A text-book of diseases of the nose and throat

Front matter

Class.

Book.

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Preface To The Fifth Edition

In presenting the fifth revised edition of this work, as in previous editions, the same general plan and arrangement have been adhered to. The entire book has been thoroughly revised. The following new articles have been added : Vaccine Therapy ; Lactic Bacteriotherapy in Atrophic Rhinitis ; Salvarsan in the Treatment of Syphilis of the Upper Respiratory Tract; Sphenopalatine Ganglia Neuralgia ; Negative Air-pressure in Accessory Sinus Disease ; Chronic Hyperplastic Ethmoiditis ; Congenital Insufficiency of the Palate ; Lactic Bacteriotherapy in Pharyngeal Affections ; and an article describing the Removal of a Plate of Artificial Teeth from the Esophagus. The chapter on tonsils has been thoroughly revised and the surgical technic brought up to date. In the following chapters alterations and additions have been made : General Consideration of Mucous Membranes; Simple Acute Rhinitis; Lithemic Rhinitis ; Diphtheritic Rhinitis ; Atrophic Rhinitis ; Nasal Syphilis ; Thymic Asthma ; Papilloma of Larynx ; Correction of Septal Deformities (various methods) ; Diseases of the Anterior Nasal Cavities ; Ocular Symptoms in Diseases of the Nasal Cavities ; Complications in Ethmoiditis and Frontal Sinusitis ; Streptococcic Pharyngitis ; Pneumococcus Infection of the Pharynx ; Vincent's Angina ; Syphilis of the Pharynx ; Anemia of the Pharynx ; Singer's Nodules ; Syphilis of the Larynx ; Laryngeal Tuberculosis ; Diplophonia ; Adductor Paralysis.

A number of new illustrations have been added, and many of the old illustrations have been replaced by new ones.

It has been the author's aim to give in full the etiology and pathology of the various diseases, so that by this detailed description treatment is indicated and easily directed. As in the previous editions, the author has endeavored to take up each subject from a general standpoint and to consider under diagnosis, pathology, and treatment all systemic conditions in their relation to the

6 PREFACE TO THE FIFTH EDITION.

special diseases of the throat and nose, as the same general fundamental principles involved in general medicine are certainly applicable to any specialty.

Literature, both American and European, has been carefully reviewed, and the opinions and methods expressed have been given careful consideration.

I am indebted to Drs. George F. Doyle, Fielding O. Lewis, and Arthur J. Wagers for their valuable aid in the detail work necessitated in a revision ; also to Mrs. S. M. Fleming for valuable aid in preparing, arranging, and correcting of the manuscript, and especially to the W. B. Saunders Company for the continuance of their kind assistance in this as in previous editions.

D. Braden Kyle.

Preface

It has been my aim to present to the reader the subject of Diseases of the Nose and Throat in as concise a manner as is compatible with clearness. While the arrangement differs somewhat from many of the other text-books on this subject, it has been my aim to classify the diseases according to the pathological alterations caused by them. While some of the chapters necessarily show repetition, it is because of my desire to make each chapter complete in itself, so that the reader on turning to a certain subject may find under that heading the matter desired.

While there are many things in the book that may seem superfluous to the specialist, yet, since the work has been prepared for the student and the general practitioner as well, there is a necessity for this fulness and apparent repetition.

The lithographs and original illustrations are made from specimens prepared by the author in his own laboratory, and the drawings are from cases under his immediate observation. Some of the illustrations under anatomy are composite, being made from several other illustrations together with the original specimen. The cuts of instruments in many cases illustrate only one of many that might be used, but in the majority of instances the instruments are those used by the author, and the ones that have proved satisfactory in his hands.

In treatment I have endeavored to be specific for definite conditions. While the doses given may seem positive and even dogmatic, it is understood that the dose of the drug must be indicated by the symptom to be relieved. Considerable space has been devoted to certain diseases which are somewhat rare, in the belief that when information is wanted on such subjects, it should be full and complete.

I have purposely omitted reports of individual cases, and, instead, have grouped symptoms and generalized cases.

8 PREFACE.

In looking up the literature, all the standard works have been consulted, such as Bosworth, Ingals, Mackenzie, Browne, Seiler, Burnett, Sajous, Solly, Bishop, Bell, McBride, Scheppegrell, Cryer, Bryan, and Hall ; also monographs by John N. Mackenzie, Roe, Myles, Thorner, Jonathan Wright, Casselberry, Delevan, Eichardson, and others. The pathology conforms to the views advanced by Hamilton, Ziegler, Coplin, and Stengel.

