Laryngitis

“ Males are affected far more frequently than females, probably on account of greater exposure to sources of laryngitis. Benign growths are sometimes followed by malign growths in recurrence, and are sometimes converted into malignity by irritation, whether physiological, mechanical, or instrumental. Malign growths are attributed to cold, chronic laryngitis, and traumatism as the initial exciting causes. ”

“ It is far more commonly seen in syphilitic and tubercular conditions of the larynx, in kidney disease, in certain fevers, and in cases of cellulitis of the neck. The larynx is also one of the sites of Angeioneurotic oedema. In this form of laryngitis there are all the symptoms of acute laryngitis, but on a very much exaggerated scale. The dyspnoea, accompanied by marked stridor, may arise and reach a dangerous condition within the space of an hour, and demand the most prompt treatment. On examination the mucous membrane round the epiglottis is seen to be enormously swollen. ”

“ In favourable cases, which form the majority, the attack tends to abate in a few days, but on the other hand death may occur suddenly in a suffocative paroxysm, particularly in the case of children. Many cases of acute laryngitis are so comparatively slight as to make themselves known only by hoarseness and the character of the cough; nevertheless in every instance the attack demands serious attention. The treatment consists in keeping the patient in bed in an atmosphere of 60 to 70 F., made moist by steam. ”

“ The employment, every two hours, of a spray containing menthol and camphor (of each, ten grains) dissolved in alboline (two ounces) should be continued throughout the disease. If the hoarseness persists and [Pg 83] tends to become chronic, it is most advisable for the patient to consult a physician skilled in such diseases for local examination and special treatment.
CROUP.—Croup is an acute laryngitis of childhood, usually occurring between the ages of two and six years. The nervous element is more marked than in adults, so that the symptoms appear more alarming. ”

“ Especially in cases occurring in connection with measles, where the upper respiratory tract is already inflamed, the increased intensity of the laryngitis may induce so much swelling as to cause some mechanical obstruction to respiration which will arouse fears of pseudo-membranous formation, and which, during the spasms of cough and dyspnoea which are apt to occur occasionally, will closely simulate true croup. ”

“ In this affection, the majority of the symptoms, which have been already enumerated as attendant on laryngitis, are all present, and in an aggravated form. Inspiration is extremely difficult and sibilant, and occasionally the patient experiences a sensation, as if a foreign body were lodged in the passage, and had changed its position on the muscles of the part being put in motion. ”

“ It is recurrent laryngitis, another form of initial tuberculosis more grave than the first. Against laryngitis of this form treatment is of no avail.
“Another variety of initial tuberculosis is monocorditis. The patient becomes suddenly aphonic; laryngoscopic examination 252shows a cord perfectly red, congestion of which is evident, not only by the color, but by its altered volume. Contrast with the sound cord is often striking. Movements of the affected cord may be observed, but it is generally paretic. Acute monocorditis should cause us to think that it is an initial form of tuberculosis. ”

“ When acute laryngitis passes into the chronic form all the symptoms subside except a slight nasal discharge, the cough, tenderness of the larnyx, and roaring. The cough is dry, short, and hacking, rarely soft, and is heard mainly when the animal feeds, when he leaves the hot stable for the cold air, and after drinking cold water. During exercise, it is equally excited, the cough becoming harder, and the horse extending his head and neck as if to disengage some body from its throat. ”

“ In many instances the difficulty in swallowing is so great that water, and in some cases feed, is returned through the nose. This, however, does not occur in laryngitis alone, but only when the pharynx is involved in the inflammation. The glands between the lower jawbones and below the ears may be swollen. Pressure on the larynx induces coughing. The head is more or less "poked out," and has the appearance of being stiffly carried. The membrane in the nose becomes red. A discharge from the nostrils soon appears. As the disease advances, the breathing may assume a more or less noisy character ”

“ A soft, humid or rattling cough exists in the advanced stages of laryngitis, bronchitis and pneumonia when the activity of the inflammation has given way and a free exudation has taken place from the mucous membrane. It is usually accompanied by a discharge, in solipedes from the nose, and in other animals from nose and mouth. ”

“ Inflammation
of the larynx is a frequent and dangerous complaint. It usually commences with, and can scarcely be distinguished from, catarrh, except that it is attended by cough more violent and painful, and the dog expectorates considerably. Acute laryngitis is not so frequent an occurrence; but there is much danger attending it. Blood must be abstracted to as great an extent as the pulse will bear, or until it becomes evidently affected. To this must follow digitalis, nitre, tartar emetic, and aloes, and to these must be added a powerful blister. ”

“ A distinguished laryngologist has pointed out that not infrequently men who come to be treated for the chronic laryngitis, which is known as clergymen's sore throat, but which is seen so frequently in those who have to talk in the open air, auctioneers, cart-tail orators about election time, and in lecturers to large audiences who do not know how to use the voice, also complain of grievous discomfort from painful knee conditions which often makes the ascent or descent of stairs a painful task. ”

“ Tubercular laryngitis may often begin by a nodule situated on the border of the vocal cords. It is important not to confound it with singers’ nodules, these latter being more conical and more rounded. The tuberculous nodule may grow slowly, not ulcerate for a long time; interfering so little with the speaking voice that the patient often refuses any intervention. ”

“ The laryngoscope would be a great aid in diagnosis if it could be used during the distress of a membranous laryngitis. Still, it has been employed by Ziemssen, Rauchfuss, and others. But the opportunities are rare.
TREATMENT.—The objects of treatment differ with the various stages of the disease. The inflammatory symptoms of the commencement, the completed exudation, the maceration and disintegration, and also the expectoration of the pseudo-membranes, and, finally, the asphyctic stage, have each their own indications. If there is anything which must not be recommended, it is depletion. ”

