Diseases of the larynx / by Dr. J. Gottstein ... trans. and added to by P. M'Bride.
- Jacob Gottstein
- Date:
- [1883]
Licence: Public Domain Mark
Credit: Diseases of the larynx / by Dr. J. Gottstein ... trans. and added to by P. M'Bride. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![disease may be situated either on the laryngeal or external surface. It is always associated with circumscribed pain over the affected part, increased by external pressure, and, especially if the outer surface be affected, there is swelling which masks the usual prominences of the larynx (pomum Adami). If the abscess points internally, the swelling within the larynx becomes more denned, and is apt to cause symptoms of stenosis. If the abscess opens externally, the introduction of a probe gives information as to the condition of the cartilage and the extent of the necrosis; sometimes a fistula is formed which communicates with the laryngeal cavity. Diagnosis.—Laryngeal perichondritis can only be diagnosed with certainty by the demonstration of bare cartilage, or after the expectora- tion of fragments. The presence of perichondritis may be conjectured when there is a dull pain on deglutition, and when laryngoscopic examination shows swelling of the parts covering a cartilage without there being evidence of primary affection of the mucous membrane. Course, Result, and Prognosis.—The disease is usually developed slowly, but becomes acute whenever pus is formed. Death is the most common result, owing to the primary disease being unfavourably influenced by the perichondritis and long-continued suppuration; or owing to the exfoliation of large pieces of cartilage, the larynx falls in and suffocation is produced; finally, a fatal termination may be due to choking, owing to the encroachment of the abscess or to a fragment of cartilage becoming impacted in the glottis. The course of traumatic or syphilitic perichondritis is more favourable. A relative cure may result when cicatrisation occurs after exfoliation of necrosed cartilage, or when the exudation from the beginning shows a tendency to become organised into fibrous tissue, ruder these circumstances, however, important changes in the larynx always remain, which produce con siderable disturbance of function. Cicatricial contraction or fibrous thickening may produce permanent stenosis : and further, anchylosis of the crico-arytenoid articulation may probably also result from sclerosing perichondritis, as Semon has lately pointed out. Treatment.—The treatment of primary perichondritis is in the early stage the same as that of submucous laryngitis, with which it is usually combined, and from which it is often indistinguishable, viz. two to three leeches applied to the neck, and the externa] ami internal use of ice. For secondary perichondritis we can do but little. If an abscess formed, it Bhould be opened as booh as possible- oedema Bhould be treated by repeated scarification. Tracheotomy is <.t't.-n ueces&ary t.. prevent suffocation. Little can be expected from local treatment of the diseased mucous membrane, for, the ulcers being due t<. a dyscrasia, treatment must be directed to the primary cause. In all cases a tonic line of treatment should be adopted to counteract the debilitating](https://iiif.wellcomecollection.org/image/b21022641_0129.jp2/full/800%2C/0/default.jpg)
