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Related post: able, as they had been younger than the disease in the spine.
AMERICAN LARYNGOLOCICAL ASSOCI.VTION.
Thirteenth Annual Congress, held at Washington, on Tuesday,
Wednesday, and Thursday, September S2. 23, and ^4, 1891.'
The PrcMdent, Dr. W. C. Gi..
)w, of St. Louis, in tiie Chair.
The Troublesome Symptoms caused by Enlargement of
the Epiglottis, and the Advisability of reducing the Size
of this Cartilage by Operative Measures. — I »r. C. u. Rice, of
New York, read a paper on this subject. (Tcj he published.)
Dr. Mii.iiAi.i. : Did I understand Dr. Rice to state that he
had seen cases of uncomplicated, non-syphilitic, non-inaliguant,
non-tubercular, noutraumutie primary enlargement of the epi-
glottis?
Dr. Rick : ^'cs, I have.
Dr. Mui.iiALr. : Are they not uncommon?
Dr. Kick: I tliink they are.
Dr. Mui.UALi.: I have asked thi.- question because it is to me
a novel fact that there can be a case of pure, uncomplicated,
simple chondritis in any part of the body. I can understand
enlargement of the epiglottis from surrounding catarrhal or
other inflammation, which is the usual cause. I recall the case
of Venlor Xr 37.5 a lady in St. Louis who had an unyielding, irritable cough.
She went abroad a year ago and consulted a prominent laryn-
gologist, who iironouneed the cause of her cough to be a dis-
torted and enlarged epiglottis, and he galvano-cauterized it.
Following this there was much irritation of .the epiglottis and
swelling, with more cough. This lady died a week ago Venlor Xr 150 with
pulmonary tuberculosis. She told me that the prominent laryn-
gologist did not examine her lungs once. I can understand a
large, pendulous epiglottis as a result of irritation; but I can
not understand a primary non-specific enlargement of the epi-
glottis. It is new pathology to me.
Dr. S. O. Vandee PoEi. : I wish to emphasize the remarks
of Dr. Rice regarding the unfavorable results following the gal-
vano-cautery in cases of this kind. The use of the curette or
sharp spoon has Venlor Xr given me much more satisfaction. The patho- -
logical conditinn described by Dr. Rice, the hypertrophy of the
cartilaginous elements. I am not familiar with, but I have seen
enlargement, with more or less inflammation aud hypertrophy,
of the epiglottis in connection with enlargement of the tonsils.
Dr. Jarvis: I was much interested in Dr. Rice's remarks
upon hypertrophy of the epiglottis. He explains a condition
new to me — something I have never seen. The signs of con-
gestion and enlargement from infiammation we are familiar with,
but primary hypertrophy of the cartilage of the epiglottis is
new. You may perhaps remember a somewhat similar condi-
tion, whioh was referred to in connection with our discussion
of the enlargement of the sseptum nariura at a former meeting.
I then held that there might be an enlargement of this cartilage
due to increase of cartilage cells, which could only be demon-
strated by the microscope ; and, upon making further investiga-
tion, discovered that inflammatory changes in Venlor Xr 75 the submucous
tissue directly above the cartilage could be easily demonstrated.
I think that, in all probability, in the enlarged epiglottis of Dr.
Rice a similar condition will be found to exist. Change of form
of the epiglottis may result from distortion and congestion. That
we may have disturbance of function from these causes I am
satisfied. I recall the case of a clergyman who came to me with
a cough and difficult jibonation. I found a swollen epiglot-
tis, and applied cocaine in the manner recommended by Dr.
Rice, aud the patient experienced so much relief that he was
enabled to resume his duties in the pulpit. There may be no
direct advantage gained from the use of the galvano-cautery,
but we must acknowledge that the psychical eft'ect produced is
often very great, whether this agent be applied to the hyper-
trophied epiglottis or to the tip of the nose. I believe it may
have given relief from cough, but think it merely acted through
the medium of the patient's mind. A much better substitute
is to train patients to exercise tlieir will, and in this way over-
come the tendency to cough.
Dr. Wagner: About ten years ago I read a paper before
this society in which 1 reported a case of removal of the en-
tire epiglottis for carcinoma by a subhyoidean incision, the first
case on record. Before performing the operation, I con.sidered
the several methods, and came to the conclusion that removal
Feb. 13, ISy'i.J

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