Volume 5

A manual of surgical treatment / by W. Watson Cheyne and F.F. Burghard.

  • Cheyne, William Watson, Sir, 1852-1932.
Date:
1899-1903
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A manual of surgical treatment / by W. Watson Cheyne and F.F. Burghard. Source: Wellcome Collection.

    476/520 (page 450)
    Symptoms.—The symptoms are usually slight, and the disease may progress with occasional exacerbations interspersed with long periods of quiescence for many years. Dyspncea is rare, and occurs only when the glottic region is affected, and then generally somewhat early in the disease, that is, about its second year. Rarely phthisis may supervene, but the chief danger arises from the occasional necessity for tracheotomy. Treatment.—Constitutional.—Arsenic internally seems to act in most cases almost as a specific, and should be given as Fowler's solution in gradually increasing doses as tolerance is established, commencing at three to five minims for an adult and increased until fifteen or twenty minims of the solution are given three times a day. The effect is often almost as great as that of iodide of potassium in tertiary syphilis, and decided improvement is manifest at the end of a fortnight. The drug should be continued for two months after all signs of lupus have disappeared, and the case should be kept under observation for a year or more, so that any recurrence may be treated early. Combined with this treatment, tonics, cod-liver oil, change of air, and good feeding should always be employed. Local treatment.—In certain cases as much as possible of the diseased tissues may be removed. This should be done in adults in whom there is extensive disease, who do not respond to the administration of arsenic, and who are in fair general health. The epiglottis may be treated by scraping, or a piece of it may be removed by the snare. The ventricular bands or the cords are best treated by scraping. The operation is performed as has already been described for tuberculous laryngitis (see p. 447)- Should dyspncea necessitate tracheotomy, it is probable that the tube will require to be permanently maintained. After the disease has quite subsided, an operation on the lines already recommended for syphilitic stricture of the larynx may be attempted (see p. 444), but it is hardly likely to be successful if the stricture be a broad one.