ABNORMAL ANATOMY OF THE LARYNX. 



121 



epiglottis, in every case that I have seen, more 

 or less removed by ulceration. The whole con- 

 figuration of the organ is lost or spoiled, and 

 scarcely bears a resemblance to the natural 

 shape and appearance of a healthy larynx. We 

 cannot even form a conjecture of the causes 

 that occasion this formidable disease, or of the 

 circumstances that dispose to its production. 

 At some time beyond the middle period of life 

 the cartilages of the larynx, except the epiglottis, 

 and often of the trachea also, become converted 

 into bone, and from the circumstance of carious 

 bone being so constantly found in these ab- 

 scesses, it would appear that it is either during 

 the process of ossification or immediately after- 

 wards that the disease commences. I have 

 always imagined that it was at the former of 

 these periods, and that the affection was pro- 

 duced by some imperfection or irregularity in, 

 or deviation from, the ordinary and natural pro- 

 cess in a word, that this earthy unorganized 

 material was formed instead of healthy bone. I 

 had once an opportunity of seeing a case which I 

 regarded as an example of the commencement of 

 this disease, in the person of a man who, having 

 suffered from laryngeal symptoms for some 

 months, suddenly died in the M eath II ospital, ap- 

 parently from the effects of spasm. " On slitting 

 up the larynx, the cricoid cartilage appeared to 

 be highly vascular and organised. Its substance 

 was internally as red as blood, and in three or 

 four places there were specks of an earthy white 

 substance that crackled under the knife, and was 

 evidently of the same nature with that usually 

 found in caries of the laryngeal cartilages." I 

 am aware that one case can prove but little, 

 particularly in pathological science, but oppor- 

 tunities of seeing the incipient stages of such 

 an affection as this must be very rare, and every 

 case ought to be recorded that will in any man- 

 ner tend to throw light on a disease the etiology 

 of which is so extremely obscure. 



However occasioned, this earthy degeneration 

 of the laryngeal cartilages is an extremely in- 

 sidious disease, its approach being so gradual 

 as scarcely to alarm the patient, and its progress 

 slow. There is usually sore throat and difficulty 

 of swallowing, although this latter is not neces- 

 sarily a constant symptom; hoarseness, and at 

 first but trirlingly impeded respiration. These 

 inconveniences in the commencement are not 

 such as to produce much distress; for I have 

 known one patient suffer for three months and 

 another nearly nine, beforeeitherapplied for relief, 

 and in both the disease had a fatal termination. 

 Afterwards, however, the symptoms become 

 much more aggravated, the difficulty of breath- 

 ing is exceedingly distressing, and there are exa- 

 cerbations that bring the patient to the point of 

 death by suffocation. I have already noticed 

 one case in which dissolution took place at a 

 very early period, and when the occurrence 

 could only be explained t)y the suddenness and 

 severity of the spasm. At length, as the dys- 

 pnoea becomes extreme, the patient suddenly 

 experiences some partial relief; his cough, which 

 was before teasingand troublpsome,now becomes 

 softer, and the expectoration free and copious. 

 This latter has all the characters of purulent 



matter, and there are, mixed with it, particles 

 of that white, gritty, earthy substance already 

 described. Occasionally, pieces of the size of 

 a pea of this unorganised substance are coughed 

 up, and when they appear they leave very little 

 doubt of the nature of the complaint. Towards 

 the latter end of the disease the breathing be- 

 comes loud and sonorous, with a whistling 

 noise, so as to be heard at a considerable dis- 

 tance. The cough is incessant ; the expectora- 

 tion copious, with a peculiarly fetid gangrenous 

 smell ; the patient's breath has this odour also, 

 which may also be regarded as an unfavourable 

 symptom. There is at all times convulsive 

 struggling for breath, with occasional exacerba- 

 tions. In most cases, but not in all, the chest 

 becomes affected ; there is pain in some one 

 part of it or other, with a sensation of tightness 

 round the thorax as if the patient could not 

 draw a full inspiration. His strength seems to 

 give way rapidly under these symptoms ; his 

 body becomes emaciated ; he has night sweats 

 accompanied with excessive restlessness ; and 

 at last he sinks exhausted in the struggle and 

 dies. 



Throughout the entire progress of the dis- 

 ease there is seldom any well-marked paroxysm 

 of fever, although the pulse is never much 

 under JOO ; however, this may be attributed to 

 the constant irritation under which the patient 

 labours. The tongue is usually clean ; the ap- 

 petite i.'Ood in some instances ravenous ; and 

 the general functions of the body, with the 

 exception of respiration, seem to suffer but 

 little. The countenance is always pale, with 

 that sickly dirty hue that characterises hectic 

 fever. The expression evinces great anxiety ; 

 and this is so remarkable that patients suffering 

 under this species of cynanche often seem to 

 bear a strong resemblance to each other. 



It is now familiarly known to surgeons that 

 even this dreadful condition is not utterly di- 

 vested of hope, and patients in whom this dis- 

 ease had wrought such ravages as to render the 

 larynx quite unfit for the performance of its 

 functions, nevertheless survived for years after 

 an artificial opening had been practised in the 

 trachea. Some of these patients have since 

 died, and thus in a limited degree afforded op- 

 portunity for examining the extent of destruc- 

 tion produced, as well as proving the all-im- 

 portant practical fact, that ulcerations here, how- 

 ever extensive, are capable of being cicatrized 

 if the organ is only left in a state of repose. In 

 the Museum of the Royal College of Surgeons 

 in Ireland is the larynx of a patient who lived 

 for more than two years after having been ope- 

 rated on by Mr. Purdon of Belfast, and the 

 following are the appearances exhibited by the 

 preparation. About half the epiglottis had 

 been carried away, and the edge of the remnant 

 is cicatrized. The space between the root of 

 the epiglottis and the rima, rough on its sur- 

 face, irregular and warty. The ventricles 

 altered in shape, diminished in size, but not ob- 

 literated. The dimensions of the rima greatly 

 diminished. The canal of the larynx is not 

 more than one-third of its natural size, and is 

 lined by a thick uneven membrane, evidently 



