Treatment of Conjunctival the stage of board like infiltration there should be copious irrigation with normal salt solution or boric acid solution, with ointment to the lids, and lukewarm compresses (no ice). In the blennorrhceic stage, the treatment is the same as for any other purulent conjunctivitis; if the cornea is not affected, nitrate of silver may be used sparingly, in a 1 per cent. to 2 per cent. solution, or protargol, 5 per cent. to 10 per cent.
Treatment of Cutaneous and Vulvar com presses are to be applied until the membrane has disappeared, then borated iodoform powder.
Treatment of Laryngeal soon as signs of lar yngeal involvement appear, steam-inhalations must be begun at once. With them, about 40 per cent. of antitoxin cases may avoid operation. In many children's hospitals there is a special steam-room. Fig. 95 shows such a one in Pfaundler's Clinic.
Sometimes the children are given the inhalations only periodically, for an hour at a time. In private practice, Richaud's plan may be used of hanging wet clothes in the room, or submerging glowing irons or hot bricks in pans of water, or in dwellings of the poor pouring water on the hearth-plate. The best plan is to use a steam apparatus as recommended by Escherich, F. Muller, Trumpp, which projects the steam against the patient's face. To increase its effect sheets may be hung over the bed, improvising a steam-room (see Fig. 97).
To favor the elimination by the skin, hot, moist compresses may be placed around the neck, or mustard poultices. If stenosis sets in, a hot bath followed by a sweat-pack is to be recommended. During the pack a mixture of lime-blossom and elder tea may be drunk.
If, in spite of this and the antitoxin treatment, no improvement is evident, but the stenosis increases and the children become exhausted, operation is necessary to furnish free access of air to the lungs. The bloodless procedure of O'Dwyer's endolaryngeal intubation may be chosen, or the cutting operation of tracheotomy.
Intubation has so many advantages over tracheotomy that it must be considered first. One of the main advantages is that it is blood
less and permission to perform it is always obtained, while tracheotomy is often forbidden by parents who dread the knife. In addition, intuba tion consumes no more seconds of time than tracheotomy does minutes. It can be clone without assistance and without good illumination, two things necessary for the proper performance of tracheotomy. There is no danger from bleeding or from wound-infection. The duration of treatment is considerably shorter because there is no wound to heal after removal of the tube. Its results in hospitals are equally as good, about 65 per cent. recoveries (Siegert); while in private practice they are better than tracheotomy (Trumpp). Accidents during the operation (shock, heart failure, pushing clown of the membrane) arc rare and only to be feared with clumsy, prolonged attempts. On the other hand, distur bances of swallowing, coughing up of the tube or plugging, and further more, the development of pressure-ulcers with their sequels furnish more or less severe difficulties. Disturbances of speech such as chronic hoarseness, shortness of breath, etc., are on the other hand more quent after tracheotomy than after intubation (Pfaundler, Trumpp). Intubation is contraindicated if the conditions present are such that free passage of air through the tube cannot be expected or if a favorable introduction of the tube is for any reason impossible. In such cases tracheotomy must be resorted to instead, and the trachea must be opened above or below the isthmus of the thyroid. if at all possible, tracheotomy is to be done with a tube already in the trachea, as it is much easier to find the trachea then than when it is empty. Dangers during the operation are emphysema, asphyxia and bleeding; quently the same complications may arise as in intubation, increased by the possibility of infection of the wound and secondary hremorrhage, but dyqphagia, coughing up and obstruction of the cannula are far rarer.