Treatment.—The association so fre quently noticed between chronic inflam mation of the naso-pharynx and of the larynx renders it imperative always to examine the entire upper respiratory tract when continued hoarseness is com plained of. This is further supported by the fact that cases are often met with in which no benefit whatever is derived from treatment limited to the larynx until attention is given to the naso pharyngeal surfaces. Cleanliness of these parts, in fact, 'nay be considered a sine qua 7101Z of success in 90 per cent. of cases. The same remarks may be ap plied in connection with concomitant disorders of other organs.
In many cases the laryngeal inflam matory process is sustained by disorders of gastric, hepatic, and renal systems, all of which require close scrutiny.
Attacks of hoarseness in professional vocalists are often but exacerbations of chronic laryngitis, a deficiency of lubrication of the vocal bands being the main local factor. Tbis condition may successfully be combated by ad ministration every two hours of 10 grains of ammonium chloride in a tumblerful of water, and the topical use of warm sprays of a saturated solution of potas sium chloride at the same intervals. The doses are so managed that the last one should be taken at least about three hours before a performance. This avoids ex posure during the subsequent stage of perspiration. A lozenge containing 10 grains of the ammonium chloride taken between the acts is of benefit in many instances.
The following formula is useful in chronic laryngitis:— Thymol, 15 grains.
Eucalyptol, 20 grains.
Creasoti, 2 drachms.
01. pini sylvestri, 4 drachms.
01. gaultheriie, 1 drachm.
M. Sig.: For inhalation use from 2 to 5 drops. C. C. Rice (Amer. Med. Com pend, Feb., '99).
The characteristic congestion of this affection, and even the superficial ero sions frequently encountered, will often yield to a detergent spray of bicarbonate of sodium, borate of sodium, and salic ylate of sodium, 3 grains of each to the ounce of water, applied copiously three times a day to the entire upper respira tory tract—the nose, the pharynx, and the larynx.
In stubborn cases occurring in singers, spraying with a 2-per-cent. solution of lactic acid, used frequently,--eight to ten times daily,— recommended. Hy gienic measures and tonics form impor tant adjuvants. Massei (La Sem. MEd., No. 32, '94).
After cleansing, even the slight ero sions should be touched with stronger acrents Solutions of nitrate of silver are 0 • most effective, but demand considerable dexterity if laryngeal spasm is to be avoided. The laryngeal forceps must be
used, its tip, covered with a cotton pledget, being gently applied to the mucous membrane. Resorcin is an effect ive agent in a solution containing 7 grains to the ounce. A 20-grain solution f dof rin bt. n..oinol is a very effect remedv, but the dillieulty of keeping tl.e atoini r free when benzoinol is used rt rs its employment obnoxious to the tit. The infraglottie region should ot hi. overlooked when local applications are made, the patient being, also directed J.-) inhale deeply when the atomizer is Ling uscd• lodol might be substituted, but it pos sesses irritating properties when used in strong solutions: 5 grains to the ounce is the maximum strength that an in flamed larynx can stand with benefit. Solutions of sulphate of zinc, sulphate of copper, and alum. 5 g.rains to the ounce. may be substituted should the other a
Mild eases, especially those in which there exists involvement of the infra glottie tissues. are greatly benefited by benzoate of sodium. Exacerbations are sometimes quickly stopped with 5-grain doses administered every three hours, in addition to the local measures recom mended.
In certain cases the vocal bands will present, during exacerbation of the catarrhal process, the greatest amount of congestion as compared with other parts of the laryng.eal cavity. Their mucous membrane, as stated, appears thickened, bosselated. and very red at the edge, the voice being coarse and screechy when an effort to sing is made. This form of chronic laryngitis is character ized by frequent exacerbations, and finally costs a singer his voice unless he stops singing for a while and undergoes active local treatment. tabus, of Milan, proposed flaying- of the vocal bands in these cases. and obtained several satisfac tory re.snits. After thoron,:hly anms thetizing the larynx he tore off with a sharp square-tipped laryngeal forceps the superficial layer of membrane of the vocal bands—a procedure followed by slight hannorrhage, a few days' aphonin, and final recovery of the voice. I have sub stituted applications of chromic acid to destroy the thickened mucous layer, ob taining equally satisfactory results. Co caine causing a copious ilow of lubri cating fluid from the lateral tissues when applied to the larynx for a certain length of time, it is necessary to use the acid as soon as possible after the application of the 25-per-cent. solution, the strength it is advisable to employ.