RETURN OF VOICE AFTER LARYNGECTOMY.although the lungs and trachea are entirely cut off from communication with the throat and mouth. A Clinical Lecture on the Physiopathology of Voice; illustrated. De livered at lefferson College Hospital, Philadelphia, Oct. 20, 1893.
Authors: J. SOLIS-COHEN
Journal: JAMA (1893)

pearance of well-marked cases, such as those de¬ scribed as pseudo-membranous angina under pseudodiphtheria, was true diphtheria."Most cases of pseudo-membranes and exudates, confined to the tonsils in adults were not diphtheria, but a few cases looking just like them were.Most cases of acute inflammation of the pharynx and fauces, with very little or no exúdate or pseudomembrane, were not diphtheria, but a very few were, and in all of these there was a direct history of infection.The majority of uncomplicated cases of pseudo-membranous laryngitis were true diphtheria, but a few in the summer and fall, and quite a num¬ ber in the late winter and spring were not true diph¬ theria.In most, a clinical differential diagnosis was impossible without cultures.In young children, cases of diphtheria with exúdate confined to or extending beyond the crypts, and those with little or considerable pseudo-membrane were at times true diphtheria and at times not.The two classes of cases often presented similar appearances.True pseudo-membranes confined to the nose were, in all uncomplicated cases, true diphtheria."In the milder cases of pseudo-membranous inflam¬ mations, one condition was frequently observed, which was an almost certain sign of true diphtheria.This was the presence of irregularly placed patches of adherent pseudo-membrane on some other por¬ tions than the tonsils or margins of the faucial pillars or uvula.The amount of membrane usually differed on the two sides.The thick gray pseudomembranes which cover a large portion of the ton¬ sils, the soft palate, and often nostrils, and naso¬ pharynx were always the lesion of true diphtheria."Upon the line of these observations we must now deal with pseudo-membranous inflammations.They are pregnant with wisdom that is of inestimable value in diagnosis, prognosis, preventive and cura¬ tive treatment.Dr. Park details the technique of his culture methods for diagnosis, and the writer is making a test of these from, the standpoint of the private practitioner.The results are not as yet perfectly satisfactory.The position of the question and the value of bactériologie diagnosis at present is best summed up by Koplik in his article.He says : "Clinically it is impossible, from simple inspec¬ tion, to sift the cases of non-characteristic true diphtheria from other forms of non-diphtheritic angina."In the bactériologie examination of these cases, and with the subsequent animal tests, lies the only true diagnosis.Is it possible for us at present, in private practice, to examine each case as has been done in the foregoing studies?The author is not so sanguine upon this last point as Baginsky of Berlin, in his last article upon diphtheria.It is possible in the clinic-and hospital to do such work, for the facilities are readily at hand, as also the conditions for study.In private practice, however, for the present we must insist upon the proper isolation of all doubtful cases of throat disease, and the time is right-for pushing the doctrine of isolation to its farthest limits.Gentlemen, I now announce the.Section on Diseases of Children to be open and ready to proceed with the business before it.