Jens Jensen Dodt.

Archives of laryngology. ... . Volume I-IV. [March 1880-October 1883.] online

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there was tubercular ulceration of the larynx or trachea." Such
is certainly not similar to our experience, nor does it correspond
with the experience of excellent microscopists in New York.

Whenever anaemia of the larynx is well marked, it should al-
wajrs induce the attendant physician to make a careful examina-
tion of the lungs, so frequently is this local aspect a forerunner of
laryngeal phthisis.

Perichondritis of the larynx, as a primary disease, is rarely met
with. In 45 autopsies where necrosis of one or other of the car-
tilages was found, laryngeal phthisis, syphilis, or cancer, were re-
sponsible for causing it most frequently.

Whenever the laryngeal passage remains contracted after the



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78 Archives of Laryngology.

inflammatory process has subsided, it may be dilated by mechani-
cal means. Schroetter's method is fully described, and impor-
tance is properly attached to his recent device of " using pewter
plugs, of various diameters, and about an inch and a-quarter in
length, which, being introduced into the larynx are retained in
situ by means of the tracheal canula."

Interesting sections are devoted to lupus and leprosy of the
larynx ; fractures and dislocations ; wounds of and foreign bod-
ies in this organ. The nervo-muscular and sensory affections of
the larynx are fully and accurately described, and merit in them-
selves far more than a passing notice.

The greater disposition in bilateral laryngeal paralysis to im-
plication of the abductor filaments than the adductor filaments, is
hypothetically explained either by their superficiality, or by an in-
crement of nerve- force, which comes to the adductors from the
superior laryngeal nerve. It is well known the author has
never favored particularly the use of the galvano-cautery in endo-
laryngeai operations. In this work he states (p. 5of ) that this
method of extirpation appears to him especially indicated *' in
cases of small growths situated in the upper part of the tra-
chea."

The right-angled canula of Durham, of which several fig-
ures are inserted, is described and commended. The only ob-
jections to its use are that mucus is apt to become attached to the
joints of the inner tubes, and these may become corroded. The
former drawback is unworthy of serious consideration ; the latter
renders it obligatory to examine the condition of the joints care-
fully before making use of the instrument. General anaesthesia
should, as a rule, be avoided during the operation of tracheotomy
in adults. If it be necessary to administer a general anaesthetic,
chloroform is preferred to any other, as it causes less irritation of
the laryngeal mucous membrane. The author is opposed to the
use of the thermo-cautery in laryngo-tracheal operations, on the
ground that it " merely introduces an unnecessary complication
into the operation."

For the extraction of a foreign body after the windpipe is
opened, and when it has become fixed in the trachea and is not
at once expelled, the author's tube forceps answers the purpose
better than the instrument invented by Gross. Amongst the
formulae for topical remedies, those which have beei) found of
especial use by the author are printed in black (Egyptian) type.



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Reviews and Book Notices, 79

This treatise terminates with a very complete index. The typog-
raphy, paper and general appearance of the volume, are satisfac-
tory.

To conclude, this is in every sense a most admirable work, re-
flecting lasting credit upon its distinguished author. He is al-
ways clear, concise^ and methodical. He is likewise judicious in
his personal views and in his estimate of what others have done.
The labor which is so well attested in every page is truly surprising.
All sources of information have been thoroughly sifted, and but
little remains to be gleaned by other writers upon the topics
treated of. Not only is the bibliographical research most praise-
worthy in its extent ; it is equally so in its exactness. Few errors
occur, and when they do, are relatively unimportant. To this
record of what others have accomplished, are added the results
of his own valuable experience. Everywhere we can discover
what he individually has done ; what remedies and surgical
methods he has tried, and what successes and reverses have
crowned his .endeavors. How much the author has advanced our
knowledge of throat affections, those alone can properly estimate
who have worked faithfully in the same field. His present work
he calls a manual ; for us it is, in reality, a system of the subjects
taught in its pages, and as such it will remain. To the author
himself, it may well be a source of continued and increasing satis-
faction, [b. r.]

A practical treatise on nasal catarrh. By Beverly
Robinson, A.M., M.D. (Paris), Lecturer on Clinical Medicine at
the Bellevue Hospital Medical College, New York ; Physician to
St. Luke's and Charity Hospitals, etc. 8vo, pp. 182, New York :
Waiiam Wood & Co., 1880.

