Recurrence in a Case of Abscess 
of the Epiglottis. 
By FRANK T. CHAMBERLIN M. D., Washington, D. C. 
Professor of Laryngology Georgetown Medical College; Specialist to Georgetown 
University; Physician-in-Charge of Throat and Chest Service at 
Eastern Dispensary; etc., etc. 
Reprinted from VIRGINIA MEDICAL MONTHLY, March, 1893. RECURRENCE IN A CASE OP ABSCESS 
OF THE EPIGLOTTIS* 
By FRANK T. CHAMBERLIN, M. D., Washington, D. C. 
In the Medical Record of April 11th, 1891, I reported a 
case of Cold Abscess of the Epiglottis, of which the following 
is a synopsis : 
Nov. 28,1890.-U. B., male, age 28 years (colored); no 
specific or tubercular history. Duration of uneasy sensation 
in throat four years. Difficulty of respiration at times, and 
troublesome desire to swallow. Dysphagia cause of patient 
applying for treatment. Mouth-full-of-mush character of 
voice. No history of foreign body or injury to laryngeal or 
pharyngeal cavities other than that which might have been 
produced by stimulants, as patient was what might be 
termed a heavy drinker. 
Inspection showed a large buccal cavity, with tumor ex- 
tending behind and above the palate about three-fourths of 
an inch, resembling a small intestine inflated with air, and 
about the circumference of a keat egg. On swallowing, the 
tumor would disappear. Surface of tumor covered with 
arborescent vessels, originating from two main trunks run- 
ning parallel with its long diameter. Inflammatory appear- 
ance slight, probably owing to a stimulant taken before ex- 
amination. Feel of tumor indicated fluid. There was con- 
siderable anaesthesia of the part, but I was unable to locate 
attachment with the finger owing to length of pharynx and 
occlusion of cavity by the body. Laryngeal mirror failed 
to help matters, owing to obstructed view. 
On Nov. 29th, in the presence of Drs. Bowen, Beatty, Car- 
raher and Safford, I applied a 4 per cent, solution of cocaine 
hydrochlorate, and aspirated the tumor, but succeeded in 
getting only a few drops of yellowish fluid, which proved 
* Read at a meeting of the Medical and Surgical Society of the District 
of Columbia, January 9th, 1893. 2 
later under the microscope to be pus. An incision with the 
bistoury gave a little over two and a half ounces of fluid ; 
the sac contracting as flow went on, necessitated holding 
same with forceps to prevent its slipping from view. After 
perfect evacuation of sac, laryngeal mirror gave appear- 
ance of a laryngitis and the epiglottis, with the epiglottis 
slightly depressed in the center with a doughy look of the 
anterior surface. Further inspection with the forceps showed 
that the membrane was completely undermined with the 
exception of a slight portion of the left side, and that the 
tissue was so elastic as to give the organ almost its normal 
appearance with the above exceptions. 
Appearance of pharynx after evacuation of tumor tended 
to substantiate history given by the patient as regards the 
time of its presence. Sides of pharynx about pillars highly 
hypertrophic, while the posterior surface extending up and 
back of the palate was so worn away as to almost outline 
the bodies of vertebrae. After treatment, rest of organ for a 
time and liquid diet. 
Nov. 30th.-No inflammatory conditions, but sensation of 
something to be swallowed still present; sedative lozenges 
prescribed. 
Treatment later for condition of pharynx partly suc- 
cessful. 
At the time of writing, which was in Jan., 1891, there had 
been no refilling of the sac, and the organ was about normal 
in size. 
I lost track of the patient soon after, and did not see him 
again until the 20th of the following July, 1892, when he 
returned to me for treatment, owing to a return of all of the 
previous symptoms. The appearance of the tumor was 
about the same as before, except a little larger and more 
tense. The dyspnoea had increased, and the sense of swal- 
lowing something became a reality, as at times there was a 
decided attempt on the part of the patient to swallow the 
abscess, epiglottis, and all. which would set up a violent 
cough, which was usually followed by vomiting, giving re- 
lief to the paroxysm for the time. The parts about the 
tumor were inflamed and angry looking, with hyperesthe- 
sia sufficient to necessitate the use of cocaine belore making 
an examination. 
On July 21si-Present Drs. James Kerr, Sinclair, Bowen, 
Watson, and Duffey. I proceeded to evacuate the cyst as 
on the first occasion. The sac, on being emptied, proved to 
be far less elastic than in the first instance, and threatened 3 
to give trouble to respiration by falling over into the larynx. 
It was seized with laryngeal forceps and tenaculum, and 
the entire undermined portion removed close to its attach- 
ment with a pair of laryngeal-curved scissors-three at- 
tempts being necessary and three pieces of tissue being the 
result. The small attachment of the membrane to the left 
anterior surface to the extent of about |th of an inch still 
existed and was left intact; so with this exception the entire 
anterior surface was removed. The three pieces removed 
would have measured at least three inches square after con- 
traction. 
The patient suffered considerably in spite of the free use 
ef cocaine before and during the operation, the excessive 
spasm of the parts increasing greatly the difficulties of the 
procedure. The haemorrhage following the operation was 
considerable, but of short duration. The epiglottis after the 
operation was considerably larger than in the first instance, 
being so flattened out as to completely obscure a view of the 
larynx. The movements of the epiglottis were faulty for 
some days, causing difficulty to respiration and deglutition. 
The after treatment was by the insufflation of iodoform, 
zinc oxide, and sulphate of morphia, with a milk diet. The 
patient was again lost sight of in about fifteen days. 
The possibilities of the abscess being the result of tuber- 
culous ulceration was settled by Dr. W. M. Gray, Micro- 
scopist Army Medical Museum, to whom I am indebted for 
the accompanying micro-photographs and the following 
report: 
(a) Upper or external surface. 
(6) Inner surface or lining. 
" Washington, D. 0., Sept. 14, 1891. 
" My Dear Doctor,-A section of the tissue removed by you 
from the abscess of the epiglottis shows the following: The 4 
wall is composed of a band of dense fibrous connective tis- 
sue, containing blood vessels and nerves, and lined on both 
its external and internal surface by a mucous membrane, 
composed of squamous epithelial cells. I believe this ab- 
scess to have developed from one of the ducts leading from 
the submucous glands of the epiglottis." 
On July 15, 1892, I was fortunate enough to get another 
examination, which showed the epiglottis to be of about 
normal size, but of a decided omega shape, which gave a 
view of the cords, probably due to a contraction of the glosso- 
epiglottic ligament following the operation. All of his pre- 
vious symptoms had left, and he expressed himself as en- 
tirely well. The pharynx still showed the past presence 
of the growth, but gave him no trouble. 
In conclusion, should a similar case present itself to me, 
I should remove the sac after evacuation, instead of waiting 
hoping for a spontaneous cure as I did in the first instance; 
and I doubt, had I removed a larger button of the mem- 
brane than I did in the first instance, if anything more 
would have been accomplished, as the sac would probably 
have refilled later or have left a pocket in the organ as a 
receptacle for food. 
Jan 8, 1893.-Saw patient again, and laryngeal examina- 
tion gave results similar to those of July 15, 1892. 
226 New Jersey Ave., S. E.