§ 192. CEsophagitis, angina aesophagea, dysphagia in-flammntoria.

The inflammation cannot be seen in the throat. In the region where the inflammation is seated, behind the trachea and between the shoulder blades, along the spine, the patient experiences a seated, burning, aching-stinging pain. The food passes with great difficulty and pain, its passage causing at times a violent spasm, with retching, discharge of food and drink by the nose and mouth, inclination to vomit, discharge of tenacious mucus by the mouth, singultus attended with feeling of anguish, distorted and pale face, small and contracted pulse. The patient is tormented with thirst, but the patients are prevented from quenching it by the pain which swallowing causes. There is generally little fever. Cerebral symptoms, congestion of the brain, convulsions may set in as consensual symptoms.

CEsophagitis is exceedingly rare and generally traumatic, occasioned by some mechanical or chemical cause.

§ 193. If the inflammation should have been caused by foreign bodies, they have to be removed, after which mucilaginous and oleaginous things, such as small quantities of lukewarm milk, should be given. If deglutition should be impossible, the thirst has to be quenched by taking small pieces of ice into the mouth, or by applying humid fomentations around the neck, etc.

The principal remedies for oesophagitis are: Arnica, Rhus t., Cocc, Sabad., Bellad., Arsen., Mercur., Secale, Mezer., Lauroc, Carb. veg., and some others.

I have frequently removed the disposition for the frequent recurrence of angina by the third or sixth trituration of Merc. sol. Others have done this by means of . Sepia. Baryta mur. and Graphites are other excellent remedies for angina when coming on after a cold, with disposition to ulcerate.

§ 194. Laryngitis, tracheitis, and bronchitis acuta, (angina pectoris.)

Although the seat of these inflammations is different, yet their symptoms are pretty much alike. In laryngitis, the pain extends over the whole larynx, is increased by contact, deglutition, talking, cough, is attended with a sensation of tightness, and is of a stinging and burning nature. In tracheitis the pain extends along the whole throat, as far as the handle of the sternum; in bronchitis the pain extends to the middle of the sternum. These three inflammations vary from the catarrhal to the most acute form.

The catarrhal form of this disease is characterized by a titillating sensation in the larynx, hoarseness, short and hacking cough, at first attended with expectoration of a small quantity of transparent, tenacious mucus, followed by the easy hawking up of a larger quantity of globular, green, purulent matter, and with oppression of breathing and slight fever. This catarrh is almost always accompanied with coryza and catarrh of the fauces, causing but little suffering. The acute inflammation sometimes sets in without any previous catarrhal symptoms. The cough is at first dry, painful, fatiguing: it has a peculiar barking, rough, metallic sound, and is attended with expectoration of tenacious, blood-streaked mucus. The voice becomes sonorous, hissing, and is finally entirely suppressed, particularly in tracheitis and laryngitis. In laryngitis the cough is more superficial, without involving the thorax or diaphragm; in tracheitis and bronchitis it proceeds from the lower parts of the chest, and has a more metallic sound. Respiration is more or less difficult, the inspirations are attended with a distinct whizzing in the larynx; the shortness and oppression of breathing are most violent in bronchitis, and may even increase to suffocation; the respiration, voice, and cough assume a croupy form, with an expression of excessive anguish in the face. The stethoscope does not reveal any symptoms of pneumonia.

The fever is either erethic or synochal. In the latter case the pulse is frequent, hard, and full, the skin glowing, thirst violent, the fever continuous; in the former case all these phenomena are less violent and characterized by complete intermissions.

§ 195. Causes: these inflammations occur among either sex, and at every age; they are most frequent among young people and such as have frequently suffered with catarrh. They occur most frequently by the action of cold air upon the bare neck when the skin is covered with sweat, sudden passage from warm into cold air, walking or running against the wind; in some cases these inflammations are the sequel of a catarrh or whooping-cough. Laryngitis often arises from exerting the larynx too much, and is frequently met among preachers, singers, actors, etc.: it is furthermore caused by injuries of the larynx, inhalation of dust, irritating vapours, etc. An angina faucium sometimes leads to laryngitis. General diseases, such as measles, scarlatina, small-pox, syphilis, tuberculosis, etc., sometimes localize themselves in those organs.

The disease lasts from several days to three or four weeks, except in a few cases where it becomes chronic.

