26 THE TONEU LECTURES. 



aggravate it, especially if the cricoid be broken, or nearly 

 broken in two. Dysphagia is noted as present twenty-one times 

 and absent five times, and is especially present in crico:'d and 

 arytenoid necrosis. Rarely is there an}- external swelling to 

 attract attention, for I have onh' found it noted thrice. Nor 

 can the pharjnx be relied npon to warn us of impending evil, 

 for in 16 cases in which its condition was observed, it was 

 normal in 10 and inflamed in only 6. 



Most of the cases occurred before the days of the laryngo- 

 scope, so that I have only thirteen such examinations from 

 which to draw- any inferences, seven of which are recorded by 

 Tiirck. In several instances there was nothing whatever ab- 

 normal down to the vocal chords ; and tlie swelling of a 

 cricoid abscess on the posterior w^all is not visible. But the 

 usual facts observed, were the fixation of at least one chord in 

 tlie middle line, diminished mobility of the other, swelling of 

 the arj'-epiglottidean folds, stenosis of the larj-nx increased by 

 lateral pressure, a depression of the mucous membrane in case 

 of destruction of the arytenoid, and sometimes the opening of 

 an abscess, usually near the processus vocalis. A few such 

 positive facts with any additional positive symptoms should 

 lead to an equally positive treatment. 



And first the mortality is so great that the treatment is 

 of the greatest possible moment. Of 146 cases of all kinds 

 oi stenosis in which the result is recorded, 101 died and 

 45 recovered, a mortality of over 69 per cent., but not a 

 surprising result when we add the laryngeal disease to the 

 exhausting fever. But when we separate the cases operated 

 upon from those in which no operation is named, or was 

 certainly not done, the importance of the treatment becomes 

 even more appreciable. Of the TO cases not operated on, in 

 which the result is stated (and, be it observed, I have included 

 in these the cases of mere scarification), 17 recovered and 59 

 died, a mortalit}^ of over 71 per cent. Of the 70 cases operated 