The following instrument-makers have kindly furnished electrotypes of various instruments : Messrs. Charles Lentz & Sons, Yarnall Surgical Company, Jacob Ostertag, and Williams, Browne & Earle, of Philadelphia ; George Tiemann & Company and E. B. Meyrowitz, of New York ; and Truax, Greene & Co., of Chicago.

I am indebted to numerous writers for their many courtesies in furnishing reprints and copies of their various journal articles on special subjects.

I am particularly indebted to Professor Keen for giving, in a special chapter, his own method of surgical operations on the larynx.

I desire to thank Dr. W. H. King for his constant help in reference work and in reading the page proof, as well as for his valuable aid in making the index ; also Dr. J. Hervey Buchanan for his help in reference work.

Acknowledgments are due to Mr. T. F. Dagney, the managing editor of the publishing house of W. B. Saunders, for his able assistance.

D. BKADEN KYLE. 1517 Walnut Street, Philadelphia

Chapter I. Page

Anatomy of the Anterior Nasal Cavities, 17 — Postnasal Cavity, or Nasopharynx, 25 — Physiology of the Nasal Cavities, 27.

Chapter II

Illumination, 30 — Light, 30 — Mirrors, 31 — Examination, 33 — Position of the Patient, 34 — Rhinoscopy, 35 — Anterior, 35 — Posterior, 36 — Instruments Needed for Office Work, 45 — Atomizers, 46 — Nebulizer, Inhalers, Applicator, 47.

CHAPTER III. General Consideration of Mucous Membranes, Their Pathological

Changes, and Relation to General Medicine 51

General Remarks, 51 — Sialosemeiology, 53 — Inflammation, 59 — Clinical and Microscopical Phenomena, 60 — First, Second, and Third Stages, 61 — Varieties of Inflammation, 61 — (1) Catarrhal, 62 — (2) Membranous, 64 — (a) Croupous or Pseudomembranous, 64 — (b) Fibrinoplastic, 64: — (c) Diphtheritic, 64 — (3) Hemorrhagic, 65 — (4) Gangrenous, 66 — (5) Suppurative, 66 — (6) Chronic Infectious, 66 — (a) Syphilis, 66 — (b) Tuberculosis, 67 — (c) Actinomycosis, 67 — (d) Glanders, 67 — (e) Leprosy, 68 — (/) Rhinoscleroma, 68. Nasal Bacteria and their Relation to Diseases, 68.

Chapter IV

Acute Inflammatory Diseases, 72 — Taking Cold, 72 — Rhinitis, Acute, 74 — (1) Simple Acute Rhinitis, 74 — Simple Acute Rhinitis in Certain of the Constitutional Diseases, 82 — Measles, 82 — Pertussis, 83 — Scarlet Fever, 83 — Variola, 83 — Typhoid Fever, 83 — Rheumatism, Acute Articular, 83 — Diabetes Mellitus, 83 — Diphtheria, 83 — Erysipelas, 84 — Scorbutic Rhinitis, 84 — Anemic Rhinitis, 84 — Scrofu-

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lous Rhinitis, 85 — Caseous Rhinitis, 86 — Epidemic Influenza, 87 — Lithemic Rhinitis, 90 — Acute Rhinitis in the Young, 91— Vaccine Therapy in Diseases of the Nose and Accessory Sinuses, 93 — (2) Membranous Rhinitis, 97 — (a) Croupous or Pseudomembranous, 97 —(b) Fibrinoplastic, 100— (c) Diphtheritic, 102— Chronic Form, 102 — (3) Occupation Rhinitis (Traumatic), 102— (4) Hyperesthetic Rhinitis (Hay Fever), 104— (5) Ulcerative Rhinitis, 104— (6) Edematous Rhinitis (Acute Edema), 105 — (7) Phlegmonous Rhinitis, 105.

Chapter V

Chronic Inflammatory Diseases, 107 — Rhinitis, Chronic, 107 — (a) Simple Chronic Rhinitis, 107 — (b) Intumescent Rhinitis, 115 — (c) Hyperplastic Rhinitis, 116— Ozena, 123 — (d) Atrophic Rhinitis, 125 —(e) Purulent Rhinitis, 139— (/) Nasal Hydrorrhea, 141— (g) Cyanotic Rhinitis (Edematous), 144 — (h) Specific Inflammations (Granulomata), 145 — (1) Syphilis, 145 — (a) Congenital, 145 — (b) Acquired, 145 — Salvarsan and Neosalvarsan in Syphilis of Nose and Throat, 156— (c) Hereditary, 162— (2) Tuberculosis, 166— Lupus, 170— (3) Glanders, 174— (4) Leprosy, 177— (5) Actinomycosis, 179— (6) Rhinoscleroma, 180.

