Pathology.—In the idiopathic form of acute laryngitis the superficial vascular supply is mainly at fault and there are very few cases in which a certain amount of cellular infiltration does not occur, and the line of separation between the superficial and deeper changes is not easily discerned. The primary factor in such cases is probably vasomotor, and if the paresis of the vascular nerves is marked the serous infiltration by din pedesis into the tissues may be such as to give rise to slight tumefaction. The epithelium may be sof tened and localized, desquamation occurring; diminutive ero sions are sometimes found.
Treatment.—The patient should re main in a warm room, refrain from talk ing and smoking, and not allow others to smoke around him. Hot food increases the local congestion and especially the hot alcoholic drinks so frequently in dulged in. Cracked ice and ice-cream are usually grateful to the patient and benefi cent to his throat.
An acute attack of laryngitis due to "cold" may often be arrested by the early internal use of bromide of potas sium and opium. Twenty grains of the former, with 2 drachms of paregoric, re peated every three hours usually reduces the laryngeal hyperresthesia which lies at the bottom of the local symptoms to a minimum, while the likelihood of any complication is greatly decreased. The somnolence also induced tends to reduce the localized congestion. After this effect is obtained. the dose may be re duced by half and taken every two hours, two or three times. A. bottle of citrate of magnesium taken the next morning often' bring-s on the stage of resolution. This may be encouraged by means of the official compound guaiac lozenges.
In some cases the inhalation of steam impregnated with the compound tincture of guaiac is quite effective, but not nearly as much so as the method given above, which it is calculated to replace, when patient cannot take the bromides. One teaspoonful of the compound tincture is placed in a pitcher of water as hot as obtainable; the vessel is covered with a towel folded into the shape of a cone; the mouth and nose are inserted into the open top of the cone, an.d the steam is inhaled deeply as long as it is emitted. The inhalation of steam charged with the compound tincture of benzoin is pre ferred by some clinicians. It may be employed in the same manner as the tincture of guaiac.
inhalations by means of an atomizer of ft cold 2-per-cent. solution of ich thyol repeated twice daily, and not too deeply inspired for fear of producing nausea and vomiting, have g,iven excel lent results in acute laryngitis. Ciegle
wicz (Vrateh, xix, No. 8, '98).
In acute laryngitis, without cedema. inhalations of steam containing cam phor-menthol will often in the early stages aid considerably in aborting, an attack, while alter the disease has ex isted for a day or so the addition of benzoin will aid in allaying the cough and irritation. When (edema is present, hot inhalations are of little value and frequently- increase the extent of the swelling, while an iced spray of 1/2- to 1-per-cent. eamphor-menthol, alternating every half hour, or even fifteen minutes in eases where the dyspncea is severe, with a spray of the suprarenal gland, will produce a rapid change in the ap pearance of the laryngeal swelling and frequently relieve the dangerous symp toms. L. S. Somers (Merck's ..A.rchives, Dec., 1901).
In many cases the local disorder is greatly influenced by general disorders.
In female professionals, especially, stipation is almost the rule, owing ably to their irregular mode of living, their varying diet, and the continued traveling in railroad-cars. Purgatives, even mild aperients, are, for obvious reasons, out of the question when even ing after evening the sufferer is to ap pear upon the stage. Enemata, while being immediately effective, present the advantage of not diminishing the pa tient's strength. An enema composed of one pint of lukewarm water and a table spoonful of glycerin will sometimes be found to act surprisingly, not only on the intestines, but on the voice, especially if, as is often the case -with traveling artists, the bowels have not been moved for sev eral days. If fever is present, drop doses hourly of tincture of aconite will usually reduce it markedly.
In cases in which the bromides and opium cannot be given, a solution of re sorcin or alumnol, 7 grains to the ounce, should be used with an atomizer about every two hours the first day, then three times daily. To enable the solution to thoroughly bathe the bands, the voice should be sounded during inhalation, while the fluid is being sprayed in, the bands being thus brought in and forming a floor, as it were, at the lowest portion of the larynx. When the hoarseness is great, an application with cotton pledget of carbolized iodotannin or a solution of perchloride of iron, 20 grains to the ounce, causes a sudden contraction of the capillaries, which is effectively main tained by the resorcin solution.