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some obstruction might be removed thereby. In other cases, there is a constant humming or hawking, in order to clear the throat of some sticky or glutinous stuff, adhering to the back part of it; then the voice is not of that clear, ringing sound as formerly: or if it is made clear, it requires an effort, which shows that something is wrong; for nature works without an effort; after a while the effort becomes such as to cause fatigue. The voice has to be pushed out as it were; at length it becomes hoarse or cracked, after unusual speaking or reading; this is more perceptible after meals, or towards evening: some soreness begins now to be felt in the region of Adam's-Apple. There may be as yet no cough; and for weeks and months it may make no perceptible progress, even getting better; but sooner or later it becomes worse again from exposure to changes of weather and other causes; and thus it alternates, until the patient becomes exhausted in his efforts to get rid of it; the strength declines; the cough appears; the constitution yields, and death closes the scene.
It must be remembered that, sometimes, no cough makes its appearance until within a few weeks of death, but the voice becomes more and more cracked, discordant and husky; it requires the utmost effort to enounce a word above a whisper; the whole body seems to exert itself in the pronunciation of every syllable, and not only the throat, but the whole system is wearied with the effort; yet generally unattended with extreme pain, in or about the throat. Sometimes the voice becomes utterly extinct previous to dissolution.
In the progress of the disease, ulcers form in the throat, so far down as not to be visible to the common eye, and these ulcers pour Out, day by day, enormous quantities of the most offensive stuff, matter, blood, mucus, pura or mixed, a great deal of which is got rid of by expectoration, a whole pint of it in a day sometimes; another part goes by way of the stomach, destroying its tone and power of digestion, and the patient wonders " where so much corruption conies from I" and assures the physician that he "must have spit up all the lungs before now;" and yet, on a proper examination, the lungs will be found unbroken and undecayed. While this affords encouragement to persons who appear to have consumption, to have their cases properly examined, perchance the lungs may happily be sound, notwithstanding the threatening nature of appearances; it at the same time points out the necessity of prompt attention in all cases where there is any ailment about the throat, or any alteration of the voice whatever.
Many distinguished names, such as Piorry, Chomel, Louis, Belloc, Andral, Columbat De L'Isere, Sir Charles Bell, Stokes, Horace Green, and others, bear the most unhesitating testimony to this important and interesting truth: "There can be no doubt that a person may have all the apparent signs of consumption of the lungs, in consequence of the throat affection, and the lungs themselves be free from disease."
In view of this, how strongly does the irresistible conviction fasten itself upon the mind of every reflecting reader, that many have been hastily abandoned, as being in the last stages of Consumption, because they had cough, emaciation, night sweats, and difficult breathing, when a skilful physician would have detected in the throat alone, a sufficient cause for these alarming symptoms, and, by a short course of judicious treatment, have rescue 1 them from an untimely grave.
A clergyman called upon me, in New Orleans last winter, for an examination and opinion of his case, which his friends had supposed hopeless consumption. I considered it one of throat disease in the main, and treated it accordingly. In two months he writes to me:
u Dear Sir: Your prescriptions began in a few days » act very favorably. My cough is more than half abated—digestion improved fifty per cent., strength and spirits in like proportion—nothing seemed against me but too frequent pulse. My throat and voice improved wonderfully, and my respiration very much helped," &c.
The rapid improvement in this case could only have taken place on the ground of my opinion being correct as to the character of his ailment—and yet he had been sent an interminable journey south, from Kentucky through Florida, and, as he informed me, "got worse all the time." What a world of distress and anxiety, and what a large expenditure of time and money might have been saved to this gentleman, had a more truthful opinion been formed of his case before he left home.
Another clergyman, after having been under treatment for some time, writes me, and after relating the favorable changes which had taken place, says:
"And, permit me to say, Doctor, that I shall ever cherish, with grateful remembrance, the day I first visited your office for advice and prescription, and that you may long live to relieve the sufferings of the human family, and enjoy that happiness which a consciousness of doing good gives its possessor, is the prayer of your obedient servant."
A gentleman, whose life was of considerable importance to the community, called at my office wishing to know my opinion of his case. On a careful examination, I told him he was suffering more from a throat disease than anything else, and that there was no efficient remedy. As I could do him no material good, I dismissed him, expecting to see him no more. Early next morning he returned, and said, " you must do something for my throat." I prescribed, and he got better rapidly, very rapidly. Knowing, however, that he could not recover, and seeing that every day he was cherishing new hopes of life, I thought it best to acquaint his wife, to whom he had not long been married, that I considered him in a dangerous condition, and advised an immediate return to his friends, assuring her, at the same time, in the most positive terms, that he was liable to die within any hour. He could not be induced to assent to my views, and I advised him to call in another physician. He did so, and I withdrew. Within ten days, though apparently better, his wife heard a singular noise while her husband was sleeping, and before she could go to the family apartment, to give the alarm and return, he was dead. This sudden death sometimes arises from ulcers forming in the windpipe or its branches, and closing up the passages so that no air can pass; or an ulcer bursts and fills up the passages with matter, so as to suffocate. Sometimes the ulcers eat through the sides of the air passages, and making communications with adjoining parts, produce irritation, inflammation, and death.
A gentleman called at my office with a distressing hoarseness of voice, but no soreness; it required a great effort for him to speak distinctly. He had just placed himself under the care of a physician, who was said to have had some success in curing throat diseases; but hearing that I was in town, he called on me to know what I thought of his condition. I was obliged to say that he would die in a few days, and declined prescribing; first, because I knew that I could do him no material good; and second, I considered it would not be just toward his physician, to abandon his treatment without giving it a fair trial. I saw him on the street several times afterwards, but within ten days I was hastily summoned to see him, and found him dead from suffocation. It ought to be extensively known that there are several forms of throat disease, which render those who have them liable to sudden death; this is especially true of acute and chronic Laryngitis, from swelling, inflammation, or exudation about the upper part of the Larynx, which close the sides, and prevent breathing. This is very liable to come on in the night, during sleep; the breath is gradually stopped, the person becomes unconscious; instinctive struggles may give the alarm, but death usually ensues, before any person can be called; of this Washington died, after an illness of a few hours.
GENERAL HISTORY OF BRONCHITIS.
It begins as a common "bad cold," the eyes are weak and watery; there is a running from the nose, chilliness, appetite fails, general weakness; there is a feeling of fullness all over the breast, of being stuffed up, great difficulty in drawing in the breath; cough commences, spiteful, quick and dry at first, then more loose, and expectoration begins, of a tough, tenacious, gluey, pearly substance, a cup full in a day. These coughing spells , are usually most severe of mornings on first waking up; at length, as the patient gets weaker and worse, the expectoration becomes yellow, greenish, black, bloody or