Diseases of the larynx / by Dr. J. Gottstein ... trans. and added to by P. M'Bride.

  • Jacob Gottstein
Date:
[1883]
Catalogue details

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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    justifiable either on histological or practical grounds ; and we prefer to divide tumours into (1) benign and (2) malignant, not only because of histological distinctions, but because each of these divisions runs a different course and requires different treatment. Etiology.—The cause of laryngeal tumours is uncertain, although catarrh, and more particularly the chronic variety, has been most blamed for their development; positive proof of this it is, however, impossible to obtain. The author does not remember that among many thousand cases of laryngeal catarrh observed by him for a longer or shorter time he ever actually saw a tumour develop. It is, however, certain that many forms, especially papillomata, are accompanied by chronic catarrhal inflammation of the laryngeal mucous membrane ; but, on the other hand, tumours are not uncommonly found with absolutely healthy surroundings. In the first case it is doubtful whether or not the catarrh be caused by the tumours, and in the second a localised cause may be assumed as probable. Klebs has pointed out that the most common position of fibromata is on certain parts of the vocal cords, and that these correspond to the nodal points. Schnitzler, who agrees with this view, calls such growths inflammatory nodes (Entziindung- sknoten). This comparison with the stationary or nodal points in the graphic representation of sonorous vibrations is, however, not apt, because on the one hand free vibrating membranes such as the cords show different vibrations, and therefore different nodal points, with the production of each tone. It must remain for future investigation to establish whether certain anatomical and physiological conditions of the cords predispose them to the formation of tumours at certain points (anterior commissure and anterior half of the ligamentous portion) ; and if so, for what reason these parts are more prone to be attacked. Tubercle and syphilis do not favour the development of tumours properly so called, but only give rise to polypoid hypertrophy of the mucous membrane, especially at the margins of ulcers in the interary- tenoid fold. French laryngologists believe in a so-called polypoid diathee characterised by the appearance of warts in various situations, such as the hands, eyelids, and feet (Poyet). Heredity has also been spoken of in connection with laryngeal tumours, but observations in support of tins view an- so few that they cannot be considered as conclusive. A number of observations, on the other hand, go to prove the congenita] occurrence of laryngeal growths, in so far that the voice has been found hoarse and aphonic from birth, In a case described by Arthur Edis a child died from suffocation thirty-seven hours after birth, and dissection revealed a cyst SS large as a hazel nut. Mechanical irritation of the laryngeal mucous membrane through excessive use of the voice in the exercise of a profession (e.g. vocalists,