Pilocarpine injected hypodermically proves very efficacious in reducing laryn geal (edema. Six drops of a 5-per-cent. solution of the alkaloid, repeated three times at intervals of fifteen minutes, caused complete relief in the cases re ported. Suarez de Mendoza (Revue de Laryng., Aug. 15, '91).
If a case be seen at the beginning of an attack, the treatment consists of inhala tion of warm medicated vapor, the use of diaphoretics, the maintenance of the patient's room at an equable tempera ture (72° F.), with the air moistened by the vapor of boiling water, and at a later stage the application of leeches over the region of the larynx, to be followed by the continuous usc of the cold coil. The stitIsing t f ptllets of ice is also to be rtt.t.11 nitlitittl. Upon the appearance of tt N cr, staritleation IN itil the itgc.il lancet be performed.
1'. Hopkins (Med. 1Zeeord, Oct. 19, '95).
plitation of leeches to the front of the neck is very effective in acute and ritnary ugeal (edema. Levi and Latin OC.n. de Dee., '95).
ln a case of aeute idiopathic Ledema of the Lpiglottis in a man of 41, a spray of ' , per cent., iu ice-water every fifteen minutes. with ice externally, gave rill rtlit.f. W. P. Meyjes (Jour. of Laryn., ete., Alan, '97).
Acute submucous laryngitis in chil dren, characterized anatomically by sub mucous infiltration, bearing a misleading resemblance to acute mdcma, is mani fested clinically as a suffocative catarrh.
A point of particular diagnostic im portance is the association of an unim I aired VOitC With a hoarse cough. In tubation is indicated when retraction is marked. Castaneda (Jour. of Laryn., Rhin., and Otol., Apr., '97).
Tincture of belladonna, 3 drops every hour until its physiological effects be come marked, also tends to counteract the infiltration by contracting the laryn (real blood-vessels.
A.stringent solutions should only be used in circumscribed cedema, a weak solution of tannin, alumnol, or resorcin being- valuable in such cas.es. When the cases can be closely watched, a 10-per cent. solution of cocaine applied directly to the larynx causes momentary—though slight—retraction of the tissues, and may thus be advantageously used especially when surgical measures are to be resorted to: scarification, intubation, or trache otomy. In some cases, however, it seems
to increase the dyspncea.
When the dyspnoea becomes urgent, scarification of the lar3-ngeal tumefaction is indicated. With the assistance of the laryngeal mirror—held in the left hand —the procedure is quite easy after awes thetizing the larync:eal tissues with a 10-per-cent. solution of cocaine. The pocket-case curved bistoury is wrapped in a piece of bandage held in place with thread up to within an eighth of an inch of the tip, to prevent cutting the tongue with edge of the blade. The tongue be ing drawn out and held by the patient, the epiglottis will generally be seen stand ing erect, and looking, when much infil tration exists, not unlike a pale cherry. This should not be punctured first, as the patient may refuse a second incision and the first should be the most profitable one to him. The portion playing the most important part in the production of the dyspncea is the aryepiglottic fold, and this can usually be depleted by means of a short incision into its external border, thus causing the blood and serum to flow into the pyriform sinus, instead of into the larynx proper. When the patient is docile, both sides can be scarified and the epiglottis also, care being taken to prick the edges with the point rather than the internal aspect of the laryngeal walls.
When a laryngoscopic mirror is not at hand, the index finger of the left hand should be passed behind the epiglottis and used as guide for the curved bistoury.
At times scarification even when thor oughly carried out, does not relieve the dyspncea. In that case the lower portion of the larynx and the tissues beneath the vocal bands will probably be found in volved in the inflammatory process, when. examined laryngoscopically—if seen at all. Under these circumstances either intubation or tracheotomy must be resorted to. (See INTUBATION and TRAcTrEoTomy.) In acute circumscribed cederna of the larynx searifications should be made. Landgraf (Jour. of Laryn., Apr., '94).