury improperly prescribed, produce the disease. The germs may gain admission in impure milk in some cases. Inflammation of the mouth is essentially a children’s disease, only the ulcerated form being common in adults.

( including Adenoids, Chronic Tonsilitis, Deviation of the Nasal Septum, Enlarged Turbinates, and Polypi ). Any obstruction in the nose causes mouth breathing and gives rise to one or more of a long train of unfortunate results. Among the disorders producing mouth breathing, enlargement of the glandular tissue in the back of the nose and in the throat of children is most important. Glandular growths in the upper part of the throat opposite the back of the nasal cavities are known as “adenoids”; they often completely block the air passage at this point, so that breathing through the nose becomes difficult. Associated with this condition we usually see enlargement of the tonsils, two projecting bodies, one on either side of the entrance to the throat at the back of the mouth. In healthy adult throats the tonsils should be hardly visible; in children they are active glands and easily visible.