ABNORMAL ANATOMY OF THE LARYNX. 



115 



a exact and adