Pathological anatomy, pathology and physical diagnosis. : A series of clinical reports comprising the principal diseases of the human body: Volume 1

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Snoriox II 1.] DISEASES OF THIS ()ItGANS OI" TABLE XIII. ('//.<r.-.\ young man of "27) years. Fig. I. JII‘H'F [(Iryng/lis left/I ll't/PHIf/{O'l/N infiltration I'M/o the sub-nurcous [issue [71, Um «pig/offal reg/4m: (Lawn-Y. l'.. 30 years of age inveterate drinker. [Esta/y.-Taken with general weakness and sense of fatigue in the limbs. Symptoms-I‘drst three days pain in limbs and in throat; frequent pulse. burning hot skin. deep red mucous membrane of the. mouth and pharynx; swelling of the uvula.; is unable to swallow; is short of breath. Since the fourth (lav verv hurried breathing, nearly sut‘tbcates. cannot speak abov» a whisper. Soft palate very red and more swollen : anterior pillars so much enlarged as to close up the throat. Fifth day, much \vorse, excessive pain in throat, is threatened with asphyxia. l)ies the following night. Post Illartmn.-Ary-epiglot.tal Itl‘iHI'IItA'I‘IUX. folds, the mucous membrane invest- ing the whole posterior and lateral regions ()1 the larynx. portions of the pharynx, and the anterior and superior borders of the epi- glottis presented a whitish yellow appezu'ancc, and infiltrated with pus. The mucous folds (l'. S. M.) were enormously tumefied and touched each other; only pt'isteriorly was a narrow passage left for the air. The glottis and sub-glottal parts were nearly normal. The infiltrate was diffused all over the whole mucous and sub-mucous tissues. A number of erosions (E. E.) existed. The tonsils were. sound. a dying state. No history. .3 )Vas taken to the hospital in l'osf JIor/rm.-'I‘he posterior surface of the larynx presented a ridge along the cricoid cartilage, which was corroded, denuded. and perforated. In a number of places it was reduced to a very thin shell. The mucous membrane, which was thickened, formed a sack, and was filled with a great quantitv of pus. The periehondrium was obliterated. The iarvtenoid eati- tilages were. surrounded with a thickened membrane aiid the crico- arytenoid articulations destroyed. The muscles infiltrated. The necrosis and crosions extended from behind forward on each side. Fig. 21 represents the left lateral surface of the cricoid. (C E C, erosions.) ((3 T. thyroid cartilage.) ‘ Figs. 3, 31 present the posterior surface of the larynx of an indi- vidual who died of laryngeal phthisis. The bifide uvula (I). II.) and the, posterior pillars of the vclum palati (l'. l‘.) were nmeh thickened, the epiglottic edges corroded and beveled (E E). The upper laryngeal edge and 'the. mucous memb ‘ane investing its posterior surface (M. I'. E.) were dense, swollen. corroded, ulcerated, The anterior surface of the cpiglottis was eovcred with scabs,and its and covered with carunculmis eminences. Fig. 31 presents the arterior surface of the epiglottis (M. I). E.) in a similar condition as the other, and extending to the base of the tongue. The opened larynx shows the alterations on its surface. The base of the right arytenoid cartilage ((‘. A.) was denuded, corroded, and partly ossified. The lungs and the lymph-glands in thethorax were filled with ulterior portion driven backward andhelped to close up the glottis. Figs. 2. 2‘. P/Llcgmonouslarynyc'tt's andfumwtéoa oft/abscesses [n the tubercles. (A., arytenoid cartilage, the mucous membrane ulcerated and thrown back; C. A., arytenoid cartilage itself; C. V., pm'z'c/mnrlm'um. vocal cords; M. L. E., erosions on mucous surface.) forgotten, that is, that mucous rules do not (Lonny/s indicate a disease associated with Bright‘s disease, in general bodily marasmus, in old age and in severe cachexia. the membrane will have a peculiar dry, glistening, thin appea 'ance. In anaemia of chronic laryngeal ‘atarrh it Will be swollen and highly infiltrated with serum. of the alveoli, for liquids collected in the finer bronchi will produce the same symptoms. )thn the alveoli are filled with caseous or fibroid masses containing no air. the following symptoms will be manifested: total or partial in'nnobility of the chest during respira- tion; vocal fremitus and bronchophony increased in intensity over the diseased portion, aegophony; dull sound on percussion, g‘adually passing into true/trill sound '{f "It'll/Tents, over the uppcrilobes. Bronchial sound, ringing or metallic sounds. ringing rales heard by auscultation. The sputa will here also form the most reliable means of diagnosis. 