SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. iT 



III. DISEASES OP THE LARYNX. 



The laryngeal complications are noted very briefly by several 

 medical writers, such as Murchison, Flint, Liebermeister, Giie- 

 singer, etc., but it is mainly the laryngeal ulcers themselves 

 which are treated of, their surgical results being scarcely men- 

 tioned. Gross and Gray barely allude to typhoid as a cause of 

 oedema glottidis. Even systematic writers on the larynx 

 scarcely notice them. Gibb and Riihle refer to two or three 

 cases. Cohen simply names fever. Tiirck gives, however, 

 eight valuable cases. I have collected 169 cases, of which at 

 least 67 (and probably many more) certainly involved the car- 

 tilages themselves. 



The troubles which ma}' demand surgical interference are all 

 allied, and are the result of a low grade of inflammation. The 

 entire respiratory mucous membi'ane (as is shown by the fre- 

 quency of bronchitis) is in a more or less catarrhal condition 

 like that of the bowels, and occasionally other mucous mem- 

 branes such as those of tlie gall-bladder, urinary bladder, and 

 vagina. It is not, therefore, a matter of surprise, that serious 

 trouble should arise in the larynx, especially as slight varia- 

 tions in its mechanical condition gravely embarrass so vital a 

 function as respiration. 



Pathologically the troubles may be grouped into three varie- 

 ties, viz., 1. (Edematous laryngitis. 2. Ulcerative laryngitis. 

 3. Laryngeal perichondritis. Practically it is often exceed- 

 ingly difficult to separate these various forms even at the post- 

 mortem, so far do they overlap each other. (Edema may exist 

 alone or it may result from either of the others ; ulceration 

 may march steadily deeper until the cartilages are mvolved ; or 

 the perichondritis may produce an abscess which will burst, 

 and so form an ulcer. How much more difficult, na}' often 

 impossible, then is it, to diagnosticate pi-ecisely the form of 

 the disease, when, happily, the patient recovers. Dyspnoea, 

 2 



