TREATMENT OF COMPLICATIONS IN THE UPPER AIR-PASSAGES.—It is aston ishing how large a percentage of even incipient cases of pulmonary tuberculo sis present lesions of more or less se verity in the upper air-passages, and it is a question whether quite a number of patients may not attribute their trouble, primarily, to conditions of the nose or pharynx, which have, by reflex irritation, created a nidus for pulmonary infection.
It should be the invariable practice to examine the naso-pharynx and larynx of all tubercular patients the first time they are seen, whether or not there be subjective symptoms leading to the sus picion of disease of these parts. By these routine examinations, cases of chronic congestion or infiltration of the arytenoids are discovered early enough to be easily cured in nearly every in stance by prompt local treatment. Un recognized and left to themselves and climate, such cases, at least in a fair ma jority, either lead to fatal laryngeal con ditions or are the indirect cause of pre vention of cure of incipient pulmonary lesions.
Statistics show that not less than 25 per cent. of persons suffering from pul monary tuberculosis have more or less involvement of the larynx and naso pharynx. (See TUBERCULOSIS OF THE LARYNX.) The naso-pharynx should be put in the best possible condition by frequent spraying with albolene solutions, fol lowed by sprays containing such appli cations as may be individually indicated.
Polypi must be removed; hypertrophic mucosa or turbinated bones may be re duced by fused nitrate, chromic acid, or suprarenal extract. Excrescences of a bony nature must be removed by opera tion. Slight laryngeal congestions yield readily to a cleansing spray, followed by a solution of alumnol, 10 to 20 grains to the ounce, or silver nitrate, 4 to 10 grains to the ounce. Chronic conges tion and infiltration require, besides the cleansing by Dobell's solution, a local application of strong alumnol, of the strength of 25 to 50 per cent.; lactic acid, 20- to 25-per-cent. solution; silver nitrate, 30 grains to the ounce, or the fused crystals. For ulcerations, good re sults may be attained by a spray of hy drogen peroxide, 50 per cent., followed by Dobell's to remove secretions. After this a direct application of either lactic acid, 20 to 25 per cent., or Chappell's creasote mixture. Sluggish granulations should be stimulated by fused nitrate.
Mucous tags remaining after removal of papilloma disappear under treatment with suprarenal extract. Tracheal ulcer ations do well with intratracheal injec tions of argonin. 5 grains to the ounce, or a weak solution of silver nitrate.