LXXXII. Fulminating Septic Infection of the Pharynx and Larynx
LXXXII. Fulminating Septic Infection of the Pharynx and Larynx
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LXXXII。
DOI：
10.1177/000348942403300415
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发表时间：
1924
期刊：
影响因子：
--
通讯作者：
Harmon Smith
中科院分区：
文献类型：
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作者：
Harmon Smith
在提出这个问题时，我主要是受个人经历的驱使，特别是在过去两年中，在每一年中，病例的严重性都是如此，有时怀疑病人是否会康复。在一个病例中，气管切开术是必要的;在两个病例中，这似乎是不可避免的，在第三个病例中，病人死亡了。我将只描述那些非常严重的情况，从咽部开始，特别是在扁桃体中，向下延伸到喉部或进入喉部。我不会包括路德维希心绞痛或涉及口腔、颌下区域、舌等的许多类型的蜂窝织炎。我们可能会合理地问，为什么在扁桃体或咽侧壁明显简单的感染中，会突然出现广泛的炎症浸润一侧或两侧的咽，随后出现悬雍垂（可能是声门）水肿，没有明显的脓灶，伴随着呼吸困难，严重的身体疲惫和全身败血症的所有症状？简单的开始只不过是普通医生经常用水杨酸盐和简单的漱口水进行治疗;即使在专家看来，除了他每天在诊所里观察到的证据之外，最初也没有任何不寻常的证据。对于一个可能的答案，我想请你注意这种情况的病因，作为一种解释，这是乔纳森·赖特博士多年前首次强调的，最近他在我个人的要求下扩大了。首先，交感神经系统存在严重的抑郁症，这可能是在-
In presenting this subject I am actuated largely by personalexperiences, occurring particularly in the last two years, in each of which the gravity of the case was such that it was at times doubtful if the patient would recover. In one case a tracheotomy was necessary; in two it seemed almost unavoidable, and in the third the patient succumbed. I will describe only those very grave conditions which, beginning in the pharynx, particularly in the tonsils, extend downwards towards or into the larynx. I will not include Ludwig's angina or the many types of phlegmon involving the mouth, submaxillary region, tongue, etc. \Ve may reasonably ask why, in an apparently simple infection of the tonsil or lateral pharyngeal wall, there will suddenly develop an extensive inflammatory infiltration of one or both sides of the pharynx, followed by edema of the uvula, possibly of the glottis, with no pus focus apparent, and this accompanied with difficult respiration, profound physical exhaustion and all the symptoms of general sepsis? The simple beginning is nothing more than is frequently treated by the general practitioner with the administration of a salicylate and a simple gargle; nor does it at first present, even to the eye of the specialist, any unusual evidences beyond that observed by him daily in his clinic. For a possible answer, I would call your attention to the etiology of this condition as offering an explanation, which was first emphasized a number of years ago by Dr. Jonathan Wright, and which he has enlarged upon more recently at my personal request. In the first place there exists that profound depression of the sympathetic nervous system which may have been in-