With the invited co-operation of Prof. J. W. DOWLING and Dr. GEORGE G. SHELTON, New York City. A NEW (?) DISEASE AFFECTING THE BASE OF THE TONGUE. BY J. M. SCHLEY, M. D., NEW YORK CITY. There are many conditions affecting those parts to which the laryngologist has paid especial attention still mal-understood. We have only to cite the Crown Prince of Germany's throat as such an instance. After Virchow's learned writing on his histological examination you may draw your own conclusions as to whether it be a simple papilloma or a carcinoma. Recent events point undoubtedly to the latter. Again, some time ago, an article, with illustrative cases of supposed lupus (?) (primary) of the larynx was published in the Archives of Laryngology. The author claims to have seen seven such instances and cured three. The others were lost sight of. Any person having experience with lupus (simple or erythematous) knows full well that such an affair as related in all honesty--is well-nigh impossible. There are conditions, however, that we meet with which puzzle-baffle us for Annual Meeting. an explanation. It is no doubt possible that people from time to time have suffered from hypertrophy of the glandular tissue at the base of the tongue, or acute inflammatory conditions, yet they have gone unrecognized until within the past ten years. Doctor Lennox Browne (London) published in the Comptes Rendus of the Laryngological Congress held at Milan in September, 1880, his personal observations on this new (?) affection. Since then many articles have appeared on this subject, those of Moore, Fauvel and Stoerck being especially worthy of notice. Some Americans have also cited their experience, as Robinson, Rice, Gleitzman, Curtis, etc. I have examined three persons suffering from glandular enlargement at the base of the tongue within the past eighteen months. The notation of the first one coming under my notice will suffice for them all. A young singer applied at my clinic for treatment. She was thin of form, nervous, and anxious about her condition and voice. Her main support was by singing. On careful physical examination nothing was discovered beyond an insufficient mitral valve. She was not hysterical, neither had she ever had an attack of hysteria. The nasal fossæ were healthy, the naso-pharyngeal space slightly hyperamic, posterior wall of pharynx healthy, larynx normal. She complained of fullness in the pharynx, a desire to swallow something in pharynx at times causing pain, always causing discomfort, a stiffness (?) of the tongue, and an impossibility to gauge or modulate her voice as she was accustomed to do. She located her trouble correctly-as I found afterwards at the base of the tongue, for, after satisfying myself of the general healthy state and appearance of the surrounding tissues, my examination was directed to the papillæ. Here I found congestion, enlargement and sensitiveness to the touch. This patient was very persistent in her attendance, and after three or four months' treatment with a strong Lugol solution she has been nearly entirely relieved. Apis mel., Lachesis, and Mercurius dulc. II were the medicines administered seriatim. This was the first case of the kind I had noticed, the glandular tissue being markedly enlarged, reddened, overlapping the epiglottis in its center and on its sides. I thought I had noticed or perhaps could define a new malady from this person's novel condition, but found on looking over recent literature that similar states had been observed and written upon. There is no doubt that such pathological conditions are mistaken often for others. I believe homoeopathic treatment will cure these congestions and hypertrophies often without local treatment or cauterization. FUNCTIONAL APHONIA. BY LOUIS A. BULL, M. D., BUFFALO, N. Y. Mrs. æt. 31, was referred to me last October for the relief of a persistent aphonia. This is her history: Had always been a delicate child subject to lung troubles; had not begun to menstruate until twenty, and had always been irregular; when the menses appeared they generally lasted a week or more and were very profuse. Last April she had a miscarriage, since which she had menstruated but twice, the last time seven weeks before my seeing her, and then very profusely. Her present trouble dated back, so she said, some six weeks, to a night when she got her feet wet. She awoke in the morning with a croupy cough, and in the course of three days her voice left her and had been but a whisper since. Rhinoscopy showed the nasal passages to be nearly in a normal condition; turning the mirror downward the membrane lining the pharynx and larynx was seen to be in a state of sub-acute congestion; the vocal cords, while they lacked the pearly lustre of health, were white and moved freely as they were acted upon by the abductors and adductors; the membrane of the trachea was pale. Physical examination of the chest found a quickened pulse due principally to excitement; there was nothing else to call attention to the heart. In the left infra-clavicular region, next the sternum, in a spot about three inches square, jerky respiration was heard, and the spot proved to be sore upon percussion. She also complained of a pain under the left breast which passed through the chest to the scapula, but which was without objective sign; these were the sequelæ of a pleurisy which she had had in the early spring. Finding nothing