Introduction Laryngopharyngeal reflux (LPR) is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

BEFORE the year 1797 scurvy was very common in the Navy. In that year, as a result of the mutiny at the Nore, improvements were made in the accommodation and diet of the men. Fresh vegetables, meat and lemon juice were supplied more freely. In spite of this, scurvy continued to be a common disease for many years until, with the introduction of steam, voyages became shorter and fresh food was supplied as a matter of course, not as a rare privilege. Before the year 1860 great reliance was placed upon juice prepared from the Mediterranean lemon as an antiscorbutic. This juice when freshly prepared by processes which did not destroy the vitamin C was proved in many cases to be effec-F-W I LIDecembver 14, 1925.

CORRESPONDENCE, any work done by this National Council for Mental Hygiene. Not long since I did meet a member of the Council, and asked hiim how it was getting on; what it had so far achieved. The reply I got was somewhat disconcerting. " All I know," he said, " about the association is that I have had letters asking me for my subscriptions." Can anyone enlighten those interested in mental hygiene as to what has happened to this association, whose birth was heralded by great trumiipet blasts from the leading papers? To the uninitiated this National Council for Mental Hlygiene can only be likened to "The young man who jumped off the top of St. Paul's, And has never done anything since."-I am, etc., LIONEL A. 7'WEATHERLY, M.D. Bournemoutih, Jan. 26th.

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