24 



THE TONER LECTURES. 



the larynx but also into the pliarynx, and a fistulous oponing 

 be establishetl by which food may enter the larynx and trachea. 



Fig. 5. 



Perichondritis after Typhoid. Opposite a the (Edematous ary-epijrlottidean 

 folds are seen. Below the vocal chords the larynx was narrowed by thickening 

 of the connective tissue. Opposite b a movable piece of the destroyed and 

 broken cricoid, which has perforated the oesophagus, is seen.— EUhle, Kehlkoi)f- 

 Krankh., p. 178 &. PI. I., Fig. 2. 



This, Dittrieh thinks, is the most frequent point of opening ; 

 but I have only found it recorded in six instances, though such 

 an abscess would have burst here in several other cases had 

 life been prolonged. An additional complication may follow, 

 also in the phaiynx. The cricoid presses upon its posterior 

 wall, both from swelling and from gravity, and this pressure, 

 together with the foul purulent discharge, raaj' cause an ulcer ; 

 or, as in a case recorded by Armstrong, a retro-pharyngeal 

 abscess. Hoffmann' records another case of retro-pharyngeal 

 abscess extending from the base of the skull to the diaphragm, 

 laj'ing bare the left subclavian artery. This, however, did not 

 result from a laryngeal necrosis. 



The earliest S3'mptom of grave lar^-ngeal disease is usuallj'' 



• Op. cit., p. se 



