Syphilis of the larynx, trachea, and bronchi / by J. Solis Cohen.

  • Solis-Cohen, Jacob da Silva, 1838-1927.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Syphilis of the larynx, trachea, and bronchi / by J. Solis Cohen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    sues incapable of undergoing absorption, and thus they produce deformity, occlusion of the larynx, and stricture. The strictures are often incapable of yielding to systematic dilatation, even when insti- tuted early ; and hence tracheotomy is usually necessary to provide artificial means for respiration below the seat of obstruction. After tracheotomy, the process may progress to complete obliteration. These strictures are of the most varying form and calibre, some of them distorting the configuration of the interior of the larynx almost out of recognition. Fortunately, most of them occur in the supra- glottic region, where they are far more accessible to effective treatment. Lesions of either soft tissues or cartilage in the neighborhood of the important crico-arytenoid articulations excite non-specific inflammation of the joint which may produce true or false ankylosis. Syphilis is probably the most frequent cause of this lesion. When the specific process invades the joint, the ligaments and perichondrium suffer; and then true ankylosis, or luxation, or disarticulation, and even discharge of the arytenoid and supra-arytenoid cartilages may ensue. In the latter stage of unrestrained lesion, the cachexia is much the same as in analogous advanced stages of tuberculosis. Myopathic paralyses of the muscles of the larynx may occur in the •later periods of secondary syphilis, and at any period of tertiary syph- ilis. They are most frequently unilateral, the left side being affected far oftener than the right. The onset is often sudden or acute, fol- lowing severe or sudden exposure to cold and dampness. The paral- ysis often affects the dilator muscles, and bilateral paralysis of the dilators is not infrequent. Paralyses of the arytenoid muscle and of the entire constrictor group are the most frequent varieties. These paralyses differ in their pathological origin from other examples of paralysis m syphilis, which are due, respectively, to compression of the tract of the nerve-supply by diseased tracheo-bronchial glands or other structure, and to neural or cerebral lesions which present in the latter stages of the confirmed dy^crasia. Tertiary lesions of the trachea are first observed so very fi-equently in the stage of ulceration, that it had been assumed that tertiary syph- ilis of the trachea always produces ulceration (Vierling). Schech and others have reported instances of resorption of gummata under specific medication. The clinical tendency, however, is to ulceration. Tra- cheal ulcerative lesions are sometimes unassociated with lesions else- where in the aerial tract. Much more commonly they are found associate:! with similar lesions in the larynx, in the bronchi, or in both. Pharyngeal syphilis exists in many instances (thirty out of forty-six,
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