in the throat or chest to account for the aphonia I questioned her closely as to whether she might not be pregnant; she was very sanguine that she was not, as she frequently went over some weeks. I sought a private interview with the husband and found him sure that such was the case, as his wife had lost her voice when enciente before and had recovered it shortly after the miscarriage. He intimated a desire to have the same remedy used in the present attack, but was at once informed that operative pro ceedings in my office never went below the diaphragm. I was told that the woman's mother used to have precisely similar attacks, but was unable to find whether the aphonia lasted entirely through the pregnancy. I report this case because of two interesting features: FirstThe cause of the functional aphonia-pregnancy-which must be rare, as I find it in but one of my authorities, Cohen,* and there it is merely mentioned; and Second-The apparent hereditary tendency to such aphonia. ENLARGED TONSILS. BY GEO. M. DILLOW, M. D., NEW YORK CITY. Before cursorily reviewing my experience in the treatment of enlarged tonsils, especially by local applications, the subject assigned me by the Chairman of the Bureau, it will be advantageous to glance briefly at their histology. The tonsils are lymph ganglia situated between the pillars of the soft palate, enveloped in a more or less perfect sheath of fibrous connective tissue, and covered by a nucous membrane, rich in muciparous glands. In other words, they are aggregations of lymph tissue, a widely spread formation in the mucosa of the pharynx and throughout the submucosa generally. This lymph tissue consists essentially of crowded lymph corpuscles enmeshed in a delicate reticulum of myxomatous connective tissue. Single conglomerations of this lymph tissue, usually globular or pear-shaped, are called lymph follicles, and groups of these follicles, separated from each other by a more highly developed myxomatous connective tissue which holds numerous lymph and blood vessels, make up the lymph ganglia, of which the tonsils furnish a conspicuous example. The covering mucous membrane dips down into numerous clefts in these lymph ganglia, the clefts often having several lateral elongations branching from them, thus forming the so-called crypts of the tonsils. The tonsils are, therefore, to be grouped histologically, and, to a larger extent, physiologically, with the so-called follicular glands at the base of the tongue, with the pharyngeal *"Diseases of the Throat and Nasal Passages," second edition, page 543. or Luschka's tonsil in the vault of the pharynx, with the lymph follicles in the walls of the stomach, with the lymphtic glands, probably with the thymus gland, and possibly with the thyroid body, the supra-renal capsules and the spleen. It is to be remembered that the functions of all these bodies are essentially unknown, or known very remotely; but, in every probability, they are profoundly connected with the processes of nutrition. It is significant that lymph tissue reaches its highest development in the young, and that it is in the developmental period of life that hypertrophy of the tonsils mainly exists. When the tonsils become enlarged there is an hypertrophy of all their constituent elements, the lymph follicles partaking most largely in the process. From these considerations it is easy to infer that local treatment addressed to the surface of the tonsils would be futile, a conclusion which agrees with the results of clinical experience. The tonsillar disease is a manifestation of a wider spread and obscure nutritional disorder, and it is to hygienic and dietetic measures, conjoined with remedies influencing nutrition and the lymphatic system, that we must look for a really rational method of cure. The authorities generally agree that local applications are ineffectual, and that the main stress must be laid upon constitutional treatment. Herein, also, I find the explanations for the fact that the mercurials, the iodides, the calcareas and the barium salts are clinically most useful. I have observed that the remedy which reduces the tonsils, furnishes the key to the constitutional remedy for the patient, and I avoid tonsillotomy except as a last resort, and only for the mechanical effects of their removal, because: (1) The effects commonly ascribed to enlarged tonsils, according to my view, appear to be coincident and concomitant manifestations of a constitutional disorder; (2) by their removal I lose the criterion by which I gauge improvement in the underlying constitutional condition; and (3) because I find the obstruction to respiration most frequently in the accompanying catarrhal swelling of the naso-pharyngeal mucous membrane. If a more detailed view be taken, chronically enlarged tonsils may be classified, according to size, into minor, medium and excessive; according to structure, into the lymph or soft, and fibrous or hard; according to age, into puerile, pubescent and adult; according to diathesis, into catarrhal, strumous and rheumatic. The minor and medium sizes I do not excise, addressing treatment to the constitutional state and the concomitant catarrhal condition in the nasal passages. It is only when there is a tendency to repeated attacks of acute tonsillitis, follicular or suppurative, which I cannot control readily by internal remedies, that I remove a portion of the gland |