Chapter VII

Inflammatory Diseases, 184 — Ulcers, 184 — (1) Non-infected, 185 — (a) Simple, 185— (1) Catarrhal, 185— (2) Herpetic, 185— (3) Eczematous, 185 — (4) Due to Foreign Bodies, 186 — (5) Neuroparalytic, 186— (6) Scorbutic, 186— (7) Diabetic, 187— (8) Varicose, 187— Chemic, 187— (6) Compound Malignant, 188— (2) Infected, 188— (1) Tubercular (Lupoid), 188— (2) Syphilitic, 188— (3) Leprous, 189— (4) Glanders, 189— (5) Diphtheritic, 190— (6) In Measles, 190 —(7) In Rheumatism, 190— (8) In Scarlet Fever, 190— (9) In Small-pox, 190— (10) In Typhoid Fever, 190— (11) In Typhus Fever, 190.

CHAPTER VIII. Neuroses 191

(1) Neuroses of Olfaction, 191 — Parosmia, 191 — Hyperosmia, 192 — Anosmia, 192 — (2) Reflex Nasal Neuroses, 193 — (3) Respiratory Neuroses, 193— (4) Sneezing, 193— (5) Hydrorrhea, 194— (6) Hyperesthetic Rhinitis, 194— (7) Nasal Cough, -208— (8) Reflexes Outside of the Respiratory Tract, 212— (9) Migraine, 213— (10) Congestive Headache, 213— (11) Neuralgia, 213— (12) Sexual Reflexes, 215.

Chapter IX. Page

Non-inflammatory Diseases, 217 — Epistaxis, 217 — Varieties as to Cause, 217— (1) Traumatic, 217— (2) Local Nasal Lesions, 218— (3) Constitutional Conditions, 218 — (4) Vicarious, 219 — Hemophiliacs, 223.

CHAPTER X. Foreign Bodies in the Anterior Nasal Cavities 224

(1) Inanimate, 224— (a) Rhinoliths, 224— (b) Miscellaneous, 226 —(2) Animate, 228— (a) Parasites, 228.

CHAPTER XL

Classification, 232 — General Remarks, 233 — Papilloma of Nares, 234 — Papilloma of Nasopharynx, 234 — Papilloma of Pharynx, 235 — Papilloma of Larynx, 235 — Adenoma of Anterior Nares, 238 — Adenoma of Pharynx, 238 — Adenoma of Fauces, 239 — Adenoma of Larynx, 240 — Angioma of Nasal Passage, 240 — Angioma of Fauces, 242 — Angioma of Pharynx and Uvula, 242 — Angioma of Tonsil, 243 — Angioma of Larynx, 243 — Chondroma of Nasal Passage, 243 — Chondroma of Nasopharynx, 244 — Chondroma of Larynx, 245 — Exostosis, 245 — Fibroma of Nasal Passage, 247 — Fibroma of Nasopharynx, 249 — Fibroma of Tonsil, 250— Fibroma of Larynx, 251 — Lipoma of Nares, 253 — Lipoma of Nasopharynx, 253 — Lipoma of Tonsil, 253 — Lipoma of Pharynx, 253 — Lipoma of Larynx, 254 — Osteoma of Nares, 254 — Myxoma (Nasal Polypus), 256 — Fibrous Nasal Polyp, or Myxofibroma, 261 — Fibromyxoma of Nasopharynx, 263 — Mucocele, 265 — Mucocele of Nasopharynx, 265 — Mucocele of Larynx, 265.

Embryonic Epithelial Tumors, 267— Carcinoma of Nasal Passage, 267 — Carcinoma of Nasopharynx, 269 — Carcinoma of Soft Palate, 270 — Carcinoma of Pharynx, 271 — Carcinoma of Tonsil, 272 — Carcinoma of Larynx, 273.

Embryonic Connective-tissue Tumors, 278 — Sarcoma of Nasal Passage, 278— Sarcoma of Nasopharynx, 280 — Sarcoma of Fauces, Pillars, and Soft Palate, 281 — Sarcoma of Pharynx, 281 — Sarcoma of Tonsil, 283 — Sarcoma of Larynx, 284.

