TUBERCULOSIS OF THE LARYNX I have never seen a primary tuberculosis of the larynx; secondary infection, however, is common in older children. This complication is evidenced by a roughness or hoarseness of the voice. Laryngoscopic examination shows a profuse redness and swelling about one or more ulcers or tubercles. The pain is frequently marked and interferes with swallowing and nutrition. The cough may be very troublesome. The ulcers can be confused only with syphilitic affections. However the presence of the pulmonary condition in tuberculosis as well as the sharply circumscribed nature of the syphilitic ulcers serve to differ entiate the two.
Treatment consists of mild applications of lactic acid. Cocaine is used to relieve the pain.
ScuorutA is a disease of childhood, and of puberty, occurring some what more often in the female than in the male sex.
The name "Scrofula" is derived from Skropho, I root; and signi fies a young swine. The basis for this term was very likely suggested by the striking disfigurement of the face and neck occurring in typical cases, and which indeed reminds us of the appearance of a pig.
the beginning of the last century, the name scrof ula was very often used synonymously with tuberculosis. Liennec considered scrofula nothing more than a tuberculous disease of the glands and in this conception had many followers.
Virchow combated this opinion. For him, the tubercle alone is characteristic of tuberculosis, not the caseous degeneration upon which LIennec laid special weight, since this may occur also in other conditions, as cancer, etc.
The scrofulous affections, according to Virehow are "irritative changes in the tissues, which have, partly, a hyperplastic, and partly an inflammatory character." Scrofula in the narrower sense, lie con siders a disease of the lymphatic nodes, which is provoked by a certain weakness, or imperfect structure of the respective, glandular regions.
The discovery of the tubercle bacillus by Koch, led to the positive proof, that joint and bone disease, lupus, scrofuloderma and lichen scrofulosum are of a tuberculous nature, and hence belong properly under the general term, tuberculosis, and must be distinguished from scrofula. That this distinction is not always made is to be explained
by the fact that these diseases were known for generations by the very name of scrofula, and are still believed to be scrofulous changes by the laity.
The lymph-nodes, considered diagnostically so very important in scrofula, showed tuberculosis not only in the nodes presenting histolog ical changes, but in addition the nodes that were simply enlarged could be proven to be infected with tuberculosis in cut sections, and especially by the serum test. Here ought to be added, that since the admirable researches of Bartel and of the Weichselbaum School, there can no longer he any doubt that a lymph-node infected by tuberculosis need not always show specific tuberculous changes.
Even though it is quite generally admitted that the above-men tioned affections, as well as the scrofulous lymph-nodes are of a tuber culous nature, still, the affections of the skin and mucous membranes are not always so considered. These latter affections do not as a rule, show tubercle bacilli, and for that reason, as many authors assert, can not be classed as tuberculous. Cornet believes that the changes in the skin and mucous membranes are caused not only by the tubercle bacilli, but also by the presence of pyogenic bacteria, such as the staphylococci and streptococci. Still it is not quite clear why these infections in chil dren lead to such severe and stubborn changes; as do not take place in similar bacterial infections.
We will now discuss the indistinct theory called Predisposition to Scrofula ; an expression which is less often applied to other diseases, or is the subject of so much contention and insufficient explanation. Even the views of Virchow as referred to above, contained such ideas on this subject, without. telling us of what the assumed weakness or insufficient functions of the respective lymph-nodes consisted.