§ 196. It is sometimes very difficult to select the proper specific for this disease. If the cough be dry. 5* or if the hawking up of mucus be extremely difficult, Bell., Bryon., Chamom., Cina, Ignat., Nux v., Merc, Phosph., Sulph., etc., will have to be selected.* Nux v. is most suitable when the cough is rough and dry, or caused by scraping and titillation in the throat, (in which case Veratrum is excellent, provided the other symptoms correspond;) when the cough is most violent in the evening or morning, and disturbs the patient's rest all night; when the cough is attended with headache, as if the skull would burst. Nux v. is likewise suitable when the racking cough is attended with a bruised feeling in the umbilical region, which is likewise painful to the touch. Chamomilla should.be employed for similar symptoms, when the cough is most violent at night. When the cough comes on at night only, it is either removed or at any rate relieved by Hyoscyamus. For short cough accompanied with fluent coryza, becoming spasmodic after continuing for some time, and occurring equally at any time of the day, Euphrasia or Ignatia are recommendable, according as either remedy is indicated by the other symptoms. If the cough should get worse in the cold air and be less in a warm temperature, if it should exacerbate in the evening and continue so the whole night, Rhus t. is indicated, and for the latter symptom alone, Capsicum. Sulphur should be given if the hoarseness is very great and the cough is worse in the evening and on lying down. In catarrh the selection of a remedy sometimes depends upon apparently trivial symptoms. § 197. If the inflammatory irritation should be characterized by fever, oppressed respiration, hoarseness and croupy cough, Aconite is to be employed. After the diminution of the fever, the remaining cough, which is sometimes accompanied with a sort of spasm in the larynx, and results in retching or vomiting of mucus, should be combatted by Nux v., Ipec, Puls., Bell., Merc, Dros., Spong:, Iodium, Bryonia, Hyoscy-amus, Cina, Lictuca vir., and particularly Conium and Ipec in repeated doses, will be found useful when the cough is a simple irritability or spasmodic cough, without retching.

* Aconite is not to be omitted - Hempel.

§ 198. Bronchitis is very frequent, and occurs particularly among children. It generally comes on sudden!}-, without any precursory catarrhal symptoms. The pain is seated in the upper part of the thorax below the neck. It is a feeling of pain spread over a large surface, a constriction, pressure and various other unpleasant sensations, which are not seated or emanate from a single spot. The patient is able to lie in any situation, except that the trunk has to be kept bent over. The breathing is hurried, painful, irregular, and becomes more and more troublesome; it is frequently characterized by a peculiar kind of rattling, or fermenting in the chest; sometimes by a wheezing or whiffing noise, without croup-sound. The cough has no particular sound; sometimes it sounds loose, as if the patient would expectorate at every turn of cough; the expectoration is scanty, affording little or no relief. Bronchitis is unattended with hoarseness, without any particular roughness of voice, without any sensation of pain or obstacle in the larynx, without any striking paroxysms. Bronchitis may be distinguished from laryngitis and tracheitis, and from pneumonia, by the excessive fever, by the hurried breathing, which generally expresses the most frightful anguish, by the expression of anxiety and sadness in the face, by the pain being spread all through the chest. Particularly striking is the sudden debility, with small, quick and feeble pulse and copious expectoration, which is at last rendered impossible by the excessive debility.

The treatment should he commenced with Aconite. If after the abatement of the, fever, local symptoms should still remain, with anxious and hurried breathing, Ipec. or Samb. are indicated; if the breathing should be wheezing, Spongia, China, Chamomilla; if there should be a sense of constriction during breathing, Nux v., Veratr., Puls., Bellad.; for general debility , with violent action of the pectoral muscles during an inspiration, give Arsenic; if the inspirations should evince a paralytic condition of the lungs, Tart. emet. is most suitable. A frequently-recurring tracheitis is most certainly removed by Iodium and Phosph. (which sometimes cures the affection from the commencement).* Nitrum,Mang. carb., Carb. veg., Dig., Canth., and Sulph., may likewise prove useful.

A so-called suffocative catarrh, is a condition of the thoracic organs, closely resembling the above-described inflammatory symptoms. This kind of catarrh is generally preceded by catarrhal symptoms, with coryza, which disappears spontaneously, without any definite cause. The first attack generally sets in at night. After the cough and coryza have disappeared, the patient ought to be well, but this is not the case; the patient is out of humour, feels oppressed, lazy, languid, he has flushes of heat, no appetite, but great desire to sleep. After going to sleep, towards midnight, the inspirations become more and more oppressed, rattling, attended with anxiety, tossing about, moaning, the patient is lying in a state of sopor, from Which it is difficult to rouse him. Such catarrhs occur very frequently in individuals who have frequently been attacked with catarrhal affections and inflammation of the thoracic organs, and who have weak chests. Arsenic is a specific remedy for such suffocative catarrhs. When these suffocative catarrhs occur in children, in consequence of exposure to cold, they generally yield to Chamomilla or Ipecacuanha, after which a dose of Bryonia may be given. In some cases, Sambucus is the appropriate specific.

For the moist cough which sometimes remains after such an inflammation, and is attended with profuse expectoration, the following remedies will prove useful: Puls., Dulc, Chamom., Bryon., Arn., Statin., Sepia, Ly-cop., Silic, Phosph., Graph., Natrum mur., Senega, etc.