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.

    257/288 (page 245)
    take place, often with resnlting thickening, anchylosis of the crico- arytenoid articulation, etc. Oedema, too, not uncommonly co-exists with perichondritis. , , , r i,. In some cases there is paresis or paralysis of the-muscles, probably due to their serous infiltration (Rvdde). Mackenzie ^ observed two instances of lasting paralysis of the adductors of one cord, and believed that the condition was probably of a diphtheritic nature. It is also possible that in such cases the cause of the immobility of the cords might be anchylosis of the crico-arytenoid articulation. The most constant symptom in all variolous aftections of the larynx is vocal disturbance. Croup, occurring, during the course of variola differs from simple croup in the following respects: (1) Absence ot couo'h (2) The disturbance in respiration is but exceptionally so marked as in genuine croup. (3) The absence of the suffocative paroxysms which are characteristic of the latter. Perichondritis gives rise to severe shooting pain in the larynx, and sometimes dysphagia^ The diagnosis of this condition is not always easy, but it is justified when, in addition to marked swelling and ulceration of the mucous membrane, immobility of individual parts can be demonstrated with the mirror. Other changes in the larynx can likewise only be demonstrated by means of the laryngoscope. Prognosis.—The local condition as such usually results more favour- ably than one would expect, from the severe nature of the primary disease; even croupous laryngitis in variola is not as dangerous as idiopathic croup. Differences, however, seem to be due to the character of an epidemic, for, while Eiihle writes, the course of this form of croup (variolous) is, if the primary disease runs a favourable course, almost always favourable, Lori considers diphtheria a very serious complication of smallpox ; most smallpox patients, attacked by it die Ecchymoses are of more serious import, partly because they are a symptom of decomposition of blood, and partly because they may be so large as to cause impeded respiration ; perichondritis and oedema of the larynx are of equally unfavoui-able significance. Treatment.—Variolous catarrh requires no treatment, usually dis- appearing spontaneously ; the same commonly applies to pustules and • croupous exudation. If ulceration has taken place, attempts may be made to promote healing by the use of astringeats. If large extravasa- tions of blood or oedema interfere with breathing, punctures may be made with the laryngeal lancet. If perichondritis has occurred without ulceration of the mucous membrane, an attem]3t may be made by means of deep' incision to evacuate the pus. Whenever there is danger of suffocation, whether from croup, osdema, or perichondritis, tracheotomy must not be too long delayed.