Catarrhal Inflammation of the Larynx Acute
IN the acute form of what is commonly called "sore throat" we have more or less feverishness, huskiness or suppression of the voice, painful swallowing and more or less difficulty in respiration.
The disease is usually brought on by atmospheric changes; cold draughts of air either inspired or striking exposed parts of the body; cold, wet feet; inhalation of irritating substances like dust, gas, smoke, etc.; prolonged efforts at public speaking; in children violent fits of crying.
The attack begins rather abruptly, with a feeling of dryness, rawness, and tickling or scratching in the throat, together with the sensation of the presence of a foreign body in the throat, hoarseness and a persistent tendency to clear the throat. The larynx is tender on pressure.
A hard dry cough is usually attendant. The first day or two the cough is not attended with very much secretion which, however, becomes later more profuse and slightly streaked with blood. The voice at first husky, soon becomes altogether lost. The respiration is very slightly if at all increased in adults, though children are more sensitive, being kept for the most part more indoors and sheltered. With these the flushed face, hot skin, coated tongue, dry cough and scratchy," "lumpy" throat should render the case immediately suspicious.
The disease lasts, usually, about a week; or if very severe, or if the patient is not able to give himself proper attention, it may be prolonged to three or four weeks.
Treatment. There is never any danger but what the throat will clear up if properly treated, in every case of "simple" sore throat. Confinement to a room of uniform temperature, and absolute rest for the voice is necessary. The air of the room should be kept moist with steam vapor medicated or not, though the former is preferable. At the very beginning the feet should be placed in a hot mustard bath and a large dose of Epsom salts administered. Prompt action on the skin will often abort the severity of an attack. For this purpose aspirin and Dover's powder in 3 to 5 grain doses every three or four hours is beneficial and comforting, relieving both the pain and reducing the temperature by increasing the perspiration. In rheumatic subjects aspirin works well alone or in combination with salicyhc acid. In malarial districts the addition of two grains of quinine to the dose is advantageous. A cold compress, covered with oiled silk, to the larynx is very grateful and will greatly aid in relieving the congestion; or an ice collar may be used if more convenient. The continual use of hot applications to the throat while soothing and gratifying to the patient apparently causes increased congestion in some cases. A pitcher of boiling water with a cornucopia of paper placed over it makes an inhaler which is at once simple and efficient. One of the best formulas to use in this way as a medicated vapor is: menthol, grs. ii; tinct. benzoin comp. and laudanum of each one half ounce; nl ix and add one teaspoonful to a pint of boiling water, and inhale for five to ten minutes at a time every hour. The oils of eucalyptus, turpentine, pine or juniper berries may be used in the same way in the proportions of one half ounce to the pint. Some of the various lozenges containing menthol ' camphor or anmonium chloride are very acceptable to relieve the " tickly
Local Treatment. The upper passages should always be cleaned with a spray or an irrigation of warm normal (i.e., 2 per cent) salt solution. This is to prevent extension of the trouble into the head and nose at the same time cleansing the passages of any source of irritation or contagion. Solutions of Dobell's, Seiler's, or the compound antiseptic powder of the U. S. P. may be similarly used.
Inhalations of menthol and camphor dissolved in albolene are valuable and soothing especially in the "dry" stages of the attack. To use these effectually the tip of the tongue should be wrapped with a piece of gauze, extended and held by one hand while the nostrils are pinched with the other. The patient now inhales and exhales through the mouth, bringing the vapor into contact with every part of the throat. Strong applications or sprays to the larynx and throat should never be used.
In every case of catarrhal laryngitis it is important to maintain and preserve the general good condition of the patient. Reconstructives and nerve tonics, such as strychnine or nux vomica with quinine and iron, are indicated. Alcohol and tobacco should be tabooed during an attack. Frequently a prolonged rest for the voice and throat or a change to a warmer drier climate is necessary.
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