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Show DISI‘ZAS_ I 0F TIIE ()HGAXS OF TABLE XIV. -The very emaciated patient had suffered fora long time from .ing cough and enormous cxpectoration. thoracic viscera normal. \Vas moribund the arytenoid cartilages. thick and slightlv red. excoriatcd. viscera normal except the larger bronchi, In lower portion of larynx a soft tumor covered bv blue-colored mucous membrane. Beneath it an abscess of an inch in width. in which the cricoid cartilagc was situated. perfectlv isolated from its surrounding soft tissuesf The abscess extended on both sides which contained some greenish-yellow secreta. The mucous incinbrane of trachea was very red and very soft. Slight swelling in loWer larvngcal region externally. Internally. epiglottis normal; glottis of'normal color but much constrictwl. I'osteriorly. the iuucous membrane between when brought to hospital. \Vas in a complete state of coma. I)ied an hourlater. Alife/Isj/.-Twelve hours after death. In cranial and V thoracic cavities all "I of February. dyspntra and sense of suffocation. orthopinra. face livid. l'erforined laryngott'uny: did not relieve him: died the following night. ])osf JInrh‘m.--Alalominal. cranial. and most of A. \V. Carpenter. 40 years old. I'l/slo/y/ H/u/ Noni/MoHI.\'.-I‘Illtel‘e(l (,llltll‘ity IIOSPITEII. Berlin. J\]')i‘il 1.1. [SECTION voice deep and hoarse, stridulous resi'iirat'ion. croupv cough, expectorates muco-pus. l'ulsc very rapid and soft. Face pale. Hub I‘llus. I. £.-Os/ro-c/«M7lira/ml of Lari/w: (Im: R I‘ISI)II\).\TI(IN After dividing the posterior pharyngeal wall the glottis (Fig. I) was found extremely narrow. the left half of the larynx very much swollen. although forward and downward. of normal color. and its mucous membrane but little redder than usual. The stricture of the glottis was caused by an osteo-chondronia situated on thyroid cartilage. and penetrating into the larynx. The intervening soft tissues were partly compressed and partly altered by ulceration and gangrene. Fig.1 presents the. pharynx and imsophagus divided and their walls thrown back. A, root of the tongue :7/1. posterior surface of epiglottis; c, larynx. swollen on the leftside; 1/. apex of posterior found to be attached only above and in front: behind it was coinpletcly surrounded by the abscess. The whole was denuded of its 1wrichondrium. in many places corroded. were intact. The trachea and bronchi Fig. 53.-;t, root of tongue: h. epiglottis: c. upper edge of glottis: 1/. superior cornu of thyroid: (, reflected sides of pharvnx and (esophagus: f, divided larynx, internal surface: 1/. divided cricoid in abscess cavity; /«. cavitv of the abscess: f. internal wound made by laryngotomy. ‘ i Fig. I-Same as the previous. the epiglottis removed. A. root eornn of hyoid bone; (r, comiiienceinent of (esophagus. Fig 2.-T/m 1172ch of flu' [VII/Id half of NW Irma/11.1? is luff cm‘o'c: t/«c [(777 is d/ro/m/ in HM inf/Mic. On further dissection the cartilage was A, root of tongue: I}, epiglottis; r. of tongue: l1. portion of mucous membrane of epiglottis; (1. inter- osteo-eln)ndromatous tumor of thyroid cartilage: «I. larger cornu of liyoid bone; c. upper portion of the left half of the thyroid cartilage: f. opening for passage of superior laryngeal artery; 1/. lateral part of cricoid cartilage surrounded by the tumor: 5. border of mucous membrane: /.‘. left sterno-hyoid muscle: 1. left sternothyroid muscle: 1/1, crico-thyroid muscle: 1:. thyroid gland. slightly nal surface of left half of the thyroid cartilage; It. sub-mucous connective tissue in place of destroyed cartilage: c, fattv tissue beneath the epiglottis: '7'. a portion of crico~thvrbid membrane still adherent to a remnant of the cartilage (f):- 1/. cricoid cartilage severed by laryngotoniy; /1. internal surface of abscess: 1', wound made by operation; /;. m. sterno-hyoid and sterno-thyroid muscles: indurated; o, inner surface of sup. thyroid artery. atheroinatous: 1. mucous membrane of (esophagus: m. in. posterior surface of thvroid. i p. tracheal cavity. normal: 7. portions of pharynx and (esophagus. Figs. 3, 4.