HYPER^MIA AND CATARRH. 9 



The distinctive points between chronic simple catarrh and ulcera- 

 lion or growths in the larynx are to be discussed hereafter. 



PROGNOSIS. The prognosis both of acute and chronic laryngitis 

 becomes apparent from the foregoing sketch of its symptoms. When 

 uncomplicated, the disease is seldom fatal. The prognosis as to com- 

 plete recovery is favorable in the acute disease, although a tendency to 

 relapse remains ; in chronic cases, it is more unfavorable. Induration of 

 the submucous tissue is incapable of resolution. 



TREATMENT Prophylaxis. It is advisable, rather cautiously to 

 habituate children to the causes of this disease than to enervate them 

 by a systematic over-protection which tends to increase the liability to 

 its attacks upon every trifling occasion. Do not shut up little children 

 in the house, even though they have suffered from laryngitis ; but keep 

 them in the open air. 



In bad weather, iet them be warmly clad ; but their necks should 

 never be overheated with thick woollen shawls, etc. A silk ribbon worn 

 about the neck has the reputation of a sympathetic prophylactic. Wash- 

 ing of the throat in cold water, and cold river and sea bathing, cannot 

 be sufficiently commended. They form the best of prophylactics ; but, 

 in prescribing their use, the most definite and rigid rules must be laid 

 down as to time, duration, and temperature. The more precisely we 

 direct, so much more punctually do patients obey. 



Indication as to Cause. If the cause of the catarrh be the direct 

 action of some irritant upon the mucous membrane, the patient must be 

 protected from its further influence. To guard the affected larynx from 

 further irritation, let the patient be kept in a uniform temperature, regu- 

 lated by the thermometer. Forbid all loud and continued talking or 

 singing, and, above all, urge the patient to resist the inclination to 

 cough. Even though not entirely successful in this, yet much may be 

 gained by determination on his part. The assertion that he cannot help 

 coughing should never deter you from persistently telling him not to 

 cough. In violent paroxysms, which, although consequent upon the 

 catarrh, are active causes of its perpetuation, the common " cough- 

 drops " and syrups containing antimony are useless. If the remedies 

 mentioned above prove inadequate, we must resort to the narcotics. 

 True, great caution in exhibiting these agents is demanded in treating 

 children, but among adults they certainly have not been used with 

 proper boldness and freedom. It is surely more reasonable, and in- 

 dubitably more efficacious, to prescribe ten grains of Dover's powder 

 at night, or occasional small doses of morphia (morphias, gr. j ; aqua 

 laurocerasi, 3ij; gtt. x every three hours) to a patient with severe 

 laryngeal cough, than to plague him with liquorice, caramel, sulphuret 

 of antimony, and the like 