“ Laryngitis, cynanche trachealis, most frequently occurs in children, and in them it is termed croup; but it also, though rarely, attacks adults. The voice is brazen, hoarse, and croaking; the355 cough is barking, and the countenance suffused. Inspiration is long, painful, effected with much difficulty, and attended with a wheezing or rattling noise. ”

“ In the catarrhal condition the temperature is usually greater than in the membranous form. The dyspnea in catarrhal laryngitis is usually paroxysmal; it is less exaggerated during the day but worse at night, while the membranous type is constant and rapidly becomes more exaggerated. The dyspnea occurs on both inspiration and expiration, while in the catarrhal form it occurs only on inspiration. If the culture shows Klebs-Loeffler bacilli it is considered laryngeal diphtheria. ”

“ Among the general causes the most fruitful are the high feeding, hot, close stables, heats and chills, and other circumstances attendant on domestication. Laryngitis may be an extension from coryza, pharyngitis, bronchitis or pneumonia. It may further be but a local manifestation of influenza or strangles, contagious pneumonia, etc. The disease is acute, subacute, or chronic.
Symptoms of acute form. All acquainted with horses can recognize the general symptoms of sore throat. The nose is elevated and protruded to avoid compression of the larynx ”

“ ETIOLOGY.—Inflammation of the mucous membrane, local irritation or injury, ulceration, cell-proliferation, and excessive granulation seem to be the exciting causes of benign neoplasms. They follow on laryngitis, whether catarrhal, syphilitic, tuberculous, exanthematic, toxic, or traumatic. They [p. 128] are quite common, so to speak, several thousands of cases being on record, and as many or more probably being unrecorded. Heredity does not seem to play any special part in their production. They are occasionally congenital, and may be developed at any age ”

“ Tuberculous patients, in whom the tuberculous process in the larynx begins with a sensation of a lump in the throat, may be in very good health, but this particular impression is often the first symptom which they observe in a laryngitis, which finally becomes tuberculous. At the moment when the patient complains of this symptom it may happen that laryngoscopic examination fails to detect any lesion. It is useless to add that this form is especially met with in the female. It most nearly resembles that form that begins with a dysphagia that persists to the end ”

“ It may be necessary in order to save life, to have a physician make an opening by incision into the windpipe for the admission of air into the lungs. This process is called Tracheotomy.
Diet in Laryngitis.—Hard and dry toasts should be avoided, for they give pain on being swallowed, same reason applies to highly seasoned foods. Milk, custards, eggs, scraped beef may be taken. Difficulty in swallowing may be overcome by allowing the patient to lie flat on the bed, etc., with his face over the edge. Food can be sucked through the tube from a vessel placed below ”

“ The idea of preventing or curing the laryngitis, or consumption, in a lady, when there is nothing but gauze, or a bit of ribbon and a galvanized bosom pin, between her neck and the cold and changeable atmosphere of the north or east, is ridiculously absurd. ”

“ Treatment of Chronic Laryngitis. The patient should have a loose airy box with an equable temperature. The avoidance of work and exposure must be sought for the time. Green food, cut roots, boiled grain, or bran mashes, with little or no hay, or other dry food, must be given. The bowels must be regulated. An electuary compound of linseed meal, molasses, and a drachm of belladonna extract to every tablespoonful of the mixture, may be given to the extent of a tablespoonful smeared on the inner side of the cheek twice daily. A mustard poultice to the throat has 122often a good effect. ”

“ Large tumors are not met with, but oedema and phlegmonous inflammations are by no means rare.
ETIOLOGY.—The predisposition varies according to individuals, ages, and seasons. Some mucous membranes appear to be more sensitive than others. The hereditary transmission of peculiarities of structure of all or some tissues or organs is apparent, in the case of laryngitis, in the fact that many children in the same family or the children of parents who were sufferers themselves are affected. Children are more liable than adults, infants more than children: 20 per cent. ”

“ Patients suffering from catarrhal laryngitis or a tendency in that direction must avoid all irritation of the pharynx and larynx. They must not smoke, or talk too much or too loud. Those few clergymen who suffer from clergymen's sore throat in consequence of speaking only will remember that they can speak just as forcibly when speaking less vehemently. The use of alcoholic beverages, unless greatly diluted, is prohibited. Catarrh of the nares and pharynx must get cured. ”

“ Laryngeal phthisis completely developed presents multiple and varied symptoms, some more characteristic than others. In one patient are found symptoms functionally grave, out of proportion to the lesions relatively benign. In another, physical signs take first place; there may be an ulceration completely obliterating one cord, or considerable œdema of the arytenoids and vestibule, which closes the opening of the glottis. Having 250reached the period when tuberculosis is easily recognized, the various patients are able to date their laryngitis from diverse pathologic beginnings. ”

“ The more important are tuberculosis of the intestines, tuberculous peritonitis, perforation of lung giving rise to pneumo-hydrothorax, pneumorrhagia, pulmonary gangrene, tuberculous meningitis, and chronic laryngitis affecting deglutition. The less important affections are pleurisy with effusion, thrombosis of the femoral or the iliac vein, a circumscribed non-tuberculous acute pneumonia, chronic laryngitis not affecting deglutition, intercostal neuralgia, and perineal fistula. Profuse hæmoptysis is sometimes a grave event, and may prove the immediate cause of death. ”

“ Abstinence is to be enjoined from all exposures or indulgences deleterious to the parts diseased; with as sparing a use of the voice as is compatible with ordinary domestic or social demands, and absolute rest for prolonged periods of days at a time whenever unusual demands have resulted in exacerbating the malady. Under such treatment many cases of simple catarrhal or glandular chronic laryngitis may get well, as has been intimated, without any special local measures. ”