'When circumscribed cavities are situated beneath the thoracic Wall, no matter whether they are formed by dilatations of bronchi, loss of pulmonic tissue, or partial pneumo-thorax, the same tone Will be obtained by percussion. Of course, the sputa will have to be examined to ascertain, from the nature of the detritus they contain, whether the bronchial tissue or the pulmonic is undergoing destruction. The most definite symptom of the presence of a cavity is a metallic sound heard on percussion. As this kind of sound is also heard in other lesions, other symptoms must be noticed in connection with this, and these are: diminished visible respiratory motion of the part of the chest over the cavity, collapse of that portion to a greater extent. sudden protrusion of some intercostal spaces during forcible expiration (as in coughing, etc), weaker pectoral fremitus; increased bronchophony, occasionally ‘(EQ‘OI'leII)', and when the cavity is extensive and its walls are smooth, metallic sounds, associated with the. others. are heardby auscultation. Usu- ally muffled tympanitic, seldom metallic. sounds are produced by percussion. \Vhen a cavity is totally filled with liquid its tympanitic sound will disappear; when partly filled with liquid and partly with air, especially when the liquid freely moves in the cavity, the tympanitic sound will sometimes disappear and reappear as the person moves. The so-called sound of IL cracked pot (pot felt?) is often produced by percussion over cavities. Auscultation will dis- cover bronchial respiratory murmur. In large, smooth-walled ravities amphorie resonance is often produced. The rales are all of the ringing kind. When they are very intense their vibrations are frequently plainly palpable externally. To the cervical portion of the respiratory organs belong the larynx, trachea, and the thyroid body; for all three constitute one apparatus even in the earliest foetal period. (V. Burr, Rama/r. Kocll/ltcr.) Besides many congenital anomalies which may exist in either of the parts of that apparatus, a number of morbid alterations may take place in the organ, some of which cause local, and some general, disturbance of the respiratm-y functions. The larynx may be dislo ated by mechanical injuries, or pathological changes of its own tissues, or others adjacent to it. Its form and volume may undergo greater or lesser modifications. It may become Acute. Coir/rr/ml Lru‘on/fz‘is. Catarrhal infiamn'iation most frequently affects the mucous membrane of the larynx, and is manifested by injection, hyper:emia, swelling, softening of the membrane, and bv increased as well as altered secretion. \Vhilst the liyperzcniia is "only perceptible in the looser portions. the swelling extends everywhere. The sub-mucous tissue and its glands are likewise involved. This difi'use swelling, which closes the glottis, constitutes the most important symptom of the disease. Owing to the great elasticity of the membrane rupture of vessels very seldom happens in acute iatarrh, so much oftener is there loss of epithelial tissue. (excoriations). Eccliymoses are often formed in conjunction with excoriation. In the early stages of the inflammation the secretion is rather scant-there is only burning and dryness of the larynx; later, a tough, transparent, glassy secretion, occasionally mixed with blood, appears. \Vhen it is derived from the sub-mucous glands it comes in the form of little transparent balls or lumps, when from the folds of Morgagni it is yellow and turbid; front excoriations it appears like pus, and is very abundant. The de- nuded places mostly found on the vocal cords appear as bright red depressions with very sharp edges. In simple catarrh the ulcera- tions never penetrate the whole thickness of' the membrane; but when it is formed in consequence of primary tuberculous, syphilitic, leprous, or lupous ulce ‘ation,then the