Diagnóstico y tratamiento de las enfermedades laríngeas en la historia de la medicina. I: La era prelaringoscópica

BACKGROUND: ANATOMY, PHYSIOLOGY AND PATHOLOGY: Hippocrates and Aristotle did not yet have a clear idea of the anatomy and physiology of the larynx. 500 years later Galenos carried out subtle studies on animals and elaborated a fairly precise description of the different cartilages, muscles and nerves of the larynx; he was the first to demonstrate the superior and the recurrent nerves of the larynx. He performed numerous experiments on animals with temporary or permanent interruption of the nervous function and thus developed a correct opinion of the vocal physiology. However, he did not draw clinical conclusions from his knowledge. In the 16th century the macroscopic anatomy of the larynx was elaborated further bei Andreas Vesalius, Fabricius ab Aquapendente et al.; Jacob Henle in 1838 described the different epithelia in the larynx, based on microscopic studies. The pathology was inaugurated by Giovanni-Battista Morgagni in 1761, including the pathology of the larynx. Francis Home in Edinburgh (1765) and Pierre-Fidèle Bretonneau in Tours (1826) made the first studies on croup and diphtheria and coined these names. Fr. Hermann Albers in Bonn in 1829 published the first monography on diseases of the larynx, incorporating more than 80 relevant case reports from the literature and numerous observations of his own. The first system of the pathology of the larynx was put up by von Rokitansky in Vienna. DIAGNOSIS AND THERAPY OF DISEASES OF THE LARYNX: Before the invention of laryngoscopy the physicians could deduce the underlying disease only from the clinical symptoms like hoarseness, dyspnoea, dysphagia. The conservative therapy followed the theory of humours and included bloodletting, leeches, purgatives and emetics; the surgical procedures were blind caustery with silver nitrate and ablation of polyps guided by palpation and scarification with a knife in cases of oedema; in desperate dyspnoea endonasal intubation was attempted (Desault 1789-1803) or a tracheotomy performed. Concluding the chapters a typical patient history of 1813 with a case of purulent laryngitis where most of these measures were applied but could not avert but rather provoked the death of the patient. This historical development is described with numerous anecdotic details.

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Recorrido histórico de la anatomía, fisiología y patología laríngeas desde Hipócrates y Galeno hasta Vesalio, Morgagni y Henle (1838). Antes del laringoscopio, el diagnóstico solo podía inferirse de síntomas clínicos como disfonía, disnea y disfagia. La terapéutica humoral incluía sangrías, sanguijuelas, purgantes y eméticos; la cirugía, cauterización ciega con nitrato de plata y ablación de pólipos por palpación; en un caso de 1813 con laringitis purulenta, estas medidas no evitaron la muerte, sino que más bien la provocaron.

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