ON CATARRH. 349 



■ated. This is an exceedingly painful condition, but may, if taken in time, 

 be relieved, simply by inflating the middle ear with air. As to the treat- 

 ment of Catarrh, of course it would be impossible for anybody to exhaust the 

 subject, or even approach exhaustion. 



It is to the treatment of chronic catarrhal affections of the lining of the 

 nose, throat and ear, that we propose to confine our remarks this evening. 

 Cases attended with hyper-secretion of mucus, partial loss of smell, dryness of 

 the throat, the unpleasant sensation, if not positive pain, from attempts at 

 swallowing, usually disclose upon inspection a double character of morbid 

 change, a suppurative and proliferous inflammation, at the same time, in 

 different parts of the same membrane ; for instance, the lining of the infer- 

 ior passages of the nose and the covering of the inferior turbinated bones 

 yield an abundant secretion; perhaps the covering of the superior turbin- 

 ated bones at the same time ; but it frequently happens that the membrane 

 covering the superior turbinated bones is perfectly dry, considerably swol- 

 len, very hard and indurated. At the same time the posterior wall of the 

 naso-pharyngeal space presents the appearance of induration and dryness, 

 and whatever mucus manages to flow over upon the surface of this mem- 

 brane speedily dries in a hard, tough crust. It may be^seen simply by 

 making an inhalation with the mouth open ; it maybe seen upon the entire 

 posterior naso-pharyngeal wall, down into the bucco-pharyngeal space. 

 Cases of this kind are seen in every-day practice. 



The greatest discrimination is necessary in the treatment of this double 

 form of disease, the suppurative and proliferous form co-existing in differ- 

 ent parts of the same membrane. In the first place, wherever the disposition 

 is found to discharge tenaeious substances, it becomes necessary to aid na- 

 ture by some sort of medicament which has power to dissolve the fibrinous 

 matter, and in that way facilitate its expulsion. For this salines, such as 

 are usually employed as gargles, are serviceable, applied directly to the naso- 

 pharyngeal space, with what is known as the posterior nasal syringe, which 

 is a curved instrument having a bulbous point, with a great number of per- 

 forations in the bulbous tip. With the aid of this, any of the salines usually 

 employed as gargles may be thrown into the naso-pharyngeal space, and in 

 that way brought into contact with the largest portion of the membrane, and 

 wash out the offensive matter. JSTow, if mucus accumulates in a crypt, if it 

 is found in a cavity in any part of the body, it will rapidly degenerate into 

 pus. The moment the requisite amount of moisture is withdrawn it dries- 

 The dry quality is almost invariably due to the presence of pus. If it were 

 not for pus, it would remain in the condition of ordinary mucus, and be ex- 

 pelled by being drawn up through the nose. Having cleansed the passages 

 with a solution of bromide of potassium or muriate of ammonia — if the pas- 

 sage is very dry the bromide is not so good as the ammonia. Where these 

 salts are not convenient, chloride of sodium may be used instead. It is not 

 so good a defibrinizing agent, neither has it the power to stimulate secretion 

 like the ammonia, nor has it the anaesthetic properties of bromide, yet it i& 



