Atlas and abstract of the diseases of the larynx / by L. Grünwald ; authorized translation from the German edition by Charles P. Grayson.

  • Ludwig Grünwald
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Atlas and abstract of the diseases of the larynx / by L. Grünwald ; authorized translation from the German edition by Charles P. Grayson. Source: Wellcome Collection.

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    signs of tissue-destruction becomes most characteristic (Plate 28, Fig. 1). Sometimes, however, especially in the absence of secondary proliferations, the centrally located tumor may hide itself under the appearance of a uniform SNvelling of some part of the larynx, especially the ven- tricular band. Later on the picture is complicated by alterations due to infection of the ulcerated portions, by edema and abscesses, and finally by necrosis of the cartil- age after the perichondrium has become absorbed. A most conspicuous feature is the early interference with function ; if the tumor is situated on the true vocal cord or near the crico-arytenoid articulation, as is usually the case, motile disturbances (sluggish action) manifest them- selves out of all proportion to the small tumor which may be visible; the appearance of this symptom should lead us strongly to suspect cancer. Iletastases into the glands usually occur very late; sometimes they far surpass the original tumor in extent.^' The diagnosis can be made without much trouble in the advanced stages by the characteristics just enumerated ; in the early stage it may sometimes be suggested by the last-named symptom. Any marked subjective symptom where little objective alteration is visible must be looked upon with suspicion. Pronounced sensibility, periodic hemorrhages, or obstinate hoarseness, the smallest uni- lateral proliferation or infiltration that cannot be easily accounted for, in patients over forty years of age, are most suspicious signs of cancer. The diagnosis is con- firmed by clmical observation or microscopic examination. In elderly people the rigidity which has been mentioned almost suffices for the diagnosis. In obscure cases, if the ' [The time at which secondary infiltration of the neighboring lym- phatic glands occurs varies with the situation of the primary growth. Krishaber, Butlin, and others classify malignant growths of the larynx into extrinsic and intrinsic. The former include those involving the epi- glottis arytenoids, aryepiglottic folds, and pyriform sinnsesf and the latter those affecting the vocal cords and ventricular bands, and tlie infraglottic growths It is the extrinsic which earliest lead to secondary adenopathies.—Ed.]
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