Sometimes hysterical aphonia is found in girls. It is distinguished from chronic laryngitis by the history. It begins quite suddenly and is at once complete. Equally suddenly it subsides.
A girl, between eleven and twelve years old, was under the care of my colleague, Dr. Donkin, in the East London Children's Hospital. The pa tient was one of fifteen children, and there was no neurotic tendency in the family. One child had died of croup, and the girl herself had had a " croupy " cough up to the age of seven years. She was of healthy appear ance and seemed very intelligent. Twelve weeks before her admission she had been called in the morning and had answered in her usual voice ; but when she was dressed it was found that she had complete aphonia. Her breathing was natural, and she was not subject to attacks of dyspncea. She had no cough or soreness of the throat, but there seemed to be some tenderness at the angle of the jaw. Her voice was quite whispering, but she could laugh louder than she could talk. She did not appear to be troubled by her infirmity, but was anxious to get well on account of her education.
A galvanic current was applied to the larynx. The girl cried loudly during the operation. After a second application of the same kind the voice suddenly returned. ; and she never relapsed.
Prognosis.—In uncomplicated cases of simple unless the in flammation be due to a traumatic cause, the child almost invariably re covers. In the traumatic variety the prognosis is very serious. In cases which are complicated by some acute lung affection the prognosis depends upon the pulmonary rather than upon the laryngeal complaint.
Treatment.—In ordinary simple laryngitis the child should be kept in an equable temperature ; his throat should be enveloped in cotton wool or a cold-water. compress ; and inhalation should be prescribed of steam im pregnated with tincture of benzoic (a teaspoonful to the pint of boiling water). The bowels should be relieved by a mercurial purge ; and if there be much oppression of breathing, an emetic should be ordered of ipecacu anha wine. Afterwards, a saline diaphoretic can be given containing five or ten drops of antimonial wine to the dose. A mustard foot-bath is also useful. If the cough is troublesome and disturbs the rest, small doses of paregoric may be added to the mixture.
In severe cases, where the clyspncea is distressing, a blister may be ap plied to the neck below the chin, or towards the top of the sternum. The child should be placed in a tent-bedstead, as in diphtheria, and the air around the patient should be kept moist by the steam boiler, as recom mended for that disease. The general treatment will depend upon the lung affection, which in these cases usually complicates the laryngitis.
In the violent and distressing cases which result from a scald of the glottis energetic treatment is required, as from the moment when the elyspncea becomes urgent the life of the child is in the greatest danger.
Dr. Bevan, of Dublin, after considerable experience of this form of disease, powerfully advocates a return to the old treatment by repeated doses of calomel. He states that if this plan be adopted, immediate relief to the symptoms is noticed directly green stools begin to be passed, showing that the system is under the influence of the drug. Dr. Bevan gives a grain of the salt every half hour, and recommends that this medication be begun directly the child is seen after the accident, without waiting for laryngeal symptoms to declare themselves. He greatly prefers this method of treatment to any mechanical measures for admitting air into the lungs, as these, he says, are almost invariably followed by death from pneumonia. With our improved methods of after-treatment the operation of trache otomy is, however, less often followed by fatal consequences than was for merly the case ; and if the clyspncea is urgent and threatens life, I should not hesitate to advocate the procedure, putting the child afterwards in a tent-bedstead in a warmed and moistened atmosphere.
The calomel treatment certainly seems to offer good results. In each of Dr. Bevan's cases the patient took between fifty and sixty grains of calomel ; and of four children treated in this manner, although the symp toms were excessively severe, all recovered without any sign of having been injuriously affected by the remedy. In addition to giving calomel by the mouth, mercurial inunctions were used in the worst cases to the skin ; a few leeches were applied to the upper part of the chest ; and the bowels were relieved by a copious enema. In each case, too, the treatment was be gun by an emetic to clear out the stomach. Dr. Bevan states that green stools may be expected in from eight to twenty-six hours after the first dose of the calomel.
It is important to support the strength. If there is total inability to swallow, the patient must be fed with white-wine whey by the stomach tube passed through the nose.
In cases of chronic laryngitis the throat should be brushed every two or three days with a strong solution of perchloride of iron. A little boy, aged one year and eleven months, was under my care for chronic hoarse ness of three months' standing. The child, although anaemic, had a healthy appearance, and there was no history of syphilis or trace of the disease about the body. He was quickly cured by the application to the larynx every third morning of a solution of perchloride of iron in glycerine (two drachms of the strong solution to the ounce). The application caused no spasm or other uncomfortable symptom.
Iron and cod-liver oil are useful in these cases ; and the throat may be painted externally with tincture of iodine.