Mixed Tumors, 286 — Adenocarcinoma, 286— Myxocarcinoma, 286 —Teratoma, 286— Glioma, 286— Telangiectoma, 286.

Cysts, 287 — Simple or Retention Cysts (Mucocele), 287 — Cystoma (Hygroma, Hydroma), 288— Dermoid Cysts, 288— Blood Cysts, 288.

Chapter XII

Septum, 289— (1) Malformations, 292— (2) Deformities, 293— (a) Deviations or Deflections— (1) From Disease, 294 — (2) Trau-

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matic, 294— (3) Congenital, 296— (6) Synechia, 325— (3) Collapse of Nasal Alse, 327 — (4) Caries and Necrosis, 328 — Ulceration, 328 — Perforation, 331 — (5) Edema (Submucous Infiltration), 335 — (6) Abscess, 335— (a) Acute, 335— (6) Chronic, 337— (7) Correction of External Nasal Deformities, 338— (8) Syphilis, 346— (9) Tumors, 347 — (10) Hematoma of the Septum, 347 — Angiomyxoma, 347 — Angioma, 347.

Chapter XIII

Diseases of the Accessory Sinuses, 348 — Sphenopalatine Ganglia Neuralgia, 357 — Antrum of Highmore, 358 — (a) Catarrhal Inflammations, 359 — (1) Acute Catarrhal, 359 — (2) Chronic Catarrhal, 361 — (6) Ozena, 364 — (c) Empyema, 364 — Acute Purulent Inflammation, 364 — (d) Chronic Purulent Inflammation, 366 — (e) Confined Suppuration, 368 — (/) Transillumination, 370 — Negative Air Pressure in Accessory Sinus Disease, 378 — (g) Specific Inflammations, 379— (1) Tuberculosis, 379— (2) Syphilis, 379— (3) Glanders, 379 — (4) Actinomycosis, 379 — (h) Acute Infectious Diseases, 379— (i) Emphysema, 379 — (j) Foreign Bodies in the Antrum, 381 — (k) Mucocele of the Antrum, 382 — (I) Bone-cysts of Accessory Sinuses, 383 — Tumors of the Antrum, 383 — (m) Phlegmonous Inflammation, 384 — (n) Diseases of the Ethmoid Cells, 384 — (1) Catarrhal Inflammation, 385 — Chronic Hyperplastic Ethmoiditis, 386 — (2) Ethmoidal Suppuration, 387 — (3) Mucocele and Non-infected Fluid-retention, 392— (4) Specific Inflammations, 393— (5) Tumors, 393— (o) Diseases of the Sphenoidal Sinuses, 394 — (1) Catarrhal Inflammations, 394— (2) Empyema of the Sphenoidal Sinus, 395— (3) Tumors, 398 —(4) Specific Inflammations, 398— (5) Mucocele, 399— (p) Diseases of the Frontal Sinus, 399 — (1) Acute Catarrhal Inflammation, 399 — Chronic Catarrhal Inflammation, 401 — (2) Empyema — (a) Acute Purulent, 402— (6) Chronic Purulent, 404— (3) Confined Suppuration, 405 — (4) Mucocele, 413 — (5) Foreign Bodies, 414 — (6) Infectious Processes, 414 — (7) Tumors, 415.

CHAPTER XIV. Related Pathological Conditions of the Nose and Accessory

Sinuses to the Eye 416

Chapter XV

Inflammatory Diseases, Acute and Chronic, 421 — (1) Acute Nasopharyngitis, 421 — (2) Simple Chronic Nasopharyngitis, 425 — Chronic Epipharyngeal Periadenitis in Adults, 431 — (3) Atrophic Nasopharyngitis, 437 — (4) Hyperplastic Nasopharyngitis, 440 — (5) Rhinopharyngitis Mutilans, 441 — (6) Specific Inflammations, 442 — (7) Neuroses of the Nasopharynx, 442.

