SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 19 



gone so far as to declare that the ulcers which accompany 

 perichondritis are not primary but in all cases secondary. 

 Both I believe are right, but both go too far. So far as the 

 history and post-mortem appearances would enable me to judge, 

 1 have found in 20 cases that the perichondritis preceded the 

 ulcers and caused them, while in 10 cases the ulceration had 

 caused the perichondritis. In cases of perichondritis in which 

 death takes place early, there is no opening in the mucous 

 membrane, but a submucous abscess will be found surrounding 

 the necrosed cartilage. If death takes place at a later date a 

 small opening will exist, through which the probe will enter 

 into a much larger cavity. In other cases the surface mischief 

 will be by far the most widely spread, the ulcers being roughly 

 conical, involving not only the mucous membrane, but eating 

 deeply down to the cartilages. Similar necrosis of the nasal 

 cartilages also sometimes results from fever. 



Those cases in which there is considerable cough, or the 

 patient in his delirium has cried aloud, or sung much, or those 

 in which, after distinct convalescence, there has been exposure 

 to wet and cold, are predisposed to laryngeal troubles. They 

 are exceedingly rare in children. In 94 cases in which the age 

 is recorded, I have found but 6 under 15 years of age, 60 from 

 15 to 25, and 28 above 25 years. Sex is potent here as in the 

 other diseases considered. Lisfranc thought them more com- 

 mon in women than in men, but of 110 cases, I find 86 in men 

 and only 24 in women, or 3^ to 1. 



The cause of the stenosis is various. It may be, 1st, from 

 oedema; 2d, the swelling produced by the abscess about the 

 cartilage; 3d, the sides of the glottis may fall together if 

 the cricoid be destro3'ed and in pieces ; 4th, the permanent 

 aipproximation of one, or more rarely of both vocal chords 

 from destruction of tlie fixed points of origin of the muscles ; 

 5th, as in two remarkable cases given b}'' Hofimann,' shreds of 



' Op. cit., pp. 253 and 255. 



