Case of a man in whom, shortly after removal of a loose biscuspid tooth, cellu litis of the face and neck developed. th'detutt of the pharynx developed, and afterward cedenta of the larynx. Lar yngo - tracheotomy performed. Symes (Dublin Jour. Med. Science, Aug., '92).
Acute primary cedema of the larynx is an infectious disorder, streptococei and pneunfococci having been found in several cases of that afTection. Cold and trau matisms considered as but occasional causes favoring the penetration of germs into the organism. F. Barjon (Gaz. des 115p., May 19, '94).
Inflammatory disorders of the glands of the neck, parotitis, tonsillitis, etc., may thus suddenly be complicated with cedema of the larynx with its attending dangers.
Case of ceder= of the larynx resulting from pymmia, which seemed to have fol lowed the introduction of a sound to re lieve a urethral stricture following gon orthcea. J. FL Bryan (Med. News, Feb. 6, '92).
Burning or scalding of the larynx, traumatisms,—such as those induced by the passage of foreign bodies, sharp bones, tacks,—etc., may, as stated, also act as etiological factors. Even alcohol has been known to produce localized wdema.
Case of cederna of the larynx reported, the location of which was not defined, due to the action of raw spirit poured into a woman's mouth while she was in a state of syncope. The patient recovered. G. H. Darwin (Brit. Med. Jour., Jan. 14, '88).
(Edema of the larynx comprises all eases in which the cedema is a conse quence of another local or general proc ess; no inflammatory reaction is present; the etiological factors include Bright's disease, cardiac affections, venous stasis, amemia, and general hydrmmia and angioneurotic processes. Kuttner (Vir chow's Archly, Jan. 4, '95).
Records of autopsies made under charge of Virchow, between 1873 and 1878, examined by Peltesohn gave the following results:— In 3887 examinations, cedema of the larynx was noted 210 times,-149 men, 40 in women, and 21 in children.
Forty-four cases had occurred in regional disease and 1GG in systemic disease. Of 5161 patients treated in the clinic for diseases of the throat and nose, between April 1, '87, and June 1, '89, there were only 8 with acute cedema of the larynx, —7 in men between 21 and 48 years of age and 1 in a woman 58 years of age.
Pathology of the inflannnatory condi tions of the larynx associated with cedema and redness. In a. fatal ease of
a man, 48 years of age, histological ex amination of the mucous membrane of the larynx showed the presence of a. con siderable round-cell infiltration of the submucous layer. The case, therefore, represents secondary erysipelas of the larynx, which would probably, had the patient lived longer, gone on to peri chonclritis and abscess-formation. The infection took place through the blood from an inflammatory process of the leg. G. Sittmann (Dent. Archly f. klin. Med., Dec. 13, '99).
Prognosis.—(Edema of the larynx is at times so rapidly fatal that no warning of the oncoming issue is afforded. A pa tient suffering from slight hoarseness on retiring may thus be found dead next morning. Though such cases are com paratively rare, they nevertheless show the importance of promptly attending to acute laryngeal maladies. When the iodides are being administered in con nection with throat disorders, the larynx should be frequently examined laryn .goscopically.
Cases in which the infiltration is local ized are obviously less -likely to prove mortal than those involving all the tis sues. The latter form is that most fre quently met with when general disorders —such as scarlet fever, typhoid fever, variola, etc.—act as the primary factor. Sestier found that the affection proved fatal in 158 out of 213 cases in spite of tracheotomy performed thirty times. In the 55 cases which recovered tracheotomy was performed twenty times. Bayle ports 17 cases with 16 deaths. F. E. kins (Med. Record, Oct. 19, '95).
Treatment of (Edema of the Larynx.— When cedema is present vigorous ures should be adopted when dyspnwa becomes evident. Until then, cracked ice should be kept in the mouth and cold water compresses applied around the throat. The patient should be well cov ered and given a hot mustard foot-bath, then immediately placed in bed, but in the sitting posture, and wrapped in blankets—the object being to cause nor mal diaphoresis. If this cannot be tained normally, pilocarpine should be given hypodermically, or internally if the local manifestations are not marked. The bromides are useful in reducing the local infiltration, and a dose of 20 grains in an adult, repeated as often as needed, sometimes proves very effica cions.