To hasten the process of resolution, a pill composed of 1 grain of quinia and grain of nux vomica, administered every two hours the first day, then four times a clay. Mariani's coca-wine, a wine-glass ful being taken every three hours during the day, is especially effective in this con nection, but the last dose must be taken at least three hours before using the voice professionally.
ln the trentnlint of rheumatic dis t viler.: of the larynx local measures are ticallv useless. The benzoate of so dium is sometimes quite effectual. 5 grains being ,,:iven every three hours. Salit.Nlat( of sodium is the standard remedy \\ inn it can be tolerated. (See littErNIATIsm.) CEdema of the Larynx.
tEdematous infiltration of the larynx may oceur as the result of a simple ca tarrhal process, of traumatic laryngitis, or as a complication of infectious dis orders. proximate or remote.
Symptoms.— The first manifestation may be a chill. soon followed by hoarse nfss and laryngeal pain. The most prominent symptom experienced almost from the start is a sensation of constric tion at the throat and gradually increas ing dyspncea, most marked during in spiration. There is also local heat, dry ness, and a muflled cough, which the pa tient aggravates by efforts to rid the sur faces of a supposed secretion. There is increasing huskiness, both inspiration and expiration being finally impeded. In favorable cases there is a gradual decline of all symptoms; but this course is not always observed, and, unless prompt re lief is afforded, the patient dies of asphyxia. The temperature is not, as a rule. much above the normal.
Nine eases of acute laryngitis suffi ciently grave to cause dyspnceic recession of the chest during inspiration. The pulse invariably became small during the same period. As the disease progressed, the symi tom became more and more marked until, just before tracheotomy was done in the cases requiring it, the pulse was found to be almost itnpercep tible during inspiration. Tie moment the trachea was opened and air allowed to freely enter the chest the pulse re sumed its regularity in volume and rhythm. Brockbank (British Med. Jour., June 24, '93).
CaSe of acute tudenia characterized by the following features; (1) the absence of any knowti causative agency and eon stitntional symptoms; (2) the extent of (edema whivit Itmy occur ithout marked dyspnma; (3) the peculiar char acter of the voice; (4) the marked benefit of prompt rea tment without scarification; (5) the possibility of the case belonging to a group of obscure clinical manifestations known as angio neurotic (edema or allied vasomotor phenomena. J. II. Pryor (Med. Record, July 28, '94).
The laryngoscopical examination re veals local changes varying with the cause of the (vderna. When the latter is sec
ondary to acute laryngitis, the upper por tion of the larynx over which the tissues are comparatively loose are swelled and red or reddish yellow. The epiglottis sometimes appears as a thick. cushion, covering two sausage-like bodies under it, the aryepiglottic folds. As the tissues swell, these tend to roll inward, forming a series of cushions whose edges gradu ally approach one another, steadily re ducing the lumen of the laryngeal cavity. When the cedema is the result of trau matism or contact with corrosive acids, etc., there is great redness and supple mentary local lesions. Marked inflam matory swelling also attends the erysipel atous form.
When cede= is due to a general dis order, the mucous membrane is, as a rule, paler than when it occurs as a coinplica tion of a local inflammatory process.
In cedema of the entrance of the larynx the passage to the glottis is obstructed most especially by swelling of the inner layer of the aryepiglottie folds, which lie like two morbid growths upon the ventricular bands, and thus become a great impediment to respiration. Hajek (Archives G6n. d'Hydrol., etc., B. 42, II. 1, '91).
In cedema occurring as a result of in halation of steam, fire, caustic vapors, or to the deglutition of too hot liquids, or corrosive substances taken accidentally or with suicidal intent, such as carbolic acid, sulphuric acid, etc., the onset of the symptoms is comparatively sudden. Dyspncea and spasm sometimes occur from the start, and all the symptoms of acute laryngitis enumerated are increased in intensity. The gravest local mani festation of laryngeal inflammation, (edema, is soon reached. In the majority of cases met with, however, after a series of acute manifestations, momentary dyspueea and laryngeal spasm, etc., which the physician does not, as a rule, witness, the larynx assumes a comparatively nor mal condition, as far as the patient goes, though, however, the laryngeal struct ures become infiltrated and after a few hours—sometimes an entire day—the most distressing symptoms appear, and the patient dies asphyxiated, unless re lieved. (See colored plate.) The upper portion of the larynx may show evidence of tissue-destruction when such agents as carbolic acid, ammonia, etc., have been used; but in the majority of cases laryngoscopical examination only reveals intense redness of all the laryngeal tissues, with slight swelling. The active congestion may be localized, this depending upon the causative agency. In laryngitis due to burning fluids the epiglottis may alone be in volved, but in the vast majority of cases neighbnring pharyngeal tissues, the interarytenoid space, the ventricu lar bands, and the vocal bands take part in the inflammation.