= Solution
\b[Local treatment is useful when there is an accessible lesion or a defined symptom to relieve; its concentration, delivered quantity and route must be specified separately.] Historical indications included chronic <pharyngitis> with excessive secretion, ulceration, enlarged or unhealthy tonsillar surfaces, and some forms of chronic <laryngitis>. The intended effects were cleansing, soothing, reducing secretion, or cauterising a circumscribed unhealthy surface. Merely having a sore throat was not sufficient reason for a caustic application.
The accessible <pharynx> could be treated by a gargle, a wash, a lozenge, or a carefully directed brush or sponge. A gargle does not reliably medicate the <larynx>: during normal swallowing the entrance is protected, and aspiration is an unwanted event. For laryngeal painting, the period apparatus included a light source, reflector, small warmed laryngeal mirror and a suitably bent brush. Illumination and the mirror image allowed inspection of the lesion and guidance of the instrument, instead of blind probing. A small measured loading reduced uncontrolled flow into the <airway>. An <atomiser> instead broke liquid into droplets with a jet of air or steam; the concentration in its reservoir was not the amount retained by the patient. A contemporary review discusses brushes, mirrors, caustic holders and the limitations of spraying caustic solutions.<Recent Works on the Laryngoscope (1865 review)>[pp. 310–319, local treatment and equipment]{ref}
For a numerical period example, the 1865 account of medicated inhalation gives \b[<silver nitrate>, 3–5 grains, sometimes 10 grains, per Imperial fluid ounce of distilled <water>]. These are historical reservoir concentrations, approximately 0.7–2.3 percent mass per volume, not oral doses and not modern recommendations for inhaling a corrosive. Other concentrations in the same 1865 account, each per fluid ounce of <water>, are \b[<tannic acid>, 3–10 grains; <alum>, 4–15 grains; <zinc sulfate>, 1/2–5 grains; and <opium tincture>, 1–10 minims]. The first three were intended chiefly as local astringent applications, and the last as a soothing or narcotic application. These are reports of historical practice, including hazardous applications, rather than evidence that atomising these drugs is beneficial or safe today.<Medicated inhalation in the Retrospect of Medicine (1865)>[vol. 52, pp. 102–106, especially p. 105, numbered list of drugs and silver-nitrate strengths]{ref}
Direct historical cauterisation used still stronger <silver nitrate> solutions or the solid salt for selected ulcers and growth bases. A contemporary review records disagreement over aggressive treatment and reports a recommendation of 40 grains per fluid ounce in one of the works reviewed. That disagreement is part of the answer: \b[40 grains per ounce for local painting must not be confused with a dilute gargle, an inhalation concentration or a swallowed dose]. For a less destructive mode of local medication, the period dosage table lists \b[one to four or more <tannic acid lozenges>], illustrating again the distinction between strength per item and the number administered.<Recent Works on the Laryngoscope (1865 review)>[discussion of strong silver solutions and missing dose information]{ref}<The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865)>[tannic acid lozenges and posological table]{ref}
Modern uncomplicated acute sore throat usually receives symptom relief, adequate drinking, and selective <antibiotic> treatment when indicated by the assessed cause and severity. Medicated lozenges can give a small reduction in pain in adults; that modest benefit does not validate the historical corrosive sprays. Persistent hoarseness, a focal ulcer or a suspected growth requires diagnosis rather than repeated empirical painting. <Stridor>, difficulty managing secretions or respiratory distress raises an <airway> problem, for which irritating instrumentation can be hazardous. Local treatment of a syphilitic or other specific lesion cannot replace systemic treatment of its cause.<Sore throat: acute antimicrobial prescribing by NICE>[NG84, self-care, antibiotics and referral recommendations]{ref}<Laryngitis by NHS>[persistent voice symptoms, assessment and emergency breathing symptoms]{ref}
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