LARYNGITIS.
Acute catarrhal laryngitis demands as absolute rest as possible for the larynx. The patient after a brisk saline or mercurial purge should be put to bed in a warm room (65°F.), the air of which is kept moist by the vapour of hot water from a bronchitis kettle or steam spray. Compound Tincture of l3enzoin, Hemlock Juice, or a small quantity of Carbolic Acid should be added to the boiling water or to the water in the spray apparatus. so that the atmosphere in the neighbourhood of the patient's bed may be made to contain a small percentage of the volatile ingredients.
A Mustard poultice, warm fomentation, or Spongio-Piline wrung out of warm Carbolic Lotion or hot water, should be applied to the laryn \— the latter is the most convenient and soothing. Cold may he tried where warmth is found to aggravate, and freezing the skin over the thyroid space where the internal laryngeal nerve enters sometimes cuts short the attack. Warm demulcent drinks should be freely administered and perspiration encouraged. The following mixture for an adult is suitable: R. Liquor. Ammon. Acetatis Vini Antimonialis 3vj. Skit. .Etheris Nitrosi j. Succi Conii Aqua Camphors ad 5x. Misce.
Fiat nzistura. Capiat cochlearium magnum quartis horis.
In the case of children an emetic of Ipecac. and the remedies mentioned under Croup should be administered.
Where pain and dyspncea are present the soothing effects of the warm moist atmosphere may be intensified by causing the patient to hold his head over a basin of hot water to which the Friar's Balsam, Conium juice or Carbolic Acid has been added, a sheet being loosely applied so as to confine the concentrated vapour within the temporary tent so formed about his head and neck. This method is more reliable than the use of fancy inhalers, which must be placed close to the patient's mouth.
All ordinary indications are usually met by the use of a hand-spray apparatus into which the following liquid should be put: R. • Acidi Carbolici 5j.
Glycerini Boracis 3iv.
Aqua Rosa ad 3xij. Misce.
It is unnecessary and undesirable to place the nozzle of the spray inside the patient's mouth; it should be held a few inches from his face, and he should be directed to inspire deeply during the spraying process, which need only last for a few minutes at a time at hourly intervals. A 5 per
cent. Menthol solution in liquid paraffin or paroleine used in an atomiser is also very soothing. Rarely are scarifications or caustic applications to the interior of the larynx ever justified.
Acute laryngitis demands the promptest and most energetic treatment. The patient must be surrounded by a warm atmosphere saturated with steam. The opening of the larynx should be freely scarified after cocainisation by a sharp-pointed curved bistoury, and if immediate relief be not obtained intubation should be performed or tracheotomy resorted to without delay.
A spray consisting of s in 2,500 Adrenalin when employed early may obviate operative interference; 5 to TO per cent. Cocaine can be combined with it; the danger of laryngeal spasm may be minimised by a rectal dose of 2 or 3 drs. Bromide of Sodium. When active catarrhal symptoms have been combated by the above soothing remedies the patient should use a spray of 2 per cent. Tannic Acid before leaving his room.
Chronic catarrhal ,laryngitis shows itself in impairment of the voice and hoarseness. The treatment should be directed to the primary cause, and as this is nearly always due to excessive use of the vocal cords in public speaking or singing vocal rest is essential.
Though every constitutional disturbance or error is to be corrected by improved hygienic surroundings, including change of residence for a time to a bracing or mild atmosphere, nevertheless the most striking results are always to be obtained by local remedies when at the same time restriction is placed upon the use of the voice and tobacco and alcohol are abandoned.
Nitrate of Silver in solution (3o to 6o grs. tor oz.) should he applied to the interior of the larynx every 2 or 3 days. This is a very severe and painful remedy. Often a weak solution (2o grs. tor oz.) brushed daily over the interior of the larynx gives better results than the stronger solutions, which can only he used at considerable intervals. Chloride of Zinc (3 grs. tot dr.) is the best remedy when a purely astringent effect is desired.