The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . y be, and verycommonly is, induced by irritation^ compression, jiattening out, orstretching of the left pneumogastric and recurrent laryngeal nerves, bythe pressure of the tumor. In these cases the larynx becomes the seatof the difficult respiration, its muscles being driven into a state of spasm,so as to occasion paroxysmal attacks of intense difiiculty of voice becomes hoarse, croupy, or croaking; the cough has a loudcroupy or metallic sound, and is attended by the expectoration o
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . y be, and verycommonly is, induced by irritation^ compression, jiattening out, orstretching of the left pneumogastric and recurrent laryngeal nerves, bythe pressure of the tumor. In these cases the larynx becomes the seatof the difficult respiration, its muscles being driven into a state of spasm,so as to occasion paroxysmal attacks of intense difiiculty of voice becomes hoarse, croupy, or croaking; the cough has a loudcroupy or metallic sound, and is attended by the expectoration of thinfrothy mucus. The laryngeal spasm and stridor often do not occur inordinary respiration, but are produced under exertion, or on making thepatient inspire fully and deeply. The laryngeal symptoms are some-times so much more prominent than any of the other signs of intratho-racic aneurism, and so closely resemble chronic or even acute laryngitis,with impending asphyxia, that there are not a few cases on record inwhich Surgeons have performed tracheotomy, on the supposition thatVOL. II.—6. Fig. 374.—Aneurism of Arch of Aorta, of the size ofaa almond, springing from below left SuhclavianArtery, and bursting into left bronchus. 82 SPECIAL ANEURISMS. they had to do with cases of pure and uncomplicated laryngeal disease;and in otlier instances this operation has been performed with the viewof prolonging life, even when the dependence of the laryngeal spasm onaneurism of the aorta has been recognised. Dr. George Johnson has made some important observations on theuse of the laryngoscope in the diagnosis of the cause of dyspnoea inaortic aneurism. He says that, in cases where the cause is pressure onthe recurrent laryngeal nerve, the lar3nx is seen to be healthy, and thespasm may be seen to occur. If the pressure be sufficient to abolish thefunction of the nerve, unilateral paralj^sis will occur, which can easilybe ascertained by laryngoscopic examination. The voice in such cas
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