Chapter XVI. Page

Diseases of the Uvula and the Soft Palate 443

Malformations, 443 — (1) Bifid and Rudimentary Uvula, 443 — (2) Elongation, 444 — Inflammatory Diseases, 446 — (1) Acute Uvulitis, 446— (2) Chronic Uvulitis, 447— (3) Ulceration, 447— Congenital Insufficiency of Palate, 449 — X on-inflammatory Diseases, 450 — (1) Adhesions, 450 — (2) Congenital Absence of, 451 — (3) Xeuroses, 453 — (4) Neuralgia, 453 — (5) Spasmodic Contraction, 453 — (6) Paralysis, 453 — Acute Bulbar Paralysis, 454: — Chronic Bulbar Paralysis, 454 — Apoplectiform Bulbar Paralysis, 454 — (7) Herpes of the Fauces, 455

Chapter XVII

(1) Pharyngeal Tonsil, 457 — (a) Adenoid Vegetations, 457 — (2) Faucial Tonsil, 470 — (a) Acute Superficial Tonsillitis, 471 — (b) Cryp tic Tonsillitis, 474 — (c) Rheumatic or Gouty Tonsillitis, 479 — (d) Herpetic TonsiUitis, 480— (e) Abscess, 482— (1) Tonsillar, 482— (2) Peritonsillar, 482 — Membranous Inflammation, 485 — (/) Enlargement or Hypertrophy, 487 — Surgical Tonsil, 491 — Imbedded Tonsil, 491 — (g) Caseous Tonsillitis, 509 — (/?) Chronic Abscess of the Tonsil, 511 — (i) Atrophy of the Tonsil, 511 — (j) Gangrene of the Tonsil, 511 — Mycosis of the Faucial Tonsil, 512 — Actinomycosis of the Tonsil, 512— (A:) Foreign Bodies, 513— (3) Lingual Tonsil, 513— (a) Acute Inflammation, 514 — (6) Acute Phlegmonous Inflammation, 515 — (c) Hyperplasia, 516 — (d) Mycosis, 516 — (e) Varices, 517 — (4) Laryngeal Tonsil, 517.

CHAPTER XVIII. Diseases of the Pharynx 518

Malformations and Deformities, 519 — Stenosis, 519 — Extrinsic Stenosis, 520 — Diverticula or Dilatations of the Pharynx, 520.

Acute Inflammatory Diseases — (1) Simple Acute Pharyngitis, 521 — (2) Infective Pharyngitis, 526 — Lactic Bacteriotherapy in Pharyngeal Affections, 528 — (3) Membranous Pharyngitis, 529 — (a) Croupous, Simple Membranous, (6) Fibrinoplastic, (c) Diphtheritic, 530 — Nasal Diphtheria, 535 — Streptococcic Infection of Pharynx, 547 — Pneumococcic Infection of Pharynx, 548 — (4) Gangrenous Pharyngitis, 548 — Occupation-pharyngitis, 549 — (6) Hemorrhagic Pharyngitis, 551 — (7) Glandular Pharyngitis Lateralis, 552 — (8) The Pharynx in the Exanthemata and other Febrile Affections, 553 — Scarlet Fever, 553 — Small-pox, 554 — Measles, 555 — Erysipelas, 555 — Intermittent Fever, 556 — Gout, 556 — Typhus Fever, 557 — Typhoid Fever, 557 — Influenza, 557 — Varioloid, 558 — Chicken-pox, 558 — (9) Ludwig's Angina, 558 — (10) Vincent's Angina, 558 — (11) Angina Ulcerosa Benigna, 559.

Chronic Inflammatory Diseases, 560 — (1) Simple Chronic Pharyngitis, 560— (2) Subacute Pharyngitis, 566— (3) Follicular Pharyngitis, 566 — (4) Hyperplastic Change in the Pharyngeal Structure, 572

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— (5) Atrophic Pharyngitis, 573 — (6) Cyanotic Pharyngitis, 579 — (7) Rheumatic Pharyngitis, 580 — (a) Acute, 580 — (6) Chronic, 584 — (8) Angioneurotic Edema, 585 — (9) Infectious Granulomata of the Pharynx and Nasopharynx and Tonsils, 586 — (a) Tuberculosis, 586— (1) Lupus, 590— {b) Syphilis, 592— (c) Glanders, 597— (d) Actinomycosis, 600 — (10) Abscess (Retropharyngeal), 602 — (11) Urticaria, 604— (12) Herpes, 605— (13) Pharyngomycosis, 606— (14) Keratosis, 608.

Non-inflammatory Diseases, 613 — (1) Pulsating Arteries, 613 — (2) Pharyngeal Aneurysm, 614 — (3) Anemia of the Pharynx, 614 — (4) Neuroses of the Pharynx, 615 — (a) Anesthesia, 615 — (6) Hyperesthesia, 616 — (c) Paresthesia, 616— (d) Neuralgia, 617 — (e) Neuroses of Motion, 617— (1) Spasm, 617— (/) Paralysis, 617— (4) Foreign Bodies in the Pharynx, 619.

