Prognosis.—Spontaneous cure of the slight tubercular ulcers occasionally oc curs (14 cases out of 3000, fleryng), but the normal tendency of a tubercular process in the larynx is toward aggrava tion. When the epiglottis is affected the chances of recovery are very slight. These are improved materially, however. if the patient can be removed to a mild and warm climate and when the general health can, by suitable dietetic means. out-of-door life, and the judicious use of creasote. be favorably influenced.
Treatment.—The treatment of tuber culosis of the larynx should be local and general. general indications for the eneral c, • measures will be thoroughly reviewed in the next article, and arc invariably ap plicable when the larynx is diseased, whether primarily or secondarily.
Thorough cleansing of the laryngeal surfaces is an important feature of the treatment. This can be done most satis factorily with a. lukewarm solution of borate of sodium and bicarbonate of sodium, 10 grains of each to the ounce of water, using an atomizer, or the familiar Dobell's solution. Care should be taken to relieve the surfaces of all purulent discharges, and thus prepare them for remedial agents. If this can not be done daily by the attending phy sician, some person in the immediate surroundings of the patient should be carefully instructed; but under such cir cumstances the cleansing process had better be resorted to night and morning. As a local application Elsberg's satu rated solution of iodoform in ether has stood the test of time; it must be applied with the laryngeal forceps, a cotton wad being used. For the patient's home use, a solution of menthol, 20 grains to the ounce of benzoinol,—an excellent agent for the purpose,—will not only relieve the suffering, but greatly assist the cura tive process.
More active measures are resorted to by specialists, and lactic acid may be said to hold the first position in this di rection. A 50-per-cent. solution, well rubbed into the ulcerated tissues after they have been thoroughly anaesthetized with a 20-per-cent. solution of cocaine every three days, is often productive of excellent results, but only in cases in which the local lesion is limited in ex tent. This treatment is greatly facili tated by the continued use of orthoform either in powder or, as advised by Kassel (Ther. Monats., No. 10, 'OS), in the form of an emulsion containing orthoform, 25 parts; olive-oil, 100 parts. The
burning sensation lasts only about a quarter of an hour, and is then succeeded by anaesthesia, which commonly lasts from twenty-four hours to three and a half days. The patient is able to eat all kinds of food, and the appetite is greatly increased. A distinct diminution in the amount of secretion in cases of ulcera tion is noted, but otherwise it does not appear to have any local therapeutic value. Patients do not dread the lactic acid treatment if orthoform emulsion is used regularly.
Observations extending over a period of three to nine months, on the hypo dermic administration on alternate days, in 10-minim doses gradually increased to 20, of antitubercle horse-serum prepared at the Biochemical Laboratory, Wash ington, D. C., for the United States Government, show of laryngeal ulcera tions healed, 8 cases; laryngeal ulcera tions improved, 2 cases; laryngeal ulcer ations unimproved, 2 cases; laryngeal thickenings improved, 7 cases. Subject ive symptoms also showed marked im provement, the voice returning, cough subsiding, and pain ameliorating. Wal ter F. Chappell (N. Y. Med. Jour., Sept. 10, '98).
In phthisical laryngitis, by insulating a small quantity of orthoform in the throat, the patient is able to take food in comparative comfort for two days after each application. William Cheat ham (Amer. Therap., Feb., '99).
The curette may be used to advantage when too much tissue is not involved in the tuberculous process. It should be limited, however, to primary and incipi ent cases, and to cases in which the monary lesions are very limited in area. Under such circumstances the chances of success are quite fair. Unfortunately the procedure requires a degree of dex terity which an experienced specialist alone can possess, even with the assist ance of a 20-per-cent. solution of caine, which facilitates the operation and renders it comparatively painless. Her yng's or Krause's curette may be used, the operation being watched in the laryngoscopical mirror. Cicatrization is usually complete in three or four weeks, and considerable relief is afforded if cure is not obtained. The application of a 50-per-cent. lactic acid to the curetted ' spot serves to increase the efficiency of the treatment. Unless it can be carried out thoroughly, however, it had better not be resorted to.