(EDEMA GLOTTIDIS. 45 



ought never to neglect to ascertain positively, by mjaiis of the laryn- 

 goscope, whether a tumor be not the source of the affection. 



In others of the newly-observed cases, however, besides the signs 

 of chronic laryngitis, the other symptoms formerly regarded as pathog- 

 nomonic were actually present, so that it would have been possible to 

 decide as to the existence of these tumors in the larynx, even before the 

 introduction of laryngoscopy. There was that long-drawn, laborious, 

 stridulous respiration, characteristic of stricture of the larynx, particu- 

 larly when, after any bodily exertion mounting stairs, rapid running, and 

 the like the dyspnoea had increased, and the inspiratory movements be- 

 come more energetic and frequent. Czermak and Lewin have called 

 to our attention, that in tumors above the glottis it is frequently inspira- 

 tion alone which is impeded, while if the growth be below the glottis 

 expiration may be embarrassed. 



It finally remains to be told that contrary instances have been met 

 with, which not only evinced no signs of laryngeal stricture, but in 

 which there was neither harsh cough nor hoarseness. 



The sole complaint of these patients was, of an ill-defined feeling of 

 distress in the throat, or the sensation as if an accumulation of mucus 

 were sticking in the larynx. 



The great variety in the symptoms of laryngeal tumors is easily 

 comprehensible, after what we have taught in the first chapter, about 

 the physiology of the voice. It is only in the cases in which the tumor 

 hinders the approximation of the vocal chords, or interferes with then- vi- 

 bration, that they, of necessity, occasion hoarseness or aphonia. On the 

 other hand, all tumors which do not imph'cate the functions of the vocal 

 chords cannot possibly give rise to such symptoms. Thus it depends 

 entirely upon the seat of a growth, and upon its size, as to whether it 

 cause the symptoms of laryngeal stricture or not. The treatment of 

 growths of the larynx comes under the domain of surgery. 



Since the year 1861, when my colleague Bruns^ with the aid of the 

 laryngoscope, and without incision, first extirpated a laryngeal polypus 

 from the throat of his brother, the operation, which forms one of the 

 most brilh'ant advances of modem surgery, has been performed repeat- 

 edly, both by Bruns and by other surgeons familiar with the use of the 

 laryngoscope. 



CHAPTER VIII. 



(EDEMA GLOTTIDIS. 



ETIOLOGY. During inflammation of a part where the skin is attached 

 to the subjacent region by loose areolar tissue, effusion into the latter 

 often takes place with extraordinary rapidity. 



