Cod-liver Oil and Creosote, Guaiacol or Haul internally are always beneficial. Vaccine treatment by Tuberculin injections should be tried, but it must be confessed that less is to he expected from it than in other forms of localised tuberculosis.
Local most important factor in all cases is rest to the larynx, and this should be when possible absolute if ulceration of the cords has occurred, the patient being forbidden to speak except in a low whisper. In early cases where the lesion consists of a diffuse inflammatory swelling without breach of surface, laryngeal rest with the above-mentioned measures may effect a complete resolution without resorting to surgical methods when soothing sprays are judiciously employed to relieve the catarrhal symptoms.
The method of Bier, which consists in the establishment of a passive hyperemia, has been adapted to the larynx by employing a Kuhn's mask in order to cause a negative thoracic pressure through partial obstruction of the inspiratory current passing via the nasal route.
Pain.cough and dysphagia may he relieved by the inhalation of Creosote, Menthol, Thymol and other local sedatives. In mild cases the continuous use of the common perforated zinc mask in which a few drops of a solution of creosote or menthol in spirit are sprinkled on a little cotton-wool meets all requirements, or the following formula may be used B,. Crensoti Purif. 3j.
Acid. Carbolic. 3ij. Std. Chloroformi 3ij. Thyntol gr. xxx.
A qucc Spirit. l'ini Rect. ad Div. RTisce.
Fiat solotio secundain Reflex cough may sometimes be prevented by sticking a Carbolic lozenge or painting the upper part of the larynx with Cocaine or Menthol solution. Some patients by the use of these remedies immediately; before food are enabled to swallow without pain. The best routine method of employing menthol is to use a Jo to 15 grs. per ounce solution in liquid paraffin sprayed by means of the atomiser. A (1 in io) solution in olive oil may be used as a paint, and the strength may be doubled or trebled after a time when pain or dysphagia is very severe. Cocaine should be reserved for the worst cases, and an aqueous spray of 5 to to per cent. must be
used with caution by a trained nurse a few minutes before meals. Dundas Grant relieves dysphagia by injecting Alcohol into the superior laryngeal nerve (2 grs. eucaine /3 tor oz. So per cent. alcohol).
Insuffiations may be employed by Leduc's auto-insufilator, and the best agent for use in this manner is Orthoform, io grs. of which may be diffused over the ulcerated surface before attempting to swallow. lodoform, Boric Acid, Bismuth, Iodol, Aristol, Chinosol, Resorcin, Thiocol and the innumerable host of iodoform substitutes and many other antiseptic drugs have been employed as insufflations, but orthoform is the best of all, though its analgesic properties are nil unless when applied to a breach of surface. Cocaine should never be employed in this manner, and the use of morphia or codeine is irrational.
As a preliminary to all local applications or surgical procedures, an aqueous spray of Carbolic Acid (1 in ioo) or of Borax or Sodium Bicarbon ate (5 grs. tor oz.) is advisable for cleansing purposes. Simple inhalations of steam act in the same way, and are soothing when the distress arises from a diffused catarrhal state.
Intratracheal injections are indicated where cough is incessant and a dry state of the laryngeal mucosa exists with ulceration; by their use the sputum is sterilised and the larnygeal ulcers are shielded from irritation by the currents of air passing over them in coughing and breathing. The most suitable for all purposes is the daily injection through the laryngeal aperture of 4 drs. of a warm solution of Menthol in liquid paraffin (2o per cent.) as the patient is made to take a slow and full inspiration after cocainisation; 2 per cent. Guaiacol, Creolin, Izal, Naphthalene and Eucalyptol, and a i per cent. Oil of Cinnamon are also employed.
Submucous injections of a few minims of a solution of the above substances or of o•i per cent. Perchloride of Mercury, 6o per cent. Lactic Acid, Acid Phosphate of Calcium, &c., are now seldom employed, and can only be recommended in very exceptional cases under the skill of an experienced operator.