In laryngeal tuberculosis curettage is indicated: 1. In cases of primary tuber culosis without pulmonary complica tions. 2. In circumscribed ulcerations and infiltrations. 3. In hard infiltra tions of arytenoid region of posterior wall, ventricular bands and tuberculous tumors of the epiglottis. 4. In incip ient stage of pulmonary disease with but little fever and hectic. 5. In ad vanced pulmonary disease with distress ing dysphagia. The contra-indications are: 1. Advanced pulmonary disease and hectic. 2. Disseminated tubercu losis of the larynx. 3. Extensive infil trations causing severe stenosis where tracheotomy is indicated. 4. In the timid, distrustful, with little nerve power. J. W. Gleitsman (N. T.
Jour., Jan., '93).
Among the more severe surgical meas ures at the disposal of the physician, enucleation of the diseased area with sharp forceps may be advantageous when the infiltration is limited to a location, such as the arytenoid prominences, which may readily be grasped. Thy rotomy enables the surgeon to reach all parts of the larynx from the outside and to curette thoroughly any diseased sur face. This should not be resorted to, however, when the disease is far vanced. Tracheotomy is sometimes re sorted to, to give complete rest to the larynx or when dyspncea becomes a source of suffering or threatens to be come aggravated.
An important feature of the treatment is to enable the patient to nourish him self properly. Unfortunately the dys phagia is always the most marked symp tom,and the sufferings of the patient are sometimes excruciating. The most factory method is to apply a 4-per-cent.
cocaine solution with the atomizer about 5 minutes before each meal, to the larynx, thoroughly bathing all its sur faces, and to alternate this every week with orthoform powder. The patient
does not, in this manner, become ha bituated to either drug, and the bene ficial effects of each are preserved.
Much of the suffering may be avoided in the later stages if, as suggested by Wolfenden, the patient will lie on his stomach on a bed and suck up liquid food through a tube from a receptacle placed on the floor. The food thus tends to enter the oesophagus through the pyriform sinuses on each side of the larynx, and to avoid contact with the latter.
Formaldehyde is an excellent remedy in tubercular laryngitis. The treatment is begun with solutions of from to 1 per cent., and gradually increased until a strength of 10 per cent. is applied. When strong solutions are used the larynx should be •ocainized before their application. Weak ,olntions of a single drop of liquid formaldehyde in an ounce of water have an anesthetic power that produces exceedingly gratifying results when used as a gargle or spray in ad vanced cases, where swallowing is pain ful. The use of such solutions enables the patient to avoid the discomfort and the use of cocaine. T. J. Gallagher (Jour. Amer. Med. Assoc., xxxii. p. 470, '99).
Phenosalyl, composed as follows, highly recommended:— R Carbolic acid, 9 parts. Salicylic acid. 1 part. Lactic acid, 2 parts. 3lenthol. part.
Used in sixteen cases, always applying a local anaesthetic first. Dysphagia soon became improved. dry tuberculous ulcers without oedema and infiltration became clean after a few treatments, and the larynx assumed a rosy-red color. Stanis hms von Stein (Kliniseh-therap. Koch.. Oct. 2S, 1900).