Page:A Handbook of the Theory and Practice of Medicine - Volume I - Frederick T. Roberts.djvu/407

DISEASES OF THE BRONCHI. brush. Different applications are required in different cases, but Dr. Morell-Macl<.enzie finds chloride of zinc one of the most useful mineral astringents in chronic laryngitis. Tannin is very valuable in some cases of laryngeal phthisis; and nitrate of silver in syphi- litic ulceration.

As regards morbid growths, these are generally considered as requiring removal by operation. Evulsion is the chief method of operation usually employed, and various instruments have been invented for carrying it out, but it is useless to enter into any description, as only those who have had considerable practical experience would be likely to undertake any operative interference. Even cancer may sometimes be removed with temporary benefit. Mr. Lennox Browne has, however, advocated the treatment of benign growths by the use of topical applications, instead of by their removal. Caustic remedies are of no value, except for the destruction of condylomata. The galva7iic cautery has been em- ployed in the treatment of laryngeal growths.

4. Not uncommonly tracheotomy is called for, in order to pre- vent suffocation, in cases of extensive ulceration, morbid growths, or great thickening and contraction of the larynx, and the results are sometimes very satisfactory. Subsequently it may be desirable to remove a growth by dividing the thyroid cartilage. The entire larynx has been removed with success,

5. Prevention. — In all cases where there is a liability to chronic laryngeal disease, every precaution must be taken to guard against its development, by avoiding cold, excessive use of the voice, and other causes which are known to affect the air-tube. The front of the neck should also be properly protected. In cases of phthisis the least indication of any laryngeal irritation demands prompt attention.

6. For laryngeal functional disorders general treatment is often indicated. All obvious causes of irritation must be removed, if possible. Local faradization is the gTeat remedy in paralysis of the adductors, one pole being placed over the thyroid or cricoid cartilage, and the other in contact with the vocal cords. Paralysis of the abductors usually demands the performance of tracheotomy, in order to avert suffocation.

^Etiology. — Predisposing causes. These are : — Early or advanced age; indulgence in relaxing and enervating habits; immoderate clothing of children ; debility from any cause ; the presence of certain constitutional diseases, for example, rickets, gout; chronic