We are told by the author that he has, in the lengthy essay be-
fore us, endeavored to write a succinct account of his personal
experience in matters concerning nasal catarrh, and of his convic-
tions, based upon a practical observation of the disease, and the
statement bespeaks at once attention for the book and predisposes
in favor of the interest and importance of its pages. So much has
been, and is to-day written, notably upon this very subject, that
possesses no possible claim to any originality, — works made up
by compilation, containing crude and unproven statements, false
conclusions, and inefficient and empirical therapeutics, that it is
refreshing to the jaded reviewer to unearth in his search, as he is



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8o Archives of Laryngology.

able to do in many chapters of the work under consideration^
new ideas and fresh views, both candidly and not unfrequently
forcibly expressed ; ones bearing the impress of conviction, and
evidently based upon personal and practical experience and
knowledge ; others, that while they are in many instances open
to adverse criticism, frequently not in accordance with those of
recognized authority, and in a few examples extreme, still at all
times are such as to command respect and bespeak, from the very
fairness of their propositions, respectful consideration.

A careful reading of Dr. Robinson's book has convinced us,
then, that though lacking in many of the attributes which go to
make up a successful work, it contains much that is of real merit,
and not only merit — that were, perhaps^ to damn it with faint
praise — ^but matters of value and importance to all, and all, in
this case, must necessarily embrace the profession at large, who,
equally with the specialist^ are called upon to treat the forms of
disease included under the general title, nasal catarrh ; and we
willingly and cordially express our opinion, in addition, that not-
withstanding some defects already alluded to — if defects they may
properly be called — which literary and professional experience will
remedy in the future, the book stands to-day as one of the best
contributions to our knowledge of all excepting the therapeutics
of the disease. Here, it is, unquestionably, taken as a whole, t?te
best and most reliable guide that exists at present in literature.

Our notice is, from its enforced brevity, limited to general
statement. Willingly would we, if space were at our command,
enter into detail. Proof is not lacking in the pages before us in
support of all that we have said that is open to the charge of ad-
verse criticism. On the other hand, our judgment of its merits
is the fruit of no hasty and superficial reading, nor the outcome
of any immature consideration. The same time and attention that
we have bestowed upon it will lead others, familiar with the med-
ical literature of the day, to endorse our views and unite with us
in recommending the essay of Dr. Robinson as readable and re-
liable, [g. m. l.]



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QUARTERLY REPORT AND ABSTRACT OF
LARYNGOLOGICAL LITERATURE.

By GEORGE M, LEFFERTS, M.D.

I. — LARYNX*.

9. FoURNii. On the voice in the enunch. All. Wienet Med, Zeitung, No.
37, 1880.

J I. Fritsche. On aphonia spastica. Centralblatt fUr Med, fViscA,, No,
36, 1880.

13. Heinze. a rare fonn of laryngeal stenosis. Wiener Med. Presse^ No.
44, 1880.

14. Hering. Laryngeal stenosis following perforation of a vocal cord.
MonaUsch. fUr Okrenheilk., No. 8, 1880.

16. Ingals. Treatment of diseases of the larynx. Chicago Med, Jour, and
Ex., October, 1880.

17. Jelenffy. The musculus vocalis and vocal register. Centralblatt fUr
Med. Wis,, No. 39, 1880.

i8. Jones. Fatty tumor of the larynx. Lancet, October 23, 1880.

19. Kapff. On extirpation of the larynx. Ann, des MaJ, de V Oreille et du
Larynx, September, 1880.

20. Krishaber, M. On laryngeal spasm in locomotor ataxia. Ann, des
Mai, de P Oreille et du Larynx, November, 1880.

23. Mackenzie. Congenital syphilis of the throat ; based on a study of
150 cases. Am. Jour. Med. Sci.^ October, 1880.
27. Moure. Cysts of the epiglottis. Ld France Mid., No. 87, 1880.

29. Navratil. a contribution to the pathology and therapeutics of laryn-
geal papilloma. Berlin. Klin. Wochensch., No. 42, 1880.

30. PooRE. Cases of paralysis of the left recurrent laryngeal nerve. Lan-
cet, October 23. 1880.

32, RossBACH. A new method of anaesthetizing the larynx. Wiener Med,
Presse, No. 40, 1880.

* A part of the present report, containing the complete bibliography of the lar}mxfor the
<tmrter, will t>e found hi Archivbs, No. 4, vol. i, x88o, p. 390.

81



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82 Archives of Laryngology.

