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A NEW INHALER CLIP
706
NEW INVENTIONS
Mr. A. D. SHARP (Leeds) referred to the frequent association of tuberculous laryngitis with defects of the nasal passages, such as deflected septum, large turbinates, and poor air entry. Experts differed in their estimation of the effect of artificial sunlight. The galvano-cautery, and, in severe ulceration of the larynx, the local useof lactic acid, had proved efficacious when given under a general anaesthetic, the effect of which need not be harmful. Mr. J. B. HORGAN (Cork) said that many cases of phthisis with cavity had shown at autopsy either macroscopic or microscopic lesions of the nasopharynx. Early diagnosis of laryngitis was of supreme importance, as the chances of recovery depended on treatment of the early stage ; hence the need for training of students and practitioners in the use of the laryngoscope. The PRESIDENT said that tuberculous laryngitis was essentially a chronic infection which did not encourage sufficient tissue reaction, resulting in a sort of compromise between invader and the subject of attack. Resentment in the tissues should be excited to allow the chronic infection to become an acute process ; such stimulus was afforded by the use of the electric cautery, and other agents were available according to the particular case. The principle of the need for tissue reaction should always be kept in view if treatment was to be successful, quite apart from sanatorium regime and vocal rest. He advocated ordinary X ray treatment for the general condition of laryngitis with subchordal thickening over a large area by a series of exposures five minutes at a time weekly or bi-weekly. Dr. R. R. TRAIL (Midhurst) quoted a case of recovery following artificial pneumothorax in a patient who had been given up after four months rest in bed. At Midhurst, he said, general light treatment had given good results in a type of case which had not responded to pneumothorax. It was important to avoid following only one line of treatment, for it was the individual patient who needed attention. Mr. BARWELL stated that the onset of tuberculous laryngitis, while the patient was under sanatorium treatment and after the induction of pneumothorax, afforded a bad prognosis. As a rule the earliest lesion usually occurred near the vocal process. Lactic acid he had found useful in ulceration of the cords. Tracheotomy was advisable only in the presence of marked dyspnoea, and tonsillectomy only if the laryngeal lesion was making no progress. Mr. R. R. WOODS (Dublin) said that the most that could be done was to help the patient to improve his lung condition, for if this were progressive little could be done to improve the state of the larynxhence the value of artificial pneumothorax. The prognosis of the laryngeal was exactly that of the pulmonary condition. Mr. ScoTT STEVENSON, replying, said that the fundamental points were treatment of the patient rather than the larynx, no special measures being relied upon, but such local remedies as best suited particular cases. He had found lactic acid of value for large ulcers of the larynx. Septic tonsils had been removed with good results in most cases, but not under a general anaesthetic, which was liable to be followed by acute miliary dissemination. Attention to nasal cleansing and use of an alkaline nasal douche helped to improve the laryngeal condition. Preventive were the most important, especially the examination of all pulmonary cases. laryngeal Dr. HEAF, in his reply to the points raised on prognosis, emphasised the need for consideration of
measures
all the factors in treatment a,s well as the patient’s occupation, age, and blood picture. Dr. C. D. S. AGnssIZ (London) then read a paper on TUBERCULOSIS OF THE LARYNX IN CHILDREN
condition which he described as usually without symptoms. He had not found laryngoscopy more difficult in children than in adults. In a group of 86 girls suffering from pulmonary tubercle, the sputum of 55 had shown tubercle bacilli and 15 had laryngeal tubercle, in all but one of whom tubercle bacilli were found in the sputum. In the entire series of pulmonary cases showing tubercle bacilli, the larynx had been affected in 20 to 25 per cent., but In the a primary laryngeal lesion was very rare. children of 7 to 16 years examined, tuberculous laryngitis was more often found between 11 and 16, and in girls rather than boys. While laryngeal infection was usually more common in cases where the lung lesion was extensive, it might occur with no evidence of marked lung disease and in the absence of tubercle bacilli in the sputum. In seven cases no symptoms had been noticed by parents, but the voice was toneless with slight huskiness and examination showed reddening of the cords and arytenoid deposits. Dysphagia was very rare and never as a
in adults ; at most slight transitory pain swallowing was complained of. Routine laryngoscopic examination of all children suffering from pulmonary tubercle was well worth while. The prognosis was usually good in children, the laryngeal lesion being only slowly progressive, as in a case quoted where the lesion had shown little advance severe as
on
after four years. FILM DEMONSTRATION
The session concluded with a film demonstration of the treatment of tuberculosis of the larynx by means of the Kromayer lamp, Model II. with laryngeal applicator as designed by Dr. William Beaumont, and carried out with sunlight treatment at the Camden Town clinic. A case of lupus, involving pharynx, fauces, and larynx, had received direct irradiation of the larynx by ultra-violet rays for three minutes, three times a week, the larynx being treated before the fauces without the necessity of a local anaesthetic.