-Pc/'[c/mu(Ir/bis of Cr/cm'r/ ('r/rtilutr/r wit/i For/notion of Fig. 5,-Atrophy of posterior crico-arytenoid muscle. Fig. t3.-:\trophy of left lateral cric<t-arytenoid inuscle((' A I ._) (lateral cricti-arytcnoid; c t a. anteroir cricti-thvroid). ( l A I ') Allscl'NS. Crista-A. IIarknow, man of forty years. admitted into (‘harity IIospital, Berlin, Feb. 12, 18-.--lIad severe pain in the larynx. posterior crico-arytenl'iid); (a. arytenoid cartilage.) in the secretions and sputa of children and persons affected with these diseases. giving the tissue a peculiar whitish granular appearance. They often penetrate into the. sub-inuctnis tissue, and remler it hypertrophie (clan-Mitzi»- tutu/om). Such hyperplastic formations are sometimes so large as to protrude into the vocal orifice in the shape Citron/c {writ/myriad cut/owl] differs frein the acute form by the nearly permanent dilation of the vessels. owing to long-continued hyper:emia. In the rare cases where the vessels return to their normal of large tumors, closing up the already enlarged vocal cords. and caliber they leave behind them traces in the shape of infiltration of blood pigment in their fori'ner tracks. Hypertrophy of all the make tracheotomy necessary. layers and elements of the membrane will appear as a rough laryngeal hypertrophy. surface and rugous elevations. The hypertrophic papilhe will especially protrude upon the free surface. The secretion is either muco-pus, containing great quantities of fatty degenerated epithelium and lymphoid bodies. or serous and foamy. containing but few cellular elements. There are two varieties of the chronic gitis. is a result of chronic catarrh. catarrh corresponding to the forms of secretion. In all irritative catarrhs there is a thickening of the epithelial layer. due to extensive cell division. and great collection of lymphoid bodies. which form constitutes the only symptom of chronic catarrh of the air passages. a thick layer of decayed structures floating in exudatcd serum. The mucous and sub-mucous vessels are very much, and usually. permanently, dilated. surrounded by great quantities of emigrated colorless blood corpnseles and highly hyperplastic connective tissue Croup and diphtheria are still considered by many to be the same disease in different forms. Klebs has already assigned to diphtheria in a state of cell division. CW). and Tar/r have all Brio/s, Go'lmrrl, [ti/Mr. 1%l.v'MIzs/o/. described the several forms of this Granular lai'yngitis. like granular pharyn- It is both idiopathic and associated with tuberculosis and syphilis. Anatomically it is marked by the presence of distinct granulations and white transparent mucons deposit upon the posterior surface of the epiglottis. false vocal cords, and the Folds of Morgagni. (itccasionally this Linn/nymd Crow/i. its place amongthe general infectious diseases (Arr/i. EJ‘pz‘rJ'ulI:clog/a Vol. IV). As regards croup. Virchow has strictly defined its morbid anatomical character. by characterizing it as a fibriwous The glands are turgid with mucous aml exfoliated epithelium. The catarrhal state caused by chronic hyper-.emia and stagnation of the circulation is quite different. Only thin watery secretion. slight exfoliation of the epithelium amp/«Mimi iI/Ion "WI Iri'crxurz‘im' of u mucous non/brow by infirm/mmtz'ou. It is true that there is formed occasionally a decliner-scated exudation in croupous inflannnations. beside the superficial; also that in true diphtheria of the larynx a tibrinous exudate is sonictimes formed upon the free mucous surface. The presence of 'm/cro- without cell division. enormous dilatation of the vesst s, sclerotic state of the connective tissue. dilatation of the lymph-spaces in that tissue, with collection of cellular elements beneath the basement membrane. and especially round the lobules of the conglobated mucous glands. and high graded softening of the sub-mucous .s/m/W/I diphtheriticum will alwz ,3" indicate diphtheria, its (/(lb‘lht‘t' connective tissue form a charzwteristic group of anatomical changes of this disease. Crosions are far more frequent in chronic than in acute laryngeal catarrh. They present striped depressions. surrounded. by very much swollen epithelium, and have a