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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    The symptoms consist of (1) complete anaesthesia of the mucous membrane covering the upper and middle divisions of the larynx ; (2) deficient closure of the glottis during deglutition; (3) changes of voice. Laryngoscopic examination shows the epiglottis to be immovable, and leaning against the base of the tongue, and, according to Mackenzie, there is a wavy outline of the glottis. If only one muscle be paralysed, the corresponding cord is higher than the other. Paralysis of the crico- thyroid seems only to occur after diphtheria, and is then commonly associated with paresis of other muscles.* II. PARALYSIS OF THE MUSCLES WHICH CLOSE THE GLOTTIS. As closers of the glottis we may consider the following muscles : (1) The lateral crico-arytenoids (or adductors); (2) the interarytenoid (or transverse muscle); and (3) the external and internal thyro-arytenoids, all of which are innervated by the recurrent nerve. All these muscles may be affected or they may be attacked singty or in groups. (a) Paralysis of all the Closers of the Glottis. This occurs most commonly in hysteria, and is marked by complete aphonia, which is sudden in its occurrence and disappearance. Laryngoscopic examination shows that on attempted phonation the cords remain in the position of inspiration. The condition is usually bilateral, but not always complete; sometimes one side is paralysed and the other only impaired in its action, or, again, the muscles of both sides may be only paretic, so that the cords approach one another but always leave a considerable triangular aperture. It is characteristic of this affection that the aphonia is only present on attempted articulation, but that reflex acts, such as coughing and sneezing, are accompanied by a vocal sound. In a case lately seen by the author a hysterical girl of seventeen, who had suffered from intermittent aphonia for two years (the cords, on attempted phonation, remained in the inspiratory position), also had attacks of hiccup in addition to other hysterical symptoms; the inspirations during spasm of the diaphragm were accompanied by loud, bellowing sounds, while the voice was completely aphonic. Besides motor disturbance there is also sometimes anaemia of the mucous membrane and sometimes ansesthesia of the pharynx and larynx. (0) Paralysis confined to tfu l<<f< m! Crico-arytencidt. [solated paresis of this muscle, i.e. without coincidenl affection of the thyro-arytenoid and transverse muscles, is rare and difficult to * Mackenzie lias mel w ith a case 'in.- to inflammation about the angle t' 111 * - jaw, ami this muscle must (according t.. present views) have been paralysed in the oases referred to on p. L88. In the Translator's case, however, do evidence of »uch paralysis oonld be made ont, although the question was oarefull] considered. Possibly recent observations on the Innervation furnish an explanation (Translato]).