NEW INVENTIONS A NEW INHALER CLIP
I HAVE devised a fastener on the " lever-clip principle " for use with all masks of the Schimmelbusch type. This clip can be snapped on in a moment and
release itself however many layers of used. I, personally, am in the habit gauze of using ten layers of 4-fold gauze. The clip has been made for me by Messrs. Allen and Hanburys Ltd., of Wigmore-street, London. H. E. KARSLAKE ECCLES, M.R.C.S., L.R.C.P. cannot
possibly
are
-
-
-
-
-
-,-
NEW INVENTIONS
Mr. A. D. SHARP (Leeds) referred to the frequent association of tuberculous laryngitis with defects of the nasal passages, such as deflected septum, large turbinates, and poor air entry. Experts differed in their estimation of the effect of artificial sunlight. The galvano-cautery, and, in severe ulceration of the larynx, the local useof lactic acid, had proved efficacious when given under a general anaesthetic, the effect of which need not be harmful. Mr. J. B. HORGAN (Cork) said that many cases of phthisis with cavity had shown at autopsy either macroscopic or microscopic lesions of the nasopharynx. Early diagnosis of laryngitis was of supreme importance, as the chances of recovery depended on treatment of the early stage ; hence the need for training of students and practitioners in the use of the laryngoscope. The PRESIDENT said that tuberculous laryngitis was essentially a chronic infection which did not encourage sufficient tissue reaction, resulting in a sort of compromise between invader and the subject of attack. Resentment in the tissues should be excited to allow the chronic infection to become an acute process ; such stimulus was afforded by the use of the electric cautery, and other agents were available according to the particular case. The principle of the need for tissue reaction should always be kept in view if treatment was to be successful, quite apart from sanatorium regime and vocal rest. He advocated ordinary X ray treatment for the general condition of laryngitis with subchordal thickening over a large area by a series of exposures five minutes at a time weekly or bi-weekly. Dr. R. R. TRAIL (Midhurst) quoted a case of recovery following artificial pneumothorax in a patient who had been given up after four months rest in bed. At Midhurst, he said, general light treatment had given good results in a type of case which had not responded to pneumothorax. It was important to avoid following only one line of treatment, for it was the individual patient who needed attention. Mr. BARWELL stated that the onset of tuberculous laryngitis, while the patient was under sanatorium treatment and after the induction of pneumothorax, afforded a bad prognosis. As a rule the earliest lesion usually occurred near the vocal process. Lactic acid he had found useful in ulceration of the cords. Tracheotomy was advisable only in the presence of marked dyspnoea, and tonsillectomy only if the laryngeal lesion was making no progress. Mr. R. R. WOODS (Dublin) said that the most that could be done was to help the patient to improve his lung condition, for if this were progressive little could be done to improve the state of the larynxhence the value of artificial pneumothorax. The prognosis of the laryngeal was exactly that of the pulmonary condition. Mr. ScoTT STEVENSON, replying, said that the fundamental points were treatment of the patient rather than the larynx, no special measures being relied upon, but such local remedies as best suited particular cases. He had found lactic acid of value for large ulcers of the larynx. Septic tonsils had been removed with good results in most cases, but not under a general anaesthetic, which was liable to be followed by acute miliary dissemination. Attention to nasal cleansing and use of an alkaline nasal douche helped to improve the laryngeal condition. Preventive were the most important, especially the examination of all pulmonary cases. laryngeal Dr. HEAF, in his reply to the points raised on prognosis, emphasised the need for consideration of
measures
all the factors in treatment a,s well as the patient’s occupation, age, and blood picture. Dr. C. D. S. AGnssIZ (London) then read a paper on TUBERCULOSIS OF THE LARYNX IN CHILDREN
condition which he described as usually without symptoms. He had not found laryngoscopy more difficult in children than in adults. In a group of 86 girls suffering from pulmonary tubercle, the sputum of 55 had shown tubercle bacilli and 15 had laryngeal tubercle, in all but one of whom tubercle bacilli were found in the sputum. In the entire series of pulmonary cases showing tubercle bacilli, the larynx had been affected in 20 to 25 per cent., but In the a primary laryngeal lesion was very rare. children of 7 to 16 years examined, tuberculous laryngitis was more often found between 11 and 16, and in girls rather than boys. While laryngeal infection was usually more common in cases where the lung lesion was extensive, it might occur with no evidence of marked lung disease and in the absence of tubercle bacilli in the sputum. In seven cases no symptoms had been noticed by parents, but the voice was toneless with slight huskiness and examination showed reddening of the cords and arytenoid deposits. Dysphagia was very rare and never as a
in adults ; at most slight transitory pain swallowing was complained of. Routine laryngoscopic examination of all children suffering from pulmonary tubercle was well worth while. The prognosis was usually good in children, the laryngeal lesion being only slowly progressive, as in a case quoted where the lesion had shown little advance severe as
on
after four years. FILM DEMONSTRATION
The session concluded with a film demonstration of the treatment of tuberculosis of the larynx by means of the Kromayer lamp, Model II. with laryngeal applicator as designed by Dr. William Beaumont, and carried out with sunlight treatment at the Camden Town clinic. A case of lupus, involving pharynx, fauces, and larynx, had received direct irradiation of the larynx by ultra-violet rays for three minutes, three times a week, the larynx being treated before the fauces without the necessity of a local anaesthetic.
NEW INVENTIONS A NEW INHALER CLIP
I HAVE devised a fastener on the " lever-clip principle " for use with all masks of the Schimmelbusch type. This clip can be snapped on in a moment and
release itself however many layers of used. I, personally, am in the habit gauze of using ten layers of 4-fold gauze. The clip has been made for me by Messrs. Allen and Hanburys Ltd., of Wigmore-street, London. H. E. KARSLAKE ECCLES, M.R.C.S., L.R.C.P. cannot
possibly
are
-
-
-
-
-
-,-