12 AFFECTIONS OF THE LARYXX. 



den), which we usually make use of, like those of Obersaltzbrunnen, 

 and Seltzer, mixed with warm milk, or whey; the sulphur springs, also, 

 of the Pyrenees, abo^e all the Eaux-bonnes, are, with good reason, in 

 repute, in the treatment of chronic laryngitis. Our conjectures as to 

 the modus operandi of these waters are as yet vague and untenable a 

 matter, however, far less to be regretted than the fact that we have no 

 criterion whereby to predetermine the cases in which relief may be ex- 

 pected, and those in which they do no good. 



In obstinate and inveterate cases of chronic laryngitis, local treat- 

 ment deserves an extended trial. 



The attempt to blow medicated powders into the larynx is an ancient 

 practice. For this purpose, a long quill, or a glass tube, eight or ten 

 inches in length, and several lines in diameter, is employed. A few 

 grains of the powder to be inhaled is laid within one end, the other end is 

 introduced as far as possible into the mouth of the patient, who is then 

 to close his lips, and to draw a deep inspiration, or else we may blow into 

 the external end of the tube. If this procedure should excite violent 

 inclination to cough, we may assume that a part of the medicament, at 

 least, has reached its destination, although, no doubt, the greater part 

 remains clinging to the velum palati and pharynx. The medicines most 

 frequently used in this practice by Trousseau are arg. nitrat (gr. j ij to 

 sacc. alb. 3 j ij), calomel (gr. x xx to sacc. 3 j ij), alumen. ( 3 ss j 

 to sacc. alb. 3 ij). At present, by aid of the laryngoscope, and of a curved 

 tube, inserted as far as the entrance of the larynx, we can blow into it 

 almost the whole of the powder. 



Another procedure, which acts with tolerable certainty, consists in 

 expressing the contents of a small sponge, made fast to the end of a 

 little rod of whalebone, and saturated with solution of arg. nit. (gr. xx to 

 | j) over the entrance of the larynx. The result of this mode of treat- 

 ment is often both instantaneous and brilliant, and finds a striking 

 analogue in the efficient use of solution of nitrate of silver in the treat- 

 ment of catarrhal conjunctivitis. 



An adept in the use of the laryngoscope enjoys the great advantage 

 of being able to assure himself by direct ocular observation of his suc- 

 cess in passing the sponge behind the epiglottis. 



The most recent and generally-employed method of producing the 

 direct action of medicaments upon the mucous membrane of the larynx 

 consists in causing the patient to inhale them in solution reduced to the 

 condition of a spray or mist The apparatus hitherto employed for this 

 purpose consequently bear the names of nSphogene, pulverization, 

 [nebulizer], inhalation apparatus. Of these there are two kinds. In 

 one, the slender stream of liquid to be inhaled is driven forcibly against 

 a small convex disk, and thus reduced to the condition of spray, as in the 



