PHARYNGITIS, Chronic.
The treatment in the first instance will consist in the removal of the primary cause. Gouty, rheumatic, constipative and dyspeptic conditions should he met by the remedies indicated in each case. Alcohol, and to bacco especially in the form of cigarette smoking, should be prohibited, and an open-air occupation when possible selected. As the condition is aggravated and perpetuated indefinitely by the patient's voluntary efforts at hawking up the scanty adhesive secretion which keeps the relaxed membrane in a state of irritable unrest, the best routine is to employ a weak Carbolic gargle or spray, c in Ioo, which produces a considerable degree of local anxsthesia, putting a stop to the necessity of hawking and performing needless efforts at swallowing. A similar effect is producible by sucking Carbolic Lozenges and to a feebler degree by keeping sonic bland emollient jujube or pastille in the mouth. When the irritability is great and interferes with rest Bromides internally exercise a local anesthetic action over the pharyngeal membrane after a few full doses, but cocaine should neN er be employed, as it invariably renders the relaxed membrane more irritable.
Where the pharyngeal membrane is constantly dry and crusts tend to remain on it, the best treatment is that so efficacious in atrophic rhinitis i.e., to swill the nasal and pharyngeal cavity several times a day by sniffing up a solution of 3o grs. each of Chloride and Bicarbonate of Sodium with llorax in half a tumblerful of tepid water or by thoroughly washing out the throat with this cleansing lotion employed as a douche, spray or gargle. Alucin solution, 5 grs. to i oz., with an equal amount of the Bicarbonate of Soda, is also very advantageous and keeps the membrane moist for hours.
11here the condition is simply that of relaxation of the membrane with out irritability, one of the best routines is to paint the surface daily with Nitrate of Silver solution, 20 grs. to t oz., or with Chloride of Zinc in half this strength. Painting with the Glycerin of Tannin or of Alum can be
safely and easily carried out by the patient twice a day, and sometimes affiirds considerable relief.
The following gargle is efficacious, and often enables the victim of relaxed sore throat to effectually get through a speaking or singing engage ment without undue strain: . Acid. Tannici 5ij.
Glyccrini Div.
Tina. Capsici 5j.
Infusi Rosa? A cidi aa' Mandl's pigment, Glycerin of Carbolic Acid (i part in 2 of glycerin and water) or Weak Tincture of Iodine with Glycerin of Alum(i in 6) may be painted on the relaxed membrane night and morning.
Granular treatment of this form of chronic pharyngitis is most tedious and disappointing. Cathcart attributes it mainly if not entirely to faulty voice production, and the writer has witnessed its entire disappearance after a course of lessons by a good music-teacher.
As the condition is frequently met with amongst public speakers and clergymen it is sometimes called " clergyman's sore throat," but it is better to confine the use of this term to chronic laryngitis, with which, however, granular pharyngitis is often found associated.
No treatment will avail much until the patient is made to rest his voice by abstaining from singing or public speaking. Alcohol, smoking and over-eating must be forbidden, highly seasoned or spiced dishes being avoided.
A residence in a dry warm climate, a sea voyage or a sojourn at a bracing coast with daily bathing in the open sea are all most beneficial.
Whilst every known means of improving the general health is to he persisted in, the internal administration of drugs is of little moment, except in so far as it assists general building up of constitutional vigour. Iron is usually indicated; it may be given alone or in combination with Quinine, Arsenic, Phosphorus, Iodine or Cod-Liver Oil.
Free purgation by means of any of the natural mineral waters, or a sojourn at Carlsbad, Aix, Kissinger, Ems, or Harrogate may he beneficial, especially in gouty subjects.