Erysipelas.—There is a form of acute laryngitis, closely associated with, if not an actual manifestation of, erysipelas of the larynx. This is a dangerous form, often accompanied by cedema, high fever, great hoarseness, and dyspncea almost from the start.
Infectious phlegmon of the pharynx and the larynx should be difTerentiated from erysipelas. Dysphagia, splenic engorgement, and in many instances delirium cited as the special characteristic indications of the malady. P. Merklen (Le Mereredi Med., Nov. 12, '90).
Typhoid Ferer.—The laryngeal com plications of typhoid are to a certain de gree typical in the fact that they are cir cumscribed in the great majority' of cases. The parts that most frequently show erosions are the laryngeal surface of the epiglottis near the edge, the ventricular bands, and thc upper part of the aryte noid space, the specific character of the complication being thus readily shown. The various ulcerative processes noted in scarlet fever are also occasionally ob served in typhoid fever, the tendency to spread being equally marked. The de structive process may not only present itself during tbe progress of the general affection. but at some time after.
The lesions may appear during two periods of the malady. In the beginning laryngitis is very common and ordinarily benign, rarely penetrating into the deeper tissues. It is during convalescence, two months after the commencement of the malady. that a severe form of laryngitis may be developed, a form fatal in the absence of prompt relief by tracheotomy, and leaving deformities which necessitate the indefinite retention of the cannula. These lesions usually involve the aryt enoid, epiglottic, and erieoid cartilages. Peter (I:Union Med., Mar. 10, '01).
Catarrhal laryngitis, cedema of the glottis, perichondritis, may all be seen. The last-mentioned lesion may give rise to most wide-spread results in the direc tion of stenosis, besides its immediate dangers from necrosis of the cartilag,es and the like. From the intense prostra tion and apathy of the later period of typhoid these may go for some time un noticed and progress untreated. The presence of Eberth's bacillus in the sputum noted and also in sections of the mucous membrane of the larynx in a fatal case or typhoid, showing that the laryngeal lesion is of a specific character.
and not due simply to the general effects of the fever. The importance, in eases of typhoid in which there is any sus picion of laryngeal symptoms, of exami nation with the laryngoscope emphasized Lucatello (Gazzetta degli Ospitali. No. 132. '93).
In post-mortem records of St. Bartholo mew's Hospital of sixty-one cases of typhoid fever, fourteen showed loss of substance in the larynx. The larynx had not been examined; assuming that the larynx had been examined in all the re maining fifty-three cases, which is doubt ful, ulceration was found in 26 per cent. of the fatal cases. These defects are situated generally over the tip and edges of the epiglottis and in the neighborhood of the processus voealis. The lesions are caused by micro-organisms; there is the strongest evidence that these are the pyococci, and not, except rarely, the typhoid bacilli. Kanthack and Drysdale (,Tour. of Laryn., etc., Apr., '96).
When ulceration of the larynx is noted in typhoid fever it is not necessarily typhoid in nature. The ulceration in some of the larynges obtained at autop sies of persons dead from typhoid fever are found under the microscope to be of a tubercular nature. Jobson Horne (Jour. of Laryn., etc., Apr., '96).
Perlussis.—In whooping-cough the laryngeal manifestations are sometimes quite marked, but they are not attended, as in other diseases, by ulcerative proc esses. The severe cough induced occa sionally causes marked congestion of the interarytenoid space, accompanied, at times, by extravasation and localized haemorrhage. Slight oedema is fre quently observed. Diphtheria as a com plication has been witnessed, though very rarely. The most annoying feature in connection with the larynx is a result ing hypemsthesia of the interarytenoid space, which may persist indefinitely, the patient being subject to exacerbations of coughing when using his larynx any length of time. A dry, warm, or dusty atmosphere is also likely to cause con siderable inconvenience. This sequel is especially apt to occur in adults.