34. SCHAEFFER. A ncw simple laryngoscope. Deut, Med, Wochensck.^
No. 39, 1 880.

33. SCHAEFFER. On phonetic paral3rsis. Momatssch. farOhrtnkHlk.^'Ho,
8, 1880.

36. Schmidt. On the treatment of laryngeal tuberculosis. Wietur Med.
Fresse, No. 37, 1880.

37. SCHNITZLER. On hemorrhage from, and laceration of, the vocal cords.
Wiener Med. Presse, Nos. 38, 41, 1880.

38. Semon, F. On the mechanical impairments of the functions of the
crico-arytenoid articulation (especially true and false anchylosis and luxation),
with some remarks on perichondritis of the laryngeal cartilages. Med. Times
and Gat. ^ September iZ^et seq., 1880.

42. WiEBER. Extirpation of the larynx. Ann. Anat. and Surg^. Soc.,
Brooklyn, N. Y.. June, 1880.

43. ZucKERKANDL, E. On Certain variations in the regio glosso-epiglottica.
Monatssch, far Ohrenheilk., No. 10, 1880.

9. The eunnch voice. By this term is understood a voice with a much
higher register than would properly appertain to the age, sex, and physical de-
velopment of the given individual. It is not infrequent and usually consists in
a voice the notes of which run one octave higher than is common. It must not
be confounded with the soft, flute-like voice, two to three notes higher than the
usual register, which is occasionally found in the *' tenorini," and proceeds from
a well-proportioned, but small larynx, resembling that of the female. The
lar3mx pertaining to the eunuch voice, presents, as a rule, in its external con-
figuration, nothing abnormal ; it is proportionate to the age and stature of the
man, and the lar3mgoscope reveals no change from the usual picture, as far as
anatomical conditions go. Allow the patient, however, to intone, when the
mirror is in position in the fauces, and it will at once be seen, that
though at the moment of intonation the vocal cords approach each other, leav-
ing for the air current only a small elliptical space between them, they finally
press closely one against the other ; but that this contact only takes place ante-
riorly, and that posteriorly a V-shaped space is left, its point looking forward.
At the same moment the cords are strongly tensed in an anterior-posterior di-
rection, and the larynx drawn upward and backward. If the attempt be now
made to produce still higher tones, the conditions either remain the same, or the
tension of the cords is slightly increased, and the glottic opening, posteriorly, a
little narrowed. The excessive tension of the vocal cords is evidently, then,
mainly at fault, but this fact will not explain why the register is an octave higher
than common in an otherwise natural voice. The reason will, however, be
found in the pathogenesis. Tne histories of all patients show that their pecul-
iar voice dates from the period of its mutation. The majority remember that
it at this epoch was much changed ; that they remained, for a variable period,
aphonic, and that, upon regaining the voice, its timbre and register were al-
tered to that of the so-called eunuch voice. This period of mutation we know
is characterized by the rapid growth and development of all the parts concerned
in vocalization. If this growth does not proceed harmoniously, — that is to say.



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Report and Abstract, 83

if certain parts develop more rapidly, others slowly, the lack of correspon-
dence, of growth-harmony, is quickly shown in the configuration of the rima
glottidis, which assumes the V shape, so well exemplified in the case of an eu-
nuch Yoice ; the lar3mgeal cavity, too quickly and excessively developed, the
crico-arytenoid lateralis and the thyro-arytenoid muscles are too weak to close
the vocal cords together posteriorly. Under such conditions, a boy can produce
no chest note, and endeavors to compensate for the difficulty in closing the glot-
tic opening by excessive spanning of the vocal cords. The treatment of the
condition consists in a given gymnastic exercise for the organs of voice, the
method and manner of which are fully detailed in the original paper. It may be
thus summarized : Deep methodical inspirations, phonetic expirations, the given
note to be produced without perceptible contraction in the larynx and expired
in the manner of a sigh ; these having been acquired, certain syllables are spoken
during the act, in the same manner, then words, and finally reading from a book ;
the patient, therefore, does not speak during this whole time in his familiar
eunuch voice, but always in a syllabic, deep, sonorous tone during expiration.

As a rule, fifteen to twenty da3rs of this gymnastic procedure are enough to
change the character of the voice in the affected individual. Foumie has tried
the method in thirteen cases with the best results. (See also, Proceedings, In-
ternational Congress, Archives No. 4, vol. i, 1880, p. 378.)

