Volume 1

A text-book of practical medicine : with particular reference to physiology and pathological anatomy / by Felix von Niemeyer ; translated from the eighth German edition, by special permission of the author, by George H. Humphreys and Charles E. Hackley.

Date:: 1873

Credit: A text-book of practical medicine : with particular reference to physiology and pathological anatomy / by Felix von Niemeyer ; translated from the eighth German edition, by special permission of the author, by George H. Humphreys and Charles E. Hackley. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$gieat diagnostic importance. Experience teaches that follicular ulcers of the larynx are often combined with foUicular pharyngeal ulceration. If, then, iM. patients with long-standing hoarseness and other symptoms of chronic laryngeal catarrh, we find a reddening of the mucous mem- brane of the soft palate, and see the posterior pharyngeal wall studded with small round, yellowish sores, it is to be presumed that the disease has also invaded the larynx. The majority of laryngeal ulcers may be brought into view by means of the laryngoscope, especially when situated upon the epiglottis, u]Joa the arytenoid cartilages, on the aryepiglottic folds, and ujjon the tme and false vocal chords. Treatment.—The treatment of catarrhal ulceration of the larynx is almost identical with that of tlie simple laryngeal catarrh; and, as in catanh of other mucous membranes, we do not materiall}' modify our treatment where ulceration supervenes upon simple inflammation. It cannot, however, be denied that the cure of catarrhal ulcers of the larynx takes place somewhat more rapidly when the medicaments are applied directly and solely to the sore itself, instead of over the whole mucous surface. Whoever has obtained sufficient laryngoscopic dexterity to enable him to touch the ulcers with lunar caustic in substance, or with a concentrated solution of nitrate of silver, will do well to adopt such local treatment, instead of that recommended in the last chajjter, e.sj^e- ciaUy instead of inhalation of alum or nitrate of silver in solution, '\^’hile practising local trejitment, however, whether by cautery or inlialation, the dietetic and other internal treatment already described is not to be neglected. The partiality to which specialists are so often prone is not only hurtful to the patient, but injures the credit of new therapeutic measures. When a chronic ulcer of the larynx, Avhich has long resisted a regular course of caustic at the hands of a specialist, recovers under the use of Ems-water and careful nursing of the mucous membrane, perhaps after Aveeks of absolute enforced silence, it Arill generally be found that the patient had relied solely upon the local treatment for a cure, and had lived imprudently or absurdly. CIIAPTEPw IV. TTPHOTJS AND VAEIOLOtJS ITLCERS OP THE LARYNX. Etiology.—From the teaching of Mokitansky, the belief has long prevailed that tj^hous ulceration of the larjmx proceeded from “ me- dullary infiltration of the mucous glands of the larynx Avith subsequent sloughing,” and Avas therefore quite analogous to the intestinal ulcers of typhus, Avhich are formed by the action of a similar morbid process upon the solitary' glands and the glands of Peyer.$