OCR Text |
Show DISEASES ()F TH E ()RGA N S OF ltlfiSl'IltA'I‘ION. destruction of both yo'-al cords. TABLE XVI. [Sucriox III. Fig. li-Fxtcnsive tuberculous destruction of all internal parts of the larynx caused by sub-acute tuberculosis. .Fig. III-A fissure in the internal posterior wall of the otherwise healthy larynx. Fig. It-Swelling on the internal Ixm'xuoscoric Views. Fig. 1.-.\Iucous polypus on the free edge of the right true vocal posterior wall of the larynx an early sign of tuberculosis. Fig. cord. Fig. 2.--Fibroid polypus on the left vocal cord. its upperpor- tion (edeinatous. Fig. El.-()n the right true vocal cord a conical ].‘>.--.\ catarrhal ulcer on the right vocal process. ltswall is raised by epithelial cell division. I'sually a sign ofpnlmonary phthisis. dense fibroid polypus, on its base a circular ulcer. A large Fig. ](i.-(‘a.tarrhal ulcer on the left vocal cord in ilt‘llfl‘ilfll'VI]Q'iIl-‘H polypus filling the upper laryngeal space and the Folds of Morgagni. Fig. L').-.\ fibroid below the vocal cords attached to the Fig. 17.-Tuberculous destructive ulcers on both vocal cords in anterior laryngeal wall. Softening and pendulous condition of the vocal cords. Fig. 6,-Nearly the whole posterior surface of the larynx is covered with pappiloma forming two layers, and in a state of active vegetation. Fig. 7.-Ulceraition along the edge of the left. vocal cord, dividing the fibrous covering of the cord. An ulcer existing between the arytenoid cartilagesindicates tuberculosis of the larynx. Figs. 8 and 9. Ulceration of the whole, inner surface of the false vocal cords. Fig. 8, early stage, Fig. 0, later stage of the disease--both in tubercular condition. Fig. 10.- Nodular infiltration of the true vocal cords. A deep ulcer on the posterior aspect of the arytenoid space. Fig. 11.-Tuberculous of the epiglottis, the left ary-epiglottal ligament, and the left arytenoid cartilage; a. case of slowly developing tubercnlar infiltration. the anterior surface of the epiglottis, and in are cases the true vocal cords. (Sec. III, Tab. X1], Figs. 4, 5, acute cpigloft/Iis.) Very rarely is the entire mucous surface affected. The portions thus the space is still more. filled up with pus. (Sec. III, Tab. XII, Figs. Fig. Jr. rapidlyprogressing tuberculosis. Fig. 1K-(I‘ldernatous swelling Fig. 15L-A view into the whole length of the trachea and the bifurcation of the bronchi (healthy). Fig. 20.--An enormous polvpus passing from the right vocal cord posteriorly, nearly filling the whole cavity of the larynx. Fig. 21,-Stricture of the larynx by a- 1)scudo-membrane below the vocal cords. Fig. 22,-Cicatrices after syphilitie ulceration; the epiglottis partly destroyed, in the right false vocal cord a. deep hole, adhesion to the true vocal cords. Fig. 23.-Total destruction of the larynx by syphilis. (Speedy death.) Fig. Bah-Epithelial cancer on the right vocal cord. i 3, 4.) Evacuations of such abscesses differ according as the sbft involved are formed into thick ridges or rolls, very tense, of a yellow transparent jelly-like appearance, and have a glistening sur- parts are pierced by the corrosive pus, or the *artilage is perforated by necrosis from lack of nutrition. In the first case the liquid pus only is discharged, the fundus of the abscess becomes a corrosive face. "Then the epigl(:)ttis becomes (edematous it rolls up into a ulcer, which eventually affects the cartilage, and causes infiltration swollen cylinder (Fig. 5, same Plate), and becomes very visible in into the surrounding tissues. In the second case the spread of de- struction of the cartilage will continue for some time, until portions the pharynx and is felt by the patient like a large lump, which closes up the pharyngeal and laryngeal cavities. The most dan- gerous is dropsy of the ary-epiglottal ligaments, for not only does it cause a closure of the upper portion of the larynx by swelling more than any other part of the mucous memb 'ane, but also by its being drawn into the glottal orifice during inspiration. The least dangerous is oedema of the Folds of Morgagni. The infiltrate in the chronic state is very clear, and contains very numerous albuminous and fat granules and a few lymphoid bodies. The mucous