flattened, intensely red ba" ‘. These erosions readily heal by regeneration of the epithelium. but leave behind them shallow depressions. liaginsky (m Drum-ll. le ., quJirn/ilufl, Nu. :28, 1876) described a case of we'll/m of the pharynx. Sometimes it is a secondary disease, and associated with inflammatory prm-esses in organs having apparently no connection larynx, which was characterized by its long continuance and very lateral edges of the epiglottis. and the false vocal cords are thus abundant exfoliation of the epithelium: scabs formed. and beneath these were deep erosions. The catarrh was brought on by mycotic agencies. It belonged. very likely. to that class of laryngeal affec- similarly lined. tions described by Klebs. as attributable to inicrosporon oris. Stork describes a form of laryngitis, which he callsLaryngeal If/z H/HH'i'/w a, existing endemieally in certain localities. and marked by its spread upon the whole mucous surface of the respiratory tract. The membrane either secretes enormous quantities of purulent and other secretions, or almost completely dries up. It assumes a long pro- tracted and highly destructive character. but has nothing in common with syphilitic or tuberculous af'tcctions of the larynx. Sw/mr-‘t/oiisrn, who also describes it. attributes it to inycotic iiifluences, for he found a variety of microscopic fungi both in the secretions and in the sputa of individuals affected with it. (no/m. K/II/I. IVII‘/Ll‘lt.\‘I‘/H'.. IRTR. No.11.) Loss of voice always results from chronic laryngeal catarrh. It may only amount to a slight hoarscness or to inability to speak above a whisper. Annoying inclination to cough. cspccizllly \Vllt'll the epithelial tissue is abraded. is likewise always present. Ana- tomical alterations resulting therefrom are: Dilatation of the vessels (Dildo/.3), sclerosis of the mucous membranes. more especially affecting the papillm. as on the true vocal cords and the inferior surface of the epiglottis: and hyperplastic formations of epithelium, of different sizes and extent, upon the false vocal cords. , true croupous laryngitis. (‘roup is sometimes primary, and confined to the larynx, portions of the trachea and primary bronchi. or the with the larynx directly. In many cases of infectious diseases laryngeal croup forms one of the complications and a prominent symptom, and is brought about by ‘IIHfI/sfr/s/N. In the primary form the whole laryngeal mucous memb 'ane becomes covered with a yellowish or yellowish -gray membrane of about one or two lines of thickness; the anterior surface. the l'sually a great portion of the mucous membrane of the pharynx. trachea. and primary bronchi are also covered. The iiseutlo-membrane is of a solid consistence. elastic; andwhen it is removed leaves the underlying surface very much injected and deiunlcd of its epithelium. A new 1>scud<emcmbrane is often 1 ‘ I ‘ formed after removal of the first. Sometimes the membrane attains , sinus pyrotormis. and now and then upon the true vocal cord. as ‘ appearance. enormous thickness and fills up the whole laryngeal and glottal cav- ities. The secondary is more rare than the primary.and the exudate is usually not in the shape of a coherent membrane. but is formed in spots on the internal surface of the ary-cpiglottal ligament. the soft spongy lumps of yellow color. giving to the surface a villons (Nun [I]. Til/z. XI]. I‘VII/N. I. 2.) 'Ihey Usually exist in connection with certain exudative processes goingon in other ‘ parts of the respiratory organs (fill/Vilnius [onIII/m/H'r/‘i-thc heart, the kidneys. in syphilitic and tubercular affections._ 'I he metastatic forni oflaryngcal croup occurring in infectious diseases is generally complicated with pharyngcal croup. In scarlet fever. small-pox. morbilli. tvphus. and cln>lera»typhoid the exudate is yellow. dry, and vcrv brittle. easilv removed from their bed. They form patches of tibribous substances. interspersed with mortified superficial plzupies. both being but slightly adherent to the Ililli‘nvlls'.slll'Ityt‘t‘. The histological composition of the cronpous exudate is identical in all forms. It consists of fibroid masses and cellular clcmcnts, |