SURGICAL COMPLICATIONS AND SEQUELS OP FEVERS. 21 



glottis proper, since oedema of the vocal chords is named but 

 nine times. 



The date of the development is generally here too, in the 

 later fever, or more frequently in distinct convalescence. Of 

 102 cases only 4 occurred in the first week, 13 in the second, 

 19 in the third, and 66 from four weeks to two months. They 

 follow typhoid far more frequently than typhus, in the propor- 

 tion of 106 to 49, some of the latter being probably really 

 typhoid, while 14 arose from other forms of continued fever. 



The position of the ulcers in the larynx is noteworthj'. 

 Wherever they may be, from the arytenoid to the cricoid, they 

 are almost invariably posterior. Rheiner' has shown that the 

 posterior wall of the lar^nix is the richest in vessels, and that 

 ossification begins here often as early as the twentieth year. 

 Here, then, we should expect the most frequent inflammations 

 ami thrombosis of the smaller vessels ; and when we add to 

 this the eflTect of gravity, from the continuous dorsal position, 

 and the mechanical effects of frequent use of the voice, and, 

 therefore, repeated movement of the arytenoid cartilages in 

 some delirious cases, we have a sufficient explanation of the 

 phenomenon. Emphj'sema of the neck and trunk is an occa- 

 sional result of such ulcers where thej^ penetrate the mucous 

 membrane. This was first pointed out by Wilks. Other cases 

 are reported by Steiner and Loeschner. All three were children. 



Necrosis of the cartilages is the most important form to 

 recognize, in consequence of its excessive gravity, for, of 56 

 cases in which the result is given,- 54 died. One recovered 

 after tracheotomy,'^ and one without it.^ We can scarcely agree 

 with Tiirck, thei'efore, that the prognosis is "doubtful." The 

 seat of the necrosis in the majority of the cases is the cricoid 



' Breitage zur Histologie des Kehlkopfs ; Wiirzburg, 1852. 

 2 Turck, p. 223. 



^ IT6rard. I'Union M6(l., July 14, 18.59. quoted by Trousseau, Cliu. 

 Med., Syd. Soc. Trans., 2d cd., vol. ii. p. 407. 



