348 ON CATARRH. 



all its transparency, the blood vessels in the mucous membrane being clearly 

 and distinctly visible, at the same time the venous trunks greatly distended 

 and engorged. There is hj^per-secretion of mucus, and along with this hy- 

 l^er-secretion of mucus is found, in many instances, an exudation of serum 

 from the surface. There is a set of glands in the mucous membrane lining 

 the nose known as acinous glands, which afford a secretion precisely iden- 

 tical in appearance and in chemical composition with tears. At the same time 

 the lachrymal glands are irritated. There is a greatly increased secretion of 

 tears, and when the Catarrh affects the nasal passages, extending up through 

 the nasal duct into the lining of the eyelids, we have what is called coryza. 

 That means acute Catarrh, affecting not only the nasal passages, but the 

 conjunctival membrane as well. 



We usually see cases of Catarrh that have existed for some time. The^' 

 are not apt to present themselves for treatment until the disease has shown 

 a disposition to linger, because Catarrh is one of those forms of disease that 

 attack almost all animate nature. It attacks everybody'" that breathes air— 

 every animal that breathes air is liable to acute Catarrh, and these attacks 

 often disappear of themselves, without treatment. 



Catarrhal inflammation, like any other localized inflammation, has a nat- 

 ural tendency to recover after running a definite course. But on account of 

 the complicated character of the nasal j)assages, and the liability of the secre- 

 tions to be retained in the ramifications, we find a steady disposition uj)on 

 the part of this particular membrane or lining of the nose to suffer from 

 chronic forms of disease — a sj)ecial disposition upon the part of the catarrhal 

 diseases to linger in the nasal passages. It sometimes fills the naso-pharyn- 

 geal space. It remains confined to that particular locality in many instances, 

 for weeks, months, years, and from the naso-pharjmgeal space it travels the 

 Eustachian tube into the middle ear, and produces destructive changes in 

 the wall of the tympanic cavit}-, before the presence of Catarrh is even sus- 

 pected. With the aid of the rhinoscope. Catarrh limited to the naso-pha- 

 ryngeal space may be discovered. The peculiar conditions of the membrane 

 may be readily understood by bringing the surface directly into view. I 

 say directly ; I mean indirectly into view with the aid of the rhinoscope. In 

 cases of Catarrh limited to the naso-pharyngeal space, attended with inflam- 

 mation of the ear, it has been the customary practice to regard the disease 

 as an affection of the ear, because the symptoms were not distressing until 

 the hearing became impaired, and along with the beginning of this impair- 

 ment in the hearing there was no pain in the ear. Pain, from what cause ? 

 From the swelling of the Eustachain tubes and limited supply of air in the 

 tympanic cavity, and in that manner preventing the equal pressure of the 

 air upon the drum membrane, giving rise to such tension as was sufficient 

 to create great pain — great distress. 



In some cases, where the quantity of air in the tympanic cavity from 

 this source has been very limited, slight pressure uj)on the tragus forces the 

 •drum head backward, and the joint between the malleus and incus is dislo- 



