Applied pathology in diseases of the nose, throat, and ear

Front matter

APPLIED PATHOLOGY IN DISEASES OF THE

NOSE, THROAT, AND EAR

Bulla of the Membrana Tympani in Acute Infection of the Influenzal Type

Foreword

I have long felt the need for such a work as I am herein pre¬ senting, both from my own experience as well as the communica¬ tions from many other otolaryngologists. There is not, even to this day, an English text book that is limited to the Pathology of Nose, Throat, and Ear Diseases and their borderline condi¬ tions, but I hope for the early appearance of one.

The work of Oscar Beck, of Vienna, to be published in the form of an atlas “Atlas der Histopathologie der Nase.und direr Nebenhohlen (Atlas of Histopathology of the Nose and Acces¬ sory Sinuses) will shortly appear in German and I have accepted the translation of it into English. The colored illustrations which so beautifully demonstrate the pathologic processes will enhance the value of this volume. There are many illustrations of the same conditions found in my work, only that they are plain, not retouched, microphotographs.

It has further been determined to make this work one on applied pathology, in the belief that a greater benefit will be derived from applying the pathological entities to etiology, symptoms, diagnosis, and prognosis, thereby arriving at a rational basis for treatment, exclusive of the strictly surgical interventions. In other words, the fundamental object in the analysis and management of a case is a definite knowledge of the underlying pathological change present.

It is my desire to limit this work almost exclusively to my personal experiences and therefore it should not be considered as a text book. There will be many subjects that will not appear either because I have had no personal experience pertaining thereto, or because I cannot offer any data as to their pathology. Particularly is this true in acute conditions wherein it is but seldom possible to secure actual pathological specimens, it being either surgically contraindicated, or otherwise uncalled for. However, by analogy, adhering to the fundamental prin¬ ciples of pathology, one may infer such changes as would natur¬ ally occur, for instance, in acute inflammation elsewhere.

FOREWORD

Certain gross illustrations, other than those from my own cases, have been taken and modified after other investigators only when they seemed to serve better than if taken from the original, but they always represent and typify case groups and conditions found in my own work. I wish, therefore, to ac¬ knowledge the work of Denker, Katz, Preysing, Blumenthal and Wittmaack.

In the study of pathological changes, I have considered each subject as shown grossly in the patient during examination and further corroborated by laboratory data, as x-ray, etc., or dur¬ ing operative procedure or treatment; next, the gross specimen after removal, if such be the case, with subsequent microscopical examination. I have been fortunate in a few instances to have secured postmortem specimens. The subjects presented both in gross and microscopical sections, as well as in the photo¬ graphs, are selected as typifying groups rather than individual cases. In all the laboratory work, experts have collaborated and I wish, therefore, to express my appreciation to Drs. Ludwig Hektoen, Maximilian Herzog, W. A. Evans, and Carl Beck.

More than any other contributory factor in making this work possible has been the interest shown by some of my students and fellow-workers, and I desire at this time to mention a few who figure prominently in the work: Drs. Clara Moore, Theresa Lane, W. J. Neuzil, Frank J. Novak, Jeanette Sliefferd, Harry L. Pollock, as well as my collaborators and former students, Drs. Arnold B. Kauffman and Francis L. Lederer. In apprecia¬ tion of their cooperation, I have purposely used the pronoun “we” throughout the work. I also wish to express my thanks to the artist, Mr. A. B. Streedain, for his cooperation.

I desire to acknowledge the fact that in the text the reader will frequently find that I am at variance with many of the ac¬ cepted principles both in diagnosis and treatment, and I expect criticism on this score, but these are my beliefs and I have car¬ ried them out in our practice with satisfactory results.

It will be noted that there is an absence of much of the bor¬ derline of ear, nose and throat conditions, as well as operative surgery, with which work I have been identified, but owing to the enormity of the material, these could not be incorporated in this volume. Should the demands warrant it, I have promised

FOREWORD myself the writing of such hooks with the same pleasure as the writing of this volume has given me.