CHAPTER XIX. Diseases of the Larynx 621

Method of Laryngeal Examination, 622 — Autoscopy, 626 — Inspection of the Posterior Wall of the Larynx, 627.

Malformations and Deformities, 628 — (1) Congenital — (a) Stenosis, 628 — (b) Dilatation of Pouch (Laryngocele), 629 — (c) Hypertrophies, 629 — (2) Acquired Malformations — (a) Stenosis, 629 — (1) Syphilitic, 630— (2) Tuberculous, 631— (3) Lupus, 631.

Inflammatory Diseases of the Larynx, 632 — Cough, 632 — (1) Acute Catarrhal Laryngitis, 634 — (2) Acute Catarrhal Laryngitis in Constitutional Diseases, 639 — (a) Erysipelas, 639— (b) Measles, 640 —(c) Scarlet Fever, 640— (d) Small-pox, 640— (e) Typhoid Fever, 641— (/) Typhus Fever, 641— (g) Influenza, 641— (h) Miasmatic Epiglottis, 641— (i) Rheumatism, 642 — (j) Purpura Hemorrhagica, 642 — (3) Acute Laryngitis in Children, 642 — (4) Laryngismus Stridulus, 644 — (a) Congenital Stridor, 646 — (6) Spasm of the Larynx in Children, 646 — (c) Spasm of the Larynx in Adults, 648 — (d) Spasmodic Laryngitis, 649 — (5) Acute Epiglottis, 652 — (6) Traumatic Laryngitis, 653 — (7) Suppurative Laryngitis, 654: — (8) Rheumatic Laryngitis, 655 — (9) Edematous Laryngitis, 656 — (10) Chronic Edema of the Larynx, 661 — (11) Membranous Laryngitis, 661 — (1) Croupous, 661 — (2) Fibrinoplastic, 661 — (12) Hemorrhagic Laryngitis, 666.

Chondritis and Perichondritis, 668 — Simple Chronic Inflammations, 677 — (1) Simple Chronic Laryngitis, 677 — (2) Follicular Laryngitis, 684 — (3) Dry Laryngitis, 685 — (4) Cyanotic Laryngitis, 688 — (5) Hyperplastic Laryngitis, 688 — Scleroma of the Larynx, 689 — Anemia of the Larynx, 689 — Hyperemia of the Larynx, 690 — Pemphigus of the Larynx, 690 — Singers' Nodules, 691 — Chronic Inflammations of the Larynx, 694 — (1) Syphilis of the Larynx, 694 — (2) Tuberculosis of the Larynx, 703 — Laryngeal Hemorrhage, 713 — Bronchoscopy, 714 — Technic of Laryngo-bronchoscopy, Esophagoscopy, and Direct Laryngoscopy, 718 — Foreign Bodies in the Larynx, 728 — Prolapse of Laryngeal Ventricles, 730.

Chapter XX. Page

Voice, 732 — Acoustics, 736 — Relation of the Voice to Hearing, 738— Development of Speech, 744 — Speech Defects, 748 — Conditions Producing Change in Voice, 750.

Chapter XXI

Nervous Cough, 759 — Mogiphonia, 760 — Anesthesia, 760 — Paresthesia, 761 — Hyperesthesia, 762 — Neuralgia, 762 — Hysterical Aphonia, 763 — Functional Aphonia, 766 — Chorea of the Larynx, 766 — Dysphonia Spastica, 767 — Laryngeal Vertigo, 767 — Paralysis of the Vocal Chords, 769 — (a) Paralysis of the Superior Laryngeal Nerves, 769 — (6) Recurrent Laryngeal Paralysis, 769— (c) Bilateral Abductor Paralysis, 772 — (d) Unilateral Paralysis of Abductors, 774 — Paralysis of Individual Muscles, 774 — (a) Paralysis of Central Abductors (Arytenoids), 774 — (b) Paralysis of Internal Tensors (Thyro-arytenoids), 775 — (c) Bilateral Paralysis of Abductors (Lateral Crico-arytenoids) , 775 — (d) Unilateral Abductor Paralysis (Lateral Crico-arytenoids), 775.

CHAPTER XXIII. Tracheotomy 786

Indications and Contra-indications, 786 — Operative Procedures, 786 — Instruments, 787 — High Tracheotomy, 788 — Low Tracheotomy, 789 — Laryngotomy, 790 — Complications and Dangers, 790 — Postoperative Care, 791.