Diseases of the larynx / by J. Gottstein ; translated and added to by P. McBride.

  • Gottstein, J.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the larynx / by J. Gottstein ; translated and added to by P. McBride. Source: Wellcome Collection.

    120/288 page 108
    Symptoms.—The symptoms caused by laryngeal oedema are various, and depend partly upon tlie position, the extent, and the degree of the swelling, and partly u])on the primary disease. It is not at all unusual to find circumscribed oedema associated with other local diseases, without the presence of any symptom which can be ascribed to the oedema alone; oedema may also reach a considerable degree before pro- ducing symptoms of stenosis, so that then a very slight increase of the aflcction suffices to produce suffocation. In oedema of the upper part of the larynx, patients feel as if they had a foreign body in the throat. The disturbance of voice—in so far as it is not due to other coincident laryngeal disease—consists in the note being rough and deep. Cough and pain are not characteristic of oedema, and the most marked symptom is difficulty of respiration. The stenosis may occur so suddenly that death results in a few hours, if tracheotomy be not immediately per- formed. Threatening oedema is apt to be produced by impacted foreign bodies (pieces of bone, tobacco, splinters of wood), but also occurs in weakly patients who are recovering from acute disease (especially typhoid), in the course of Bright's disease, in mediastinal tumours and aortic aneurism without any preceding laryngeal disease. Foi-tunately, those oases in which dyspnoea progresses slowly, and does not reach this height, are the more common. The dyspnoea is at first only inspiratory, and depends upon the fact that during inspiration the swollen oedematous aryepiglottic folds are pressed in a valve-like manner against the ven- tricular bands, while on expiration they are again separated. If the swelling increases, or if the oedema is from the first secondary to already existing thickening of the interior of the larynx (perichondritis or sub- mucous infiltration), inspiratory and expiratory dyspnoea are both present, and we have a complete picture of marked apnoea such as we have described in crouj) (larjaigeal stridor, descent of the larynx on inspiration, falling in of the jugular and epigastric regions, slow and deep inspiration, etc.). Laryngoscopic examination, which alone can make the diagnosis certain, shows portions of the larynx, varying according to the seat and amount of the affection, markedly swollen. The epiglottis loses its normal shape and gives the impression of two shapeless masses pressed against one another, or resembles a spherical tumour. When the affec- tion is slight it seems turned in at the edges, swollen, and immovable, either in an upright position, or depressed, so that a view of the larynx cannot be obtained; its margins are lost in the oedematous aryepiglottic folds, which form two oval tumours, almost meeting in the middle line. The oedema of the ventricular bands never reaches such an extent as that of the vestibule of the larynx. The cords themselves are rarely oedematous, although Risch has recorded a case which ended fatally in a short time, and in which, in addition to oedema of the upper portion of
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