42 AFFECTIONS OF THE LARYNX. 



The praises of specific remedies in cases of pretended cure of tubercle 

 of the larynx are founded chiefly upon error of diagnosis. On the other 

 hand, a number, although a small one, of actual cures of this malady 

 can be authenticated beyond doubt Death takes place, in most cases, 

 from exhaustion, or with the symptoms of consumption, which we shall 

 treat upon more fully *Ji discussion of the subject of tubercle of the 

 lungs. In some very rare cases, oedema glottidis is suddenly set up, 

 under which the patient rapidly succumbs. 



TBEATMENT. In the treatment of laryngeal tuberculosis, we are not 

 in condition to meet either the indication as to cause or the indication 

 from the disease. The symptomatic indications are, first of all, to combat 

 the burdensome cough and attacks of choking, which not unfrequently 

 rob the sufferer of his rest The treatment in the main must be the 

 same as that recommended for chronic laryngeal catarrh, small as the 

 result to be looked for may be. The ObersaltzbrUnnen and the Emser 

 KrShnchen waters, mixed with equal parts of hot milk, and drunk fasting 

 in the morning, seem, in some degree, to moderate the cough. Do not 

 make any objection to the roe of a herring, to be swallowed fasting, 

 nor to the hope which the patient attaches to this prescription. If the 

 pharynx be reddened ; if its blood-vessels be varicose ; if phlyctsense and 

 ulcers be visible in it, swab it with a concentrated solution of nitrate of 

 silver, and let the patient gargle assiduously with alum. In this wa;y 

 we can best guard against the too frequent " hawking," which is in 

 itself a source of annoying cough. The insufflation of lunar caustic, 

 the squeezing of a sponge saturated with a solution of nitrate of silver 

 over the entrance to the glottis, by moderating the cough, sometimes 

 have a palliative effect, if repeatedly applied ; and, in the few rare in- 

 stances in which also pulmonary phthisis recedes, this treatment may 

 even have a radical effect. Here, too, we must concede a certain prefer- 

 ence to the direct and exclusive application of nitrate of silver in solu- 

 tion, or substance, to the surface of the ulcer itself, when accomplished 

 by skilful and practised hands. 



The most important medicaments in the treatment of tubercle of the 

 larynx are the narcotics. Little as they contribute to the healing of the 

 ulcers, their palliative action upon the burdensome symptoms of the dis- 

 ease is indispensable. It has been customary to prefer the use of hy 

 oscyamus and belladonna to that of opium ; nevertheless the preparations 

 of the former remedies are seldom as uniform, and their effects, conse- 

 quently, Seldom are as trustworthy as those of opium. 



As a matter of course, the patient whose larynx suffers from ex- 

 cessive irritability from tuberculous ulceration must remain in a uni- 

 formly heated and, if possible, hi a somewhat moist atmosphere. We 

 forbid him all loud speaking ; nay, in especially bad cases, compel abso- 



