Alain reliance must, however, be placed in local treatment. This is to he carried out upon the same lines as in treating chronic pharyngitis, soothing Carbolic lotions or sprays being employed where there is much local pain or irritation. Any of the astringent gargles, sprays or swabs may be tried, but as a rule little may be expected from these measures in very chronic cases associated with much hypertrophy or numerous granulations. These must be destroyed if a radical and permanent improvement is to be aimed at.
The best method of treatment is to apply the galvano-cautery to each granule, and at the same time cause obliteration of any large veins in the diseased membrane, or Meyer's ring knife may be used.
Nitrate of Silver fused upon the end of a strong silver probe may be employed to destroy the granulations, only a few being operated upon at each sitting. A strong solution of the nitrate (t dr. tor oz. of distilled water) is a favourite means of carrying out this object; but it is a mistake to paint over any considerable area of the pharynx with this at one sitting, owing to the irritation which may ensue, unless much ulceration is present. Every second or third day is often enough, and the Carbolic Lozenge or spray may be frequently used before and after each application.
In Rault's method of " Grattage " the pharynx is painted with cocaine; a hard brush with the hairs cut short is dipped into a ro per cent. solution of Iodine and Iodide of Potassium in water, and the mucous membrane is vigorously rubbed with this till bleeding occurs. After this has subsided, a softer brush is used. At the end of about five days, when the inflamma tion has subsided, the operation is repeated once, and these two sittings are reported to effect a cure.
Hirman employs pure Crystallised Trichloracetic Acid by means of a probe and cotton-wool. This effective caustic destroys all diseased membrane without producing any pain or inflammation if cocaine be used previously. It can be applied to the nose and behind the palate. A solution (1 in 3) in Glycerin may be freely painted or swabbed over the granular surface.
Chloride of Zinc solution (15 to 20 grs. to 1 oz.) may be freely applied in mild diffused cases after local irritation has been soothed by any of the gargles or sprays or swabs already mentioned. As a rule, however, it may
be said that the gargle is the least satisfactory of all the forms of local application in the management of chronic pharnygeal affections.
Weak Tincture of Iodine with Glycerin of Alum is a very excellent solution for daily application with lint or a large brush (i in 6). It acts like landl's Pigment, and may be employed after the destruction of the granules by the cautery. Strong alcoholic solution of Guaiacol has been extolled.
Bromide of Ammonium solution (2o grs. to r oz.) has been fotind useful in subduing the irritability of the pharyngeal muscles, but the writer has had better results from its internal administration in full doses, the effects being much less transitory than when its local exhibition is relied upon.
The Chloride of Ammonium inhaler is of service in the later stages of treatment, and sometimes all through the ailment it affords relief, especially when laryngeal irritation is a prominent feature.
Where enlargement of the tonsils exists, this should be reduced by puncture with the cautery or by removing the hypertrophied organs with the guillotine.
Syphilitic pharyngitis is to be treated by remedies directed to the primary lesion—Mercury in the early stages and large doses of Iodide of Potas sium (20 or 30 yrs. three times a day) in the tertiary ulcerations.
Chlorate of Potassium 4 drs., Carbolic Acid i dr. in zo oz. Rose Water, is an excellent application or gargle for habitually cleansing the surface of syphilitic ulcers in this region, They nay be lightly touched with a small camel's-hair brush moistened (but not dripping) with a little Lig. Ifyd. Pernit., care being taken not to approach the entrance to the larynx.
The solid stick of Argent. Nit. may be applied, or Iodised Phenol may he used, or the ulcers, when well within reach, may be insufflated with todoform.
The following liquid may be swabbed over the throat upon cotton-wool: R . llydrargyri Parch] or. gr. j.
Ammonii Chlorid. gr. vij.
Glycerini Misce.
Fiat Sulatio. .11. d. a.
Where great pain and difficulty of swallowing is experienced, the pharynx may be sprayed by a nebuliser, using a 5 to To per cent. solution of Menthol in pure paraffin.