Where the cords are thickened a 40 per cent. Lactic Acid Solution may he used, and it may be necessary to excise a portion of the hypertrophied tissue in the inter-arytenoid space. Singer's nodules may be excised, but as they are usually due to faulty voice production the best plan to pursue is to correct this after a prolonged rest to the larynx.
Strong local applications can only be made by the surgeon—a serious drawback in the treatment and management of a chronic disorder—and hence the great value of sprays and inhalations, which can be used by the patient as often as deemed desirable. • Of the astringent spray solutions the following are the best: Alum (5 grs. to c oz.), Tannic Acid (5 grs. to I oz.), Perchloride of Iron (5 to to mins. of the weak liquor tor oz.), Sulphate of Zinc (2 grs. tor oz.),Sulphate of Copper gr. to r oz.), and when an alterative effect is desired weak Tincture of Iodine (5 mins. to r oz.), Chloride of Ammonium (ro grs. to oz.). Bromide of Ammonium (5 grs. to r oz.), Eucalyptus Oil (2 mins. to r oz.), Fir-wool Oil (2 mins. to r oz.), Perchloride of Mercury gr. to r oz.), Ipecacuanha Wine (roo mins. to r oz.), Sulphurous Acid dr. to r oz.), may be employed.
In subacute cases where dysphagia, pain, and irritable cough are distressing, the spray which the writer has found most useful is that formulated upon a previous page, containing Carbolic Acid and Borax; Cocaine is often prescribed, but it tends to keep up the disorder if persisted in. Menthol, 5 per cent. in paroleine, is much better where cocaine or a markedly local analgesic effect is desired.
Inhalations are useful when a soothing effect is desired, though other actions may be obtained by using various volatile substances in this form. Conium inhalations, hot water containing Eucalyptus, Terebcne, Fir-wool Oil, Creosote, Menthol, Carbolic Acid, Iodine, Benzoin or Friar's Balsam, may be each advantageously used as an inhalation. Good results may be obtained from the Chloride of Ammonium Inhaler. Pinus Pumilio Oil, 15 mins. to r pint water at r60° F., is a grateful inhalation.
Insufflations employed by blowing finely pulverised substances, such as mixtures of powdered Starch, Bismuth, and Morphia, are seldom followed by much relief.
The constant current, Faradisation, or static electricity may be tried with benefit in some cases of chronic laryngitis, and Cathcart attaches great value to the use of the electric vibrator combined with massage of the neck.
Inveterate or rebellious cases must be sent to a warm, equable, dry climate like that of Egypt. Mont Dore, Ems, and Aix-les-Bains have gained considerable repute, and Braemar at home suits many victims suffering from the effects of vocal strain.
Gouty and rheumatic laryngitis are often very intractable, and only yield when the underlying diatheses are vigorously attacked by Salicyla tes, Aspirin, Colchicum and Iodides combined with rest to the larynx and the use of local sprays and astringent applications. In most instances eliminatory treatment at a spa will be advisable.
Membranous laryngitis may be accepted as synonymous with diph theritic laryngitis, the treatment of which is dealt with under Diphtheria.
Tuberculous laryngitis in the great majority of cases is secondary to tuberculosis of the lung, but this fact should not deter the physician from attempting to relieve and if possible to effect a cure of the laryngeal lesion in all cases where the pulmonary mischief is limited and not actively progressive.
Constitutional treatment is of great importance in all cases, and must be conducted upon the same lines as in other forms of tuberculosis. Open-air life is essential, and except in very rare cases the laryngeal condition is not .a barrier to sanatorium treatment. A difficulty in swallowing should not if possible he permitted to limit the amount of food. and resort to the soft rubber oesophageal tube may be justified when the dysphagia cannot he overcome by the use of anodyne or soothing sprays and other local methods of treatment.
Semi-solids or thick liquids as a rule are more easily swallowed than fluids. and Barwell recommends finely minced raw beef free from all fat and gristle mixed with egg-yolk. Often the patient can be got to follow \Vol fenden's plan of lying upon his face on a sofa with his head hanging over time side, in which position lie can suck up milk or thick soup through a class or rubber tube from a vessel placed just below the level of his mouth. Sometimes dysphagia disappears whilst a bolus is being gulped down when a nurse standing behind the sitting patient presses firmly with each of her hands upon the side of the larynx.