II. Aphonia spastica. Fritsche communicates the histories of six cases
of this affection in which the therapeutical result is worthy of record. In five
cases the use of the galvanic current was attended with success, the applications
being made either externally over the throat, internally to the laryngeal cavity,
or centrally over the cervical vertebrae. In four cases the faradaic current, per-
sistently applied for weeks, was without result. Good results also followed the
insufflation of powders of iodide of potash. Finally, Fritsche describes a new
form of laryngeal electrode, in which, by an arrangement of the handle, elec-
trodes of different forms and direction may be used.

13. Rare form of laryng^eal stenosis. Caused by the cicatricial union
of the epiglottis with the posterior pharyngeal wall, after syphilitic ulceration
of the parts. The use of the galvano-cautery in separating the attachments was
followed by such a profuse hemorrhage that ligation of one external carotid be-
came neccessary. (See also. Proceedings, International Congress, Archives
No. 4, vol i, 1880, p. 379.)

14. Perforation of a vocal cord, laryng^eal stenosis. * * * For
two years, cough, hoarseness and dyspnoea, puiulent expectoration without blood,
stridulous breathing, painful deglutition, and aphonia. The mucous membrane
of the ventricular bands hypertrophied and reddened ; the left vocal cord im-
movable ; the right, after .removal of some pus, showed a perforating ulcer 6
mm, long and I mm, broad. In five days of mercurial treatment, marked im-
provement.

16. Treatment of diseases of the larynx. In his lecture, Ingals deals
with the treatment of inflammations of the laryngeal mucous membrane. His
advice is evidently intended for the general practitioner and not for the spe>
cialist. Some of the most important affections are passed over with superficial
consideration, and some* of the counsel given and statements made, in connect
tion with the commoner diseases, are open to fair criticism.



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84 Archives of Laryngology,

17. The tnusculns Tocalis and Toice reg^isters. Jelenffy bdieres
that this muscle never participates directly in the vibrations of the vocal cords,
and that the vibration of the edges alone of the latter, produce sound wares.
Regarding its function he has arrived at the following conclusions : I. The
thyroid cartilage being fixed, the vocal muscle draws the arytenoid cartilages
to a median position. 2. When the latter are fixed, it draws the thyroid
backward and shortens the vocal cords. 3. During the production of vocal
sounds it acts as an obturator to the air pressure in all the registers. 4. If
the muscles be tensed precisely in an antero-posterior direction, the vocal cords
are closely approximated, and the glottis completely closed ; through this pro-
cedure can chest tones only be produced. 5. When the muscles act alone as an
obturator to the air pressure and are not precisely tensed in the median line,
the glottis has an elliptic shape, and is not closed, only narrowed. Falset-
to tones alone are produced by this mechanical movement. 6. In the different
positions and shape of the glottic opening lies the cause of the difference be-
tween the chest and falsetto voice.

18. Fatty tumor of larynx. Jones exhibited at the London Pathologi-
cal Society recently, a tumor of this class as large as a Tangerine orange, with
a pedunculated attachment to the right aryteno-epiglottic fold. It was met
with in a man 40 years of age ; on opening his mouth nothing abnormal was
seen, but when he gave a peculiar gulp, the tumor was brought up and lay on
the dorsum of the tongue. It was removed by freely dividing the mucous
membrane of the pedicle and turning it out. A small cyst lined by stratified
scaly epithelium was found in it.

19. Extirpation of the larynx. The article here alluded to is a review,
by Baumfeld, of the inaugural thesis of Kapff. The latter is a risumi of the
present literature of the subject, containing no original observation.

20. Laryngeal spasm in locomotor ataxia. Krishaber's article is an
excellent one, and will be of much interest to those who have followed the
recent discussion of the points involved in the above heading. Its length pre-
cludes our giving it a fair abstract in the present report. (See also, Proceed-
ings, International Congress, Archives No. 4, vol. i, 1880, p. 386.)