whole thickness of the mem- brane is penetrated. The intensity and extent of the catarrh-a] inflammatory process varies very much. The epiglottis, the £11"- epiglottal ligaments, the vocal cords may be singly affected, or the whole extent of the larynx may become involved. The symptoms will be according to the intensity and the extent of the inflammation. )Vhen the catarrhal process extends from the. trachea upy r'ard there will be (lyspnoza and vocal derangement; when from the pharynx downward, it will be marked by difficulty in swallowing. Acute laryngeal catarrh is usually a trai'isitory disease, ending, as a rule, in recovery. Fatal terminations have been reported by Porter, Ruble, and Tobold. Spasmodic or pseudo-croup has been considered by some authors as a form of laryngeal catarrh; by others it is thought to be merely a neurosis, due to rcficx action brought about by irritation of the membrane, by accumulations of irritant mucus, or other secretions in the laryngeal cavity. The. etiology of laryngeal acute catarrh was, and still is, con- sidered by many to be cold, or a sudden change from a very high to a very low tempe‘aturc. Its contagious nature an by no means he explained by mere cold-taking, as it is well known that persons affected with laryngeal catarrh will communimte it to dilated or contracted beyond the normal, or may be invaded by others who were never exposed to change of temperature. living or lifeless foreign bodies, which would affect its tissue, its (in. Arc/2.f., Erprrénnint. Pat/(0L, Vol. IV) has called attention to the. form, or its volume. constant presence of miero-organisms in the secretions of persons thus affected. These organisms, which are always present in all buccal and laryngeal secretions, may become the ‘arriers of the contagious substances which may develop either by their agency or by others in the secretions vitiatcd by the morbid process. Lebert (in Berlin. ,K/I'H. "Vac/n'n.sc/n'{f_/) and \Virth (in. Stat/l; III/m/Im'uu) JIIorbirl Clamges in the. Laryngeal Illacous 1i]rmbwme. In jaundice, and in a state of infiltration of the bodily tissUes with Inematine, the laryngeal mucous membrane assumes a more or less deep yellow color; especially the epiglottis. the. false vocal cords, and the ary-epiglottal folds become thus intensely colored. The different portions of the mucous membrane being attached to the laryngeal walls, in some places very loosely, in some firmly, active arterial hypcracmia produces a deeper red color in the firmer parts and lighter color in the looser portions. IIyperzemia from Venous stagnation is more uniformly diffused, and its color is darker all over the whole of the lining membrane than in the arterial. Many corrosive and poisonous substances produce in this, as in other mucous membranes, more or less severe Inemorrhages. The coloration produced by it will differ acem'ding to the intensity of infiltration and quantity of diffusion in its several parts. They may form small red or dark spots or extensive ecehymoses, or very dark colored plaques. Anaemia, both general and 10 ‘al, makes the membrane look pale. In consequence of great tension, produced by sub-mucous inflammatory infiltration, as, for instance, in dropsy Klebs have, by a great. number of statistics, set forth that finely-divided chemical and mechanical irritant substances are capable of pro- ducing in the respiratory passages at first catarrh of the pharynx and trachea, and then extending to the larynx sWelling and ulceration of its mucous membrane. Infectious diseases. such as mcasles, scarlatina, small-pox. cholera-tyj)hoid, are always associated with acute laryngeal catarrh. In measles and scarlet fever this forms one of the most important symptolns. In measles the catarrh is manifested bv intense redness and injection of the larynx. In scarlet fever-it assumes a desquamative form in the shape of a white-layered exfoliation of the epithelium. In hay fever, and in the latter stages of very severe cases of whooping cough, :1 very annoving, and often dangerous, form of laryngeal catarrh is LetZerich (m l'o'c/«mc's Arr/u. I'm/s. 49. do). as well as developed. IIenke (in -lrc/I. f. [Qt/z. filed/5,), has discovered micro-organisms