Southern Medical and Surgical Journal - Georgia Regents University

American Medical Association.'[J antMfy,ounces of blood were drawn from the arnm soon after, and graindoses of tartar emetic administered.*'0n the following day (the 14th), an improvement in^the respirationhad evidently taken place."On the 15th, respiration was stillwas 84, and soft ;patient complained of soreness of the scarrifiedparts. Antimony was stopped."On the 17th he was much improved in all respects, pulse 68.*'0n the 23d he was discharged cured.further improved, the pulse*' The question of diagnosis in this disease is one of vital importance,irrespective of the present operation, but in connectionwith it its importance becomes very greatly enhanced. Withoutstopping to notice the distinctive symptoms which havebeen generally regarded as characteristic of this disease, orthose- of other diseases that are most likely to be mistaken forit, I beg leave to insist upon one sign which is strictly pathognomonic,and does not appear to have been sufficiently appreciated."I refer to the swelling of the epiglottis as ascertained by thetouch. The disc6very of it, according to Bayle, Die. des Scien.Med., tome xviii., p. 507,) is due to M. Thuillier, who proposedit in a thesis sustained before the Faculty of Medicine in Paris,in 1815. The value of this sign will be admitted if we considerhow frequent the swelling of the epiglottis co-exists wnththat of the glottis. Bayle, {lac. cit.) who dissected more thanseventeen cases of this disease, says, 'the epiglottis is rarelyintact, often it is very much swollen at its edges.' Ryland says,{he. cit., p. 48,) 'The oedema is seldom confined to theselocalities, but extends to the base and lateral edges of theepiglottis, &c.'" Among seventeen cases collected from different sources^and in which the condition of the epiglottis was ascertained,either by dissection after death, or by the touch or inspectionduring life, swelling was found in fifteen. Of the eight casesreported in this paper, the epiglottis was found swollen in seven,and in the remaininir one there was no evidence that it was notswollen."This swelling takes place either at the margin on one orboth sides of the median line, or on the lingual surface of theepiglottis at its base, filling up one or both depressions betweenit and the tongue, and obliterating the central glosso-epiglotticfraenum.'*It conveys to the touch the sensation of a soft pulpy body,easily recognized and distinguished from the stifi' rigid swellingof these parts in membranous laryngitis."The facility of ascertaining the condition of the epiglottis