In regard to the absence of radiographic illustrations, I wish to state that a great part of my radiographic work has already appeared in my “Radiographic Atlas” published a number of years ago by The Laryngoscope, and more modern work will appear in a future joint publication on radiography, covering subjects especially interesting to otolaryngologists, by Drs. Randall, Bigelow, Iglauer, Gerber and myself.

Part I Acute Diseases

CHAPTER I page

Fracture, 17; Furunculosis, 20; Frost-bite, 20; Vestibulitis Acuta, 21; Foreign Bodies, 22; Septal Abscess aud Hematoma, 23; Epistaxis, 24;

Acute Rhinitides (Rhinosinuitis), 24; Paranasal Sinus Disease—Acute,

30; Acute Sinus Disease in Children, 31; Acute Fulminating Sinuitis, 33.

Acute Labyrinthitis, 85; Perisinus Abscess, 86; Sinus Thrombosis, 87; Extradural Abscess, 89; Intradural Abscess (Acute Brain Abscess), 90; Hernia Cerebri, 91; Meningitis, 91; Acute Facial Paralysis, 93; Acute Facial P'aralysis Unassociated with Mastoid Disease, 94.

Part II Chronic Diseases Chapter VIII

External Nose, 96; Rhinophyma, 96; Lupus and Tuberculosis, 96; Lues,

CONTENTS

98; Rhinoscleroma, 100; Pus Infections—with or without Destruction of the Soft Parts, 100; Tumors, 100; Paraffinoma, 105; Vestibulum of the Nose, 109; Internal Nose, 109; Nasal Septum, 109; Traumatic Septum,

115; Lues, 117; Tuberculosis of the Septum, 119; Malignant Disease of the Septum, 120; Papilloma of the Septum, 120; Congenital Absence of the Septal Cartilage, 122; Closure of the Posterior Choanae, 122; Septum in Atrophic Rhinitis, 122; Synechia, 123; Inferior Turbinate, 124; Turgescence, 124; Hypertrophy, 125; Atrophy, 134; Atrophic Rhinitis,

134; Hyperplasia, 138; New Growths of the Inferior Turbinate, 138;

Lupus or Tuberculosis of the Inferior Turbinate, 139; Syphilis of the Inferior Turbinate, 139; Chronic Rhinosinuitis, 139; Pathology of In¬ dividual Structures, 140; Hyperplastic Rhinosinuitis, 149; The Middle Turbinate and Sinuses in Atrophic Rhinitis, 155; Sarcoma of the Sinuses,

Chapter IX

Chronic Tubitis, 167; Pharyngitis—Lateralis Hypertrophicus, 168; Atrophic Pharyngitis, 169; Thornwaldt’s Disease, 170; Syphilis of the Pharynx, 171; Tuberculosis of the Pharynx, 174; Tumors of the Pharynx,

175; Sarcoma of the Tonsil, 177; Carcinoma of the Pharynx, 177; Tonsil and Adenoid Diseases, 179; Tuberculosis of the Tonsil, 188; Luetic Tonsil,

192; Actinomycosis of Tonsil, 192; Hyperkeratosis of the Tonsil, 193; Benign Tumors, 194.

CHAPTER X Chronic Diseases op the Larynx .197

Carcinoma of the Larynx, 197; Tuberculosis of the Larynx, 206; Syphilitic Laryngitis, 210; Chronic Simple Laryngitis, 212; Fibrous Polyp, 213; Papilloma of the Larynx, 215; Ecchondroma of Larynx, 218; Laryngeal Paralyses, 218.

CHAPTER XI Chronic Diseases op the Trachea, Bronchi and Esophagus .221

Chronic Mucopurulent Tracheitis, 221; Syphilitic Tracheitis, 222; Neoplasms of the Trachea, 222; Adenoma of the Trachea, 223; Bronchorrhea, 223; Carcinoma of the Esophagus, 223; Esophageal Diverticulum,

224; Strictures of the Esophagus, 224.