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Tubercular Laryngitis

usually, laryngeal, pain, little, mucous and seat

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In childhood the laryngeal mucous membrane is comparatively rarely the seat of the may granulation ; for it is only in after-life that laryngeal phthisis becomes a common manifestation of the tubercular cachexia. Still, even at this early age tubercular granules and ulcerations are occa sionally present ; and these usually occur in cases where the force of the disease is expended more particularly upon the lungs, the other organs being comparatively unaffected.

Causation.—Ulcers of the larynx are much more common than tuber cular granules without breach of surface. MM. Rilliet and Barthez state that they have only met with a single case of tubercle of the laryngeal mucous membrane unaccompanied by ulceration, and quote a second from M. Tonnele, which occurred in a child of fourteen. According to these authors, the ulcers are usually of small size, varying from the head of a pin to a large lentil. They are 'circular and= cleanly cut, unless they occupy the vocal cords. In that case they are more commonly oval, with their long diameter in the direction of the cord. Their borders are thin and reddish in colour, and their base is usually composed of the submucous tissue—rarely of the muscular fibres. The ulcers, for the most part, are single, although sometimes more than one is present in the same case. The seat may be one or other of the vocal cords, or the posterior angle of the glottis, or the base of the epiglottis. The mucous membrane is unal tered or thickened ; sometimes it is reddened.

The trachea and larger bronchi may be also the seat of ulcers, but more usually the tracheal mucous membrance is merely reddened and thickened.

symptoms of the laryngeal complication are often in definite. There may be merely some alteration of the voice, slight pain in the region of the larynx, and if there is much swelling, dyspucea. The voice is often thick and husky ; it is never whispering as in the adult. The cough is little altered, and has no special quality pointing to this par ticular lesion. There is seldom pain or difficulty of deglutition ; and the pain in the larynx, if present at all, is rarely of much moment. The small

size and limited number of the sores is sufficient, no doubt, to account for the absence of special symptoms ; for in the adult, when aphonia is present, the ulceration is generally extensive.

Dyspucea may be a marked symptom. A little boy, aged two years and nine months, whose father had died of consumption, was admitted into the hospital, under my care, for difficulty of breathing. For six weeks previously his breath had been noticed to be short, and for a fortnight his respiration had been accompanied by a stridor. For three weeks he had been unable to swallow any solid food, although he could take liquids with out difficulty.

On admission his clyspucea was marked. At each inspiration the lower half of the breastbone was bent deeply inwards, so as to leave a pit in the epigastrium. At the same time the intercostal spaces and supra-clavicular hollows were markedly retracted. His naves worked, and all the accessory muscles of respiration were in strong action. There was some lividity of the face, and the breath-sound was accompanied by a hoarse stridor. His voice was hoarse, but not whispering. The cough was little altered, and had no metallic or ringing quality. On examination of the chest there was some dulness at each supra-spinous fossa, and much coarse bubbling was heard all over both lungs. Temperature at 6 P.M., 101.6°; respirations, 40 ; pulse, 136. There was no albumen in the mine.

The boy was in the hospital a week. His dyspncea all the time con tinued with little change. There were no exacerbations or remissions. His temperature varied between 100.6° in the morning, and 102° to 103° at night. His bowels acted twice a day, as a rule, although in one day he was purged seven times ; and he never complained of pain in the abdomen until a few hours before the end. His death occurred quite suddenly. The child, after complaining of stomach-ache, which did not appear to be severe, suddenly sank into a state of collapse, iu which he died.

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