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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    ulcers of the larynx. The pain radiates to the ear of the affected side, probably on account of stimulation of the sensory fibres of the superior laryngeal nerve, which is propagated to the auricular branch of the vagus. If the tumour be situated high, there is marked dysphagia. As the ulceration progresses the breath becomes foetid, and sometimes haemorrhage occurs either in quantity or as streaks in the muco- purulent secretion. Symptoms of laryngeal stenosis are rarely wanting; they gradually increase with the growth of the tumour, and may necessi- tate tracheotomy. At a later stage the lymphatics at the inner edge of the stemo-mastoid become enlarged, and the cancerous cachexia is not always so marked as in other forms of malignant disease. Laryngoscopic examination shows varied, and not always characteristic, images. In the early stage, when indeed the disease is seldom observed, a diffuse swelling is seen on the affected part (vocal cord, ventricular band, epiglottis, etc.), which has nothing characteristic in its appear- ance; scirrhus and sarcoma, in particular in their early stages, differ but slightly from innocent growths, such as fibromata or papillomata. The appearance is more characteristic when the tumour assumes a nodular form, as in medullary cancer. At a later stage ulcerations occur which either, as in epithelioma, attack the neighbouring mucous membrane, or, as in medullary cancer, become covered with sprouting vegetations, and leave the mucous membrane intact for a long time. The surface is then covered by a foetid purulent or muco-purulent secretion. Course and Prognosis.—The course of malignant tumours of the larynx is usually very protracted, especially if the stenosis does not lead to suffocation, or if this result be prevented by tracheotomy. Medullary cancer is slowest, and its average duration is estimated at about three years. Haemorrhage, perichondria! abscesses, perforation of the oeso- phagus, or pulmonary disease may hasten the fatal termination. Suc- cessful excision of the larynx may prolong life for a time, but experience hitherto scarcely points to permanent cure. The prognosis is bad in all tonus of cancer, but in sarcoma it is slightly more hopeful, as cure has been obtained by extirpation of the tumour by the mouth (Mackenzie, Navratil, Tiierk, Gottstein), bythyrotomy (Balassa), and by extirpation of the larynx (Bottini, Foulis). In the author's case, which was published in the Wiener Bfedizin., WochenshrifJ 105,1868), a hoy aged seven yean was operatedon for Barooma of the laryru (pathologica] anatomy by Waldeyer). He was able to oonvince himself of the complete character of the cure by laryngoscopic examination thirteen yean afterwards; the voice, too. left nothing to be desired. Diagnosis. -The account which we have already given of the symp- toms of malignant tumours of the larynx is sufficient to show the diffi- culty which often besets their diagnosis, In the early stages even