1898 The Journal of Laryngology Rhinology and Otology  
parts are dried by dipping in alcohol. Schech is content with thorough brushing with soap and water, followed by washing in five per cent, carbolic. He refers to his twenty-five years' entirely successful experience of this method. William Lamb. LARYNX. Avellis, Georg (Frankfurt).-What is the so-called Inspirato>y Stridor of Infants? (Congress of South German Laryngologists, May, 1898.) " Munchener Med. Woch.," Nos. 30 and 31, 1898. T H E symptoms of this affection are constant inspiratory
more » ... or, which lasts for months and varies in degree from time to time. There is drawing in of the episternal notch and ribs. Fever cough and hoarseness are absent: the laryn\ shows no visible changes; the child thrives and is well nourished. Over the etiology many diverge views have been given. Lori was the first to give an explanation of these cases. He states that the vocal cords come quickly together towards the end of inspiration, that the rima glottidis is closed for a moment, and that the cords go apart again in expiration. Thomson has described five cases, which McBride examined laryngoscopically without definite results. Thomson acribes the condition to a neurosis of coordination, and considers the noise to originate in the larynx. Satisfactory examination is difficult. Avellis could see neither oedema nor inflammation in the nrynx ; the free edges of the epiglottis were not drawn together. Lack and Sutherland described two cases, where the epiglottis was infolded and the aryepiglottidean folds approximated during inspiration. As age advanced the larynx developed further, and the symptoms disappeared ; the formation of the epiglottis remained the same. The stridor lasts during the whole of inspiration, and could not be caused by momentary closure of the vocal cords. Avellis suggests that the stridor may be tracheal and caused by pressure of the thynius. In 1852, Billiet observed a moist, gurgling tracheal stertor in children of seven to ten months old, which only disappeared momentarily when the children were quiet. He considered it due to irritation or swelling of the tracheal mucous membrane. Siegel described a case where tracheotomy was done without benefit, and the stridor was only overcome by introducing a long tube into the trachea. The thymus was brought forward and stitched to the external fascia; the tube was removed, and the stridor ceased. Gloichler has seen three cases where, in long-standing dyspnoea, the cause of death was an enlarged thymus. The clinical symptoms in these cases were the same. In favour of tracheal stenosis are the age of the child, the frequent spontaneous recovery in the second year, congenital occurrence, the mode of recovery (stridor recurs on movement), temporary cessation when the position of the body is changed, negative laryngeal appearances, the high position of the larynx, the entrance of air being greater into one bronchus than the other, and operative results. It is possible that stenosis might also be caused by enlarged bronchial glands. To clear up this, further investigation, which might be helped by Roentgen rays, is required. In the discussion which followed, Probsting agreed that thymus hypertrophy was the cause of the stridor. He has seen preparations in which the cause of the stridor was proved to be compression of the lower part of the trachea at the bifurcation. Killian obtained such a good direct tracheoscopy. in a child two years of age
doi:10.1017/s175514630016737x fatcat:2gzhagd43vdkhocxw6k5vfby7e