A handbook of local therapeutics / edited by Harrison Allen.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of local therapeutics / edited by Harrison Allen. Source: Wellcome Collection.

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    man physicians may find a less highly developed neurotic disposition to exist among their patients than is the case with practitioners in America Be this as it may, the agent is apt to excite the parts if introduced in the nose in the proportions demanded in the successful treatment of Chronic Nasal Catarrh. With caution, however, the nitrate of silver treatment may be successfully essayed if the mucous membrane of the nose is measur- ably free from erectile tissue. Thus, it is of value on the middle turbinated bone, but less efficient on the inferior turbinated bone ; it is distinctly ser- viceable in Oz^NA, but irritating in diseases which are accompanied with vaso-motor excitement. Again, in inflammatory states, accompanied with infiltration of the septum and the middle turbinated bone (as in the late stages of Secondary Syphilis or Tertiary Ostitis of the nasal passages), no agent is comparable to the nitrate of silver; the single precaution to be taken in its use is not to cover too large a surface at one sitting, lest an artificial coryza ensue. To neutralize the action of the drug, the parts should be flushed with a solution of sodium chloride. Careless use of the nitrate of silver on the interior of the nose may be followed by inflam- mation which may extend into the pharynx, but the same danger attends any local agent, and is especially true of the galvano-cautery, which agent some authors are inclined to laud at the expense of the nitrate of silver. To apply nitrate of silver on small areas of surface with precision, it is recommended to melt the fused stick. A probe of convenient size is covered with the fluid and carried directly to the parts, or a small piece of cotton may be wrapped around the end of a delicate cotton carrier and dipped in the saturated solution. Nitrate of silver in solutions varying in strength from one-half grain to sixty grains to the ounce has long been a standard remedy for the treat- ment of Chronic Laryngitis, especially in forms where inflammation exists on the vocal-cords. (Horace Green, On Bronchitis, New York, 1846.) Of the wide range of distinctions indicated by these varying strengths it is impossible here to speak. As a rule, weaker preparations suffice, but in the hands of skillful practitioners the stronger ones are not only useful but appear occasionally to be demanded. It is most efficient in cases accompanied by secretion. In Dry Laryngitis, chloride of zinc {q-v.^ is the better drug. In using silver an alkali should be used first, to remove the mucus. Not more than a drop or two drops of the solution should be used at a time; these may be soaked up on a piece of absorbent cotton or sponge (held in a sponge-holder), and carried directly to the affected surfaces. The application may be made twice or three times a week. Care should be taken to avoid spasm of the larynx, but if the patient shows any inclination to such spasm occurring, astringents should not be used until a local appli- cation of cocaine has first been made on the laryngeal mucous membrane.