Atlas and epitome of diseases of the mouth, pharynx, and nose / by L. Grunwald; authorized translation from the German, edited with additions by James E. Newcomb.

  • Grپnwald Ludwig, 1863-
Date:
1903
Catalogue details

Licence: In copyright

Credit: Atlas and epitome of diseases of the mouth, pharynx, and nose / by L. Grunwald; authorized translation from the German, edited with additions by James E. Newcomb. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    lature of the bronchial tree contracts; cough is produced when the irritation affects the larynx or the deeper por- tions of the pharynx ; sneezing, when the nose or the extreme anterior portion ot the palate has been irritated. I liese defensive movements are sometimes produced also m response to cutaneous stimuli, as appears from the fact that this normal reflex process is very apt to be started in some abnormal way; and, on the other hand, it indi- cates that the physiologic is separated from the pathologic. by a very narrow boundary. The alteration in the re- flexes presupposes a special predisposition of the con- ducting nerves that make up the reflex arc, or of the entire individual. Peripheral stimuli which do not in the least affect normal individuals produce spasm of the bronchial and other respiratory muscles, asthma, or, in other cases, paroxysmal attacks of coughing; and sneering. Such is the simple basis of the so-called reflex neuroses of the nose and pharynx. The initial stimulus may be derived from repeated tickling, irritation of the mucous membrane by the contact of other movable parts, such, for instance, as a small polypus, or from the changes which are presumed to take place in the outermost nerve- endings of the turbinates and septfun, which may start the reflex act even after a slight stimulus, such as a thermic impression, for instance, well within the domain of the normal. One of the most frequent causes, and one which is very commonly overlooked, especially in the case of asthma, is the constant flow of nasal discharges into the pharynx, so common in conditions associated with excess- ive nasal secretion. The laborious and often fruitless efforts to prevent the accumulation of this secretion, to- gether with the general irritation due to the chemical and mechanical causes, readily bring on the expiratory reflex. In addition to these local areas of excessive irritation and a general predisposition, there is in many cases a temporal and topographic element, the attacks coming on at certain seasons of the year or hours of the day, and in