23. Congenital syphilis of the throat. At the outset of his valuable
and interesting paper, Mackenzie asserts that laryngeal disease is not rare in
congenital syphilis ; on the contrary, that it is on« of the most constant and
characteristic of its pathological phenomena, and that the invasion of the
larynx may be looked for with as much confidence in the congenital as in the
acquired form of the disease. The reason why the lesions have not been
found more frequently Jies simply in the fact that they have not been sought.
The aim of the paper is, then, to invite attention to the throat as a frequent seat
of the lesions of congenital syphilis, and its author's faithful description of the
mode of occurrence, natural history, and characters of the disease, is the out- ,
come of a careful analytical study of some 150 cases of throat syphilis of con-
genital origin. To these cases, personally observed, have been added all cases
available in the scattered literature of the subject. The result, as embodied in
the subsequent pages of his paper, is, as we have said, a valuable one. After a
description of the superficial form of pharyngitb and its complications, we are



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Report and Abstract, 85

told that deep ulceration, a form usually considered, in text books at least, as
Tery rare in congenital syphilis, may invade the bucco-pharyngeal cavities
at any period of life, from the first week up to the age of puberty. Out of
30 cases analyzed with reference to the period of invasion, 14 occurred within
the first year, a proportion of nearly \^ and of these, 10 within the first 6
months. Of the remaining cases, the majority occurred at a period more or less
advanced toward puberty. The ulceration may occur in any situation, but its
favorite seat is the palate, and especially the hard palate. When it occurs
upon the posterior aspect of the latter, the tendency is to involve the soft pal-
ate and velum, and thence to invade the naso-pharynx and posterior nares.
Seated anteriorly, it seeks a more direct pathway to the nose. The next most
common localities are, in order of frequency, the fauces, naso-pharynx, the
posterior pharyngeal wall, the nasal fossse, the septum nasi, the tongue, and
finally the gums. A peculiarity in these ulcerations is their centrality of
position, and, furthermore, their special tendency to attack the bone and event-
uate in caries and necrosis. The ravages of the disease present the typical ap-
pearances that are found in the tertiary sjrphilis of the adult.

Although the constant irritation to which the oesophagus is subjected by the
gravitation of purulent secretion from the nose, and its carriage thither by the
movement of deglutition, determines a condition of chronic congestion and
hypersecretion of its follicles, well pronounced lesions of this organ are very
rare. Nature seems to afford a certain amount of conservative protection
which guards it against the more destructive forms of syphilis.

On the other hand, the laryngeal lesions of congenital syphilis are constant
and characteristic, and play an important role in the pathological evolution of
the dbease. The laiynx may be involved at any, but usually at an early
period. Monti states that he has twice seen laryngeal syphilis which arose
during intra-uterine life. The most common period of invasion, however, is
the first six months after birth. Out of 76 cases of laryngitis, 53 occurred
within the first year, and of these, 43 within the first six months, 17 within
the first month, and 4 within the first week of life. Ag'^, therefore, exercises
a predisposing influence upon the eruption of the disease in the larynx. This
applies not only to the superficial changes, but also to those malignant forms of
laryngeal destruction, which the pathologist occasionally encounters. Two
principal varieties of laryngeal inflammation may be distinguished in congeni-
tal syphilis. The classification of the lesions into secondary and tertiary do
not here obtain as in the case of acquired disease. In the one, the changes
are limited to the mucous membrane and sub-mucosa. Its processes are es-
sentially chronic, and there is little tendency to invasion of the deeper struc-
tures. The other is characterized by deep ulceration of an extremely acute
nature which, specially in early life, rapidly involves the cartilages and their en-
velopes and constitutes the most frightful form of the disease. In addition to
these there is a third form, in which a gradual deposit of dense fibrous ma-
terial takes place within the tissues of the larynx and leads to contraction of
its lumen.

These pathological facts justify a classification based upon the anatomical
seat of inflammation. Their separation, accordingly, into superficial, deep and
interstitial, would be much less arbitrary, Mackenzie believes, and would avoid
the confusion which the terms secondary and tertiary involve.



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86 Archives of Laryngology,

Chronic superficial laryngitis is the condition most frequently met with. It
is limited to the mucous membrane and sub-mucosa ; is essentially chronic,
runs a definite course, gives rise to well-defined changes in the larynx, and may
be divided into three stages, viz. : hjrpersemia, infiltration and hypertrophy,
and, finally, ulceration.

The deep, destructive ulcerative laryngitis corresponds, in physical charac-
ters, pretty closely to the tertiary inflammation of acquired syphilis. It may
follow the superficial form, but generally occurs independently of it. It is
sometimes among the first s3rmptoms of infection, and here is most destructive.
As a rule, deep pharyngeal ulceration precedes or coexists with this form of



Online LibraryJens Jensen DodtArchives of laryngology. ... . Volume I-IV. [March 1880-October 1883.] → online text (page 8 of 39)