118 



ABNORMAL ANATOMY OF THE LARYNX. 



ment, and the part is even painful on pressure 

 externally ; every attempt to swallow is so 

 dreadfully distressing that patients will suffer 

 to be half-famished rather than attempt to get 

 down a spoonful of fluid. In attempting to 

 examine the throat there is often great diffi- 

 culty, because the patient either cannot, or 

 from the pain it occasions, will not open his 

 mouth; but if it can be seen, it is observed 

 to be of a deep red colour, verging on purple, 

 sometimes diffused over the surface, sometimes 

 in patches, and even from an early period 

 abundantly covered by a thick glairy tenacious 

 mucus that it is difficult to wipe from it. If 

 the disease is severe, the membrane soon be- 

 comes sloughy : " the colour of the slough is 

 grey or ashey : in some few instances it appears 

 brown ; its edges are abrupt and well defined, 

 and it is surrounded by inflammation of an 

 intensely deep red colour. The slough is in 

 general slow in separating, and when thrown 

 oft' it appears to resemble a membrane of viscid 

 lymph not unlike the adventitious substance 

 formed in croup, and the surface underneath 

 looks of a bright red colour, is nearly level 

 with the adjoining parts of the membrane, and 

 seems more like the blush of erythema than 

 the relic of mortification. I believe that wher- 

 ever croup has appeared to have been conta- 

 gious it will be found that malignant scarla- 

 tina has prevailed also; and that the occur- 

 rence of the laryngeal or tracheal disease was 

 occasioned by the spreading of the inflamma- 

 tion from the fauces to the windpipe, or per- 

 haps by the actual presence of one of these 

 sloughing ulcers in the immediate neighbour- 

 hood of the glottis."* 



Such is the description of the effects of an- 

 gina maligna on the mucous membrane written 

 in the year 1825, but without any suspicion on 

 the part of the writer that it could ever be 

 ranged by the side of the affection termed 

 croup : for besides the essentially opposite 

 characters of the fever in each, which by them- 

 selves would be all-sufficient, there are the 

 following differences. The angina maligna, 

 diphtherite, or by what other appellation it is 

 to be known, for with respect to it we enjoy a 

 most happy abundance of nomenclature, com- 

 mences always in the fauces, and when it at- 

 tacks the windpipe, which is by no means very 

 frequent, it does so secondarily by spreading 

 to it; whereas croup seldom or never com- 

 mences in the fauces unless when it appears as 

 the sequela of some serious injury, such as the 

 swallowing of boiling water. Cynanche ma- 

 ligna even locally is not confined to the mucous 

 membrane, as is evidenced by the intense pain 

 in swallowing, the difficulty of opening the 

 mouth, the enlargement, suppuration, and even 

 gangrene of some of the adjacent glands; and 

 it occasionally exhibits something like a me- 

 tastatic transfer of disease to some important 

 organ, such as the brain or liver. And even 

 when recovery takes place, the difference is 

 still remarkable: it is slow, often imperfect, 



Potter on the larynx and trachea, p. 17. 



and followed by anasarca or some similar Evi- 

 dence of a broken and cachectic habit. This 

 is not the place to enter more fully into the 

 examination of these two diseases, which the 

 reader will find admirably contrasted in -Dr. 

 W. Stokes' work on diseases of the chest, 

 where the angina is spoken of under the name 

 of secondary croup. 



There remain two other affections of the 

 larynx to be noticed accompanied by asthenic 

 fever, in both of which the pathological con- 

 dition of the submucous tissue is of great im- 

 portance, viz. erysipelas and diffuse inflamma- 

 tion. I believe the larynx is very seldom the 

 primary or original seat of an erysipelatous 

 attack, at least such has not come under my 

 observation ; but I have not infrequently seen 

 it seized either by the spreading of the disease 

 from the head and face, or by some species of 

 metastasis. The constitutional symptoms during 

 life are of a low and typhoid character; the 

 local, those of painful and difficult deglutition 

 and respiration, and the termination (as far as 

 I know) always fatal. Nor are the appear- 

 ances after death always satisfactory, for, as in 

 other cases of erysipelas, the tumefaction often 

 subsides and the colour fades very soon after 

 death. In most instances, however, we find 

 the mucous membrane of a pale yellow colour 

 and apparently greatly thickened : the sub- 

 mucous tissue filled sometimes with serum, 

 sometimes with a gelatinous lymph, and some- 

 times with a sloughy and putrid matter ; the 

 natural folds of the organ obliterated, and the 

 rima more or less blocked up and closed by the 

 thickening and tumefaction of the adjacent parts. 

 But one of the most curious affections to 

 which the larynx is liable is that of diffuse in- 

 flammation. I say " curious," because it is not 

 necessary that the mucous membrane should 

 be inflamed or thickened or otherwise engaged, 

 or that there should be any remarkable swel- 

 ling of the parts, and yet the breathing is harsh, 

 sibilous, or croupy, as if from the presence of 

 some mechanical obstruction. In these cases, 

 which are always fatal, the cellular tissue is the 

 seat of the disease, and is found filled with 

 offensive purulent matter and flakes of unor- 

 ganized lymph, sometimes around the la-ynx, 

 trachea, and oesophagus, sometimes at the front 

 of the throat, and not infrequently extending 

 to a considerable distance down into the ante- 

 rior mediastinum. 



Chronic inflammation of the mucous mem- 

 brane of the larynx resembles in its effects a 

 similar form of disease in other structures, ex- 

 cept that as the aperture of the glottis is small, 

 and its functions essential to life, the same de- 

 gree of alteration or of disorganization cannot 

 have place here that may occur in other situa- 

 tions without the patient generally experiencing 

 a degree of distress that will at least direct his 

 attention to the subject. Still is this affection 

 sufficiently insidious, and its progress in many 

 instances so slow, that often irremediable mis- 

 chief is produced before assistance is sought 

 for : and thus it happens that we are obliged to 

 speak of chronic inflammation, not with re- 



