THE RHEU3IATIO DIATHESIS predis poses to a disorder of the larynx simulat ing acute laryngitis, but differing from it in that local phenomena are usually less active objectively. The voice is used with difficulty and the pain is sometimes much more severe than that experienced in other inflammatory disorders. There is dyspncea in the majority of cases.
Rheumatism of the larynx sometimes occurs in conjunction with general rheu matism. It is a serious disorder, particu larly in singers; one or both of the crico arytenoid joints may be involved in the inflammatory process, and permanent hoarseness often results.
In predisposed patients the rheumatic laryngitis may be for weeks or months the only symptom of rheumatism. W. Freudenthal (Jour. of Laryn., Feb., '95).
Case of a man, with acute generalized articular rheumatism, in whom there oc curred, as the articular pains subsided, pharyngeal and laryngeal oclynphagia, and pharyngeal dyspncea. Luc (Annales des Mal. de l'Oreille, etc., Mar., '92).
Five cases of acute rheumatic cricoaut enoid synovitis following colds. Griin wald (Berliner klin. Woch., No. 20, '92).
If the cricoarytenoid articulation is affected in rheumatic laryngitis, it is doubtful if the corresponding vocal cord will ever regain its normal range of movement, and the voice may be more or less permanently affected. G. Hunter Mackenzie (Edinburgh Med. Jour., Dec., '94).
Etiology.—Generally speaking, laryn gitis may be said to be due either to con ditions causing local congestion by mere overuse or mechanical irritation, or by continuity' of tissue.
The forms thought to be independent of specific germs are those due to ex posure to cold and clamp, the inhalation of smoke, especially tobacco-smoke in a badly-veritilatcd room, dust, irritating fumes, spices, irritating particles of all sorts, etc. Excessive use of the voice and the ingestion of alcoholic drinks, of hot or overspiced food are also frequent caus ative factors.
Nine cases of catarrhal laryngitis the result of bicycling, tricycling, etc. The disease is attrihuted to the improper position taken by these subjects in their exercise, inclining the body forward and thus impeding respiration and rendering.
it necessary to respire by the mouth as well as the nose, while the rapidity of the pace drives the air into the larynx and lungs undo. increased pressure. llago main kite\ ne de Laryn., ete., Nov. 15, '9 I .
Case tif acute laryngitis caused by otassiiim Coutrory to the other neortIttl eases el a similar character. it NN 110( sinit le (edema, but an intense 11 pt rivinia and infiltration of the mucous membrane and of the submucous tissue. Fratikenberger (Therap. Monats., vol. xii, No. 4, '97).
As already stated, catarrhal diseases of nose and naso-pliarynx greatly pre dispose to acute laryngitis, and the ma jority of cases witnessed show such a con dition as a primary factor. Singers, army-oilicers, ministers, etc., are espe cially prone to this disorder on this ac count, particularly when the voice is im properly used; but the presence of a primary catarrhal disorder of the naso pharyngeal tract may usually be dis cerned.
Catarrhal affections of the larynx are always secondary to nasal and pharyn geal catarrh. The exceptions to this rule are where the larynx has been locally irri tated by the inhalation of irritant gases or by sprays of too strong a, solution. One other exception is seen in public speakers. actors. and singers. Rice (Post grad., -May, '98).
Patients whose urine contains sugar, but whose general health has not yet suffered, often complain of a peculiar drynoss of the throat and insufficiency of the voice after use. The posterior pharyngeal wall is then found to be dry, smooth. glistening, and copper-colored and the vocal cords have a peculiar shiny. glazed appearance. These signs are diagnostic of early diabetes. O. Leichtenstern (INItinehener med. Woch., Apr. 17, 1900).
Epidemie of tracheo-laryngitis among troops on a British transport. one hun dred and twenty cases out of a thou sand men being attacked. Shivering or nausea suddenly oecurred. soon followed by a temperature of 102° or 103° F. There was no sign of involvement of the tonsils or pharynx. but there was set-ere cough, pain in the larynx, huskiness, and finally loss of the voice, and subsequent involvement of tlie trachea. C. ibbs (Brit. Aled..Imir., Apr. 28, 1900).