LARYNGITIS 31 



Symptoms.— The disease begins as an acute catarrh of the 

 larynx that develops rapidly producing severe dyspnea 

 which reaches a high degree 'in one or two days. The tem- 

 perature is high, chills occur, and the patient is prostrated. 

 There is loss of appetite. A prominent clinical symptom 

 is dyspnea associated with loud laryngeal tones, swelling, 

 and sensitiveness in the region of the throat. Slight press- 

 ure produces spasmodic cough which may lead to apnea. 

 During the act of coughing the patient ejects at first quan- 

 tities of mucus and pus through the nostril. Later croupous 

 masses may be coughed up which usually temporarily or 

 permanently improves the condition. The lymph glands 

 of the submaxillary region are swollen and tender. In some 

 instances the feces are covered with flakes of mucus or fibrin. 



Course. — Very acute. In fatal cases death usually results 

 in three days from asphyxia, or the patient may die in ten 

 days. 



The prognosis is fair. About 50 per cent, of the cases 

 recover. 



Diagnosis. — The high fever, peculiar hoarse cough, stenotic 

 (roaring) inspiratory tone and the coughing up of fibrinous 

 masses are the most important diagnostic points. One 

 should be on the lookout for foreign bodies, edema of the 

 glottis, and tumors in or near the larynx from the stand- 

 point of differential diagnosis. 



Treatment. — The inhalation of alkalies such as lime water 

 repeated every two hours and infrictions over the throat are 

 recommended. The principal indication, however, is an 

 early tracheotomy. Alcohol per rectum may also be used. 



Edematous Laryngitis (Edema of the Glottis). — Definition. — 

 By edema of the glottis we understand a serous infiltration 

 of the submucous connective tissue of the upper part of 

 the larynx (ventral surface of the epiglottis, epiglottic-ary- 

 tenoid folds and the walls of the saccules of the larynx). 

 The edematous swelling produces marked stenosis of the 

 larynx with resulting severe dyspnea. According to cause 

 we may distinguish: - 



(a) An inflammatory edema. 



(b) A noil-inflammatory edema. 



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