DOI: 10.7925/drs1.ucdlib_280422
title: Vegetation obstructing rima glottidis

description: Watercolour medical illustration depicting vegetation obstructing the rima glottidis. It has the alternative reference number 1997, 21 and P2B on the front. The Richmond Hospital Museum reference is B.e.6. The entry for this in P263/1 pg. 17 reads 'Vegetation obstructing the Rima Glottidis. Aet 34. Dr Stokes'. Under the illustration is written and slightly rubbed out 'Vegetation obstructing Rima Glottidis'. The typescript note on the back begins 'Rima Glottidis closed by warty Vegetations from its Margin'.
description: Scope and content: The full typescript note on the back reads 'Rima Glottidis closed by warty Vegetations from its Margin – Doctor Stokes said the case from which he had the recent specimens, which he then laid before the Society, was one of great interest as connected with the performance of the operation of Tracheotomy, and the circumstances which would indicate it to be necessary. It was a case presenting the unusual circumstance of a fatal chronic disease of the larynx, without disease of the lung and without the usual symptoms of mechanical obstruction to the respiration. The subject of the case was a house-painted, aet 34, admitted into the Meath Hospital on the 10th inst. This man had colica pictonum thirteen times, and his upper extremities had been paralysed three times. His voice had gradually become weak, and about eight months ago he became troubled with a cough and expectoration of a viscid mucus, but had neither haemoptysis nor pain in the chest. At the time of his admission he was extremely emaciated, his countenance pale, lips blue, mouth, teeth and tongue covered in sordes. His aspect was altogether that of a person suffering from profound disease, and whose constitution had completely given way. There was difficulty of breathing. On looking into the throat nothing could be perceived but general relaxation. The uvula appeared enlarged, but there was neither ulceration nor cicatrix in the throat. The epiglottis felt healthy and was not enlarged. There was no dysphagia and no tumour in the neck. The respiration was sometimes difficult, sometimes easy and tranquil; there was never orthopnoea. There was occasionally stridor, but it was very slight, and only occurred when the patient was excited. The voice was very weak. The respiratory murmur was almost inaudible, sometimes some slight bronchial râles would be heard in the chest, sometimes a very slight degree of dulness [sic] might be perceived. The impulse of the heart was well defined, and the sounds normal. When the respiration was suspended by voluntary effort, the first sound on the heart became inaudible. To form a diagnosis in this case, it would have been necessary to determine whether the stridulous breathing was caused by a disease of the larynx, alone, of complicated with tubercle of the lung; or whether it might not be produced by the pressure of a tumour either malignant or aneurismal. It was ascertained not to be caused by pressure; but it was not so easy to determine whether the lungs were engaged or not. The vocal phenomena were in fact useless in this case, and no useful result could be had from the physical examination of the chest. The difficulty of breathing increased, but there were no violent paroxysms of it. The stridor would perhaps accompany three or four inspirations and then intermit. At night there was some slight aberration of mind, but when roused he was perfectly intelligent. He had been despaired of from the time of his admission, and died in about a week afterwards. After death, the body was examined. It was then found that the glottis was completely obstructed by a growth of warty vegetations round the lips of the orifice, which was so perfectly closed that water would not pass through into the larynx when poured upon it. The disease was singularly localised. The epiglottis was quite healthy. The trachea was free from disease. The lungs were free from tubercle, and presented only a slight degree of sanguineous congestion in the lower lobes. There was a frothy mucus in the bronchi. There was no appearance of ulceration below the obstruction. The ventricles of the larynx were a little contracted, and the thyroid cartilage in a state of ossification. There had been a case some time ago in the Richmond Hospital, the symptoms of which were great dyspnoea occurring in paroxysms, with stridulous breathing and raucous voice. In that case the obstruction of the larynx depended on the growth of excrescences about the glottis; it was connected with syphilis and was relieved by tracheotomy. In the present case there had never been any syphilitic affection. (Museum, Richmond Hospital).'
description: Numbering/sequence: Original reference number: 1997.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.