glands are dilated and filled with the same transudate, the epithelium is exfoliated in a great measure. In the acute form the mucous glands are compressed. In the acute form the mucous membrane is tense; in the chronic form the sub-epithelial layer is filled with lymphoid cells and degenerated epithelium. Croup, laryngeal diphtheria, perichondritis, acute laryngeal catarrh,phlegmon of the larynx with diffuse 1,»haryngitis, of the parotid glands, and many other diffuse infiammations of the cervical tissues are the causes of acute (edema, which often causes very speedy death. High-graded cedema forms part of general drops It is less dangerous than the acute form. In rare cases the dropsical liquid becomes absorbed, and the collapsed membrane is then thrown into numerous folds. A few histological remnants are left behind. l'hlcgmonws Lro'yngitis. This very much resembles acute laryngeal dropsy, but differs from it in the following: That there is here a tough, mostly purulent, infiltration into the sub-mucous tissue. ()nly portions of the larynx become thus affected. But the swelling is never so massive, the parts become tough, plump, slightly discolored; the transudate forms a eoagnlum, and is mixed with pus. There are formed sub- mucous abscesses, which raise the mucous tissue above them. and eventually break through it, forming deep, undermining ulcers. The inflammation will then often extend deep into the, perichondrium, calling forth quickly extending perichmnlritis. (Sec. III, Tables XIII, XIV, many (fits figures.) Serous infiltration is very often formed in the soft adjacent tissues. Both conditions produce dangerous constrictions of the respiratory passage. I‘lnormous quantities of exudated cells are found in the inter-fibrous spaces of the sub-mucous connective tissue. Slight quantities of infiltration are usually very readily absorbed; great quantities, containing much pus, usually produce perforation by suppuration, and the matter will penetrate into the laryngeal, pharyngeal, and (esopha- ofit become obliterated. Necrosed parts of a cartilage in such a con- (lition will either be loosened from their surroundings and detached by exfoliation, or their obliteration be slowly brought about by suppurative caries. In very rare cases,healing ofsuch wounds is effected by suppuration, granulation, and subsequent cicatrization. Schol- trl/m has lately observed a case of spontaneous cure of a case by production ofa funnel-shaped cicatrix uponthe surface of the cartilage. Alterations of the laryngeal tissues in typhoid fever differ in degree and extent according to the intensity of the morbid process of the typhoid infection. There may exist very superficial affections of the laryngeal mucous membrane directly connected with general derangements in that tissue throughout the body from the typhoid miasm, or in connection with lobular pneumonia, a most frequent conqilieation in that disease. There may be acute catarrh, lizemorrhages, superficial erosions or surface mortification. \Vith the last lesion very extensive and very deep ulcerations are often connected, and are marked by a mycotic character. There may be infiltrations similar to those forming in the intestines, such as nodular orgranular, and ending in gangrene and ulceration. Fib- rinous exudation of a croupous kind often takes place as a consecutive lesion. The *atarrhal process in the laryngeal mucous membrane, although less severe than in ordinary catarrhal processes, leads, nevertheless, to denudations of the many portions of the car- tilages, by severe exfoliation and gangrene of the epithelium. The edge of such a denuded cartilage projects between two shrunk mucous surfaces. Typhoid diphtheritis is another form ofdesquam- ative laryngeal catarrh in which exfoliated epithelium is found in yellow, smaller or larger flakes, mixed with gangrenous detritus and enormous masses of microeocci. They are usually in the folds of the loose mucous surface in the epiglottal region. This form of mycosis often leads to gangrenous ulcers, and necrosis of the cartilage of the epiglottis, or the other upper cartilages. (Tum-It, ch'brrt, qufli‘, Grr/mrdt, Epphz‘r/cr, have all described those very numerous deep alterations produced by mycotic agencies, but whic i could only be lightly indicated in these few pages. Alterations in, the Lory»): in. Variala. In all cases of small-pox there are more or less intense and extensive changes in the larynx. IE. E. \Vagner states that of 170 cases of small-pox he found true pustules in the larynx in 1-H. Roki- tansky, Foerstcr, Tuerk, Schroetter, and Ziemssen positively claim to have found pustules in the larynx of persons affected with '2- geal cavities, or empty outside through the skin. (Sec. III, Tables XIII, XIV, etc.) By septic agencies the destruction becomes enormously extensive, and usually ends fatally. Under favorable circumstances there are formed cicatrices in the tissues, and partial restitu- tion of the organ finds place. (Hm/(z and I?fi*/{fi')'. Zr/'t.\'c/u'{/'t_f. Raf/on. iIIrdcz/H., Series .[1I,Vol.f,p. 237.) This lesion is generally secondary to other inflammatory and infectious primary diseases. Po'ic/murln'lz‘s. This disease, which has several synonyms, is, strictly speaking, an inflammation of the perichondrium, resulting in suppuratitm and formation of abscesses. The perichondrium of the larynx, owing to many circumstances, is more subyect to infiannnations than many other similar structures. Even normally,in old age. this tissue undergoes a. process of vascularization and ossification (Eppinger). ()nly portions of this tissue are attacked by inflamma- tion. TIM/0M says that the thyroid, cricoid, and arytenoid cartilages are frequently afflicted by pcrichondritis. Friedreich claims the greatest frequency of this inflammation to exist in the arytenoids, whilst Tuerk maintains that the ericoid cartilage is as often affected as the others. All cartilagcs are never affected at once. There is an idiopathic and a consecutive or secondary pcrichomlritis. The In all there is formed a. puriform first is of most rare occurrence. infiltration into the yaerichonilrium, which thereby swells up. The infiltrate detaches it from the cartilage and fills up the space between them. (Sec. III, Tab. XIV, Figs. 3. 4.) Tumors formed thereby project either outward toward the. surrounding tissues, or into the laryngeal cavity. (Sec. III. Tab. XIV, Figs. 1, 2.) Very soon the exudate is changed into pus and constitutes an abscess, which still further separates the membrane from the cartilage and riola. Eppinger, basing his opinion on histological researches as thoroughly made by \Veigert (in Anamnli'sc/uj Britraeqc), chbs, and Luginbuhl i111873, flatly denies the possibility of the existence of true variolous pustules in the larynx. " But," says he, " it must be conceded that examination of the tissues merely with naked eye leads to .s'IIp/ms/t/un of their existence in those parts." In the early stages the mucous membrane is uniformly injected1 moderately swollen, and but slightly covered with mucus. Upon the epiglottis, the arytenoid cartilages, and the true vocal cords, very small, white, discolored spots, having very sharp outlines, make their ap- pearance. They look like nodules, yet do they barely project above the level of the mucous surface. Underthemicroscope they prove to be but superficial alterations of the epithelium, covered by the most external layer of that tissue. Deeper down in the tissue the cells lose more and more of their structural forms and atlast form a heterogeneous lump of cellular detritus. In the more advanced stage of the disease, even the outermost layer of the epi- thelium becomes likewise altered. and the whole is raised above the level of the adjacent structure. The little raised lump becomes filled with lymph serum, and resembles a pustule. Klebs succeeded in finding numbers of Illicrococci in this little lump, and ascribes the whole alteration to their agency. The morbid changes in scarlet fever and measles are mostly exceedingly intense hyperzemia. ecchymosis, and violent, acute catarrh of‘the larynx, which, according to Tel/"M. usually precede the respective eruption of the skin. (I‘ldematous swelling‘oftcn accompanies the catarrhal process and often leads to .strtcture of the larynx. (Z13 )IINNI'II, N/offi/l.) Gangrene and fibrinous 1n- terstitial exudations are of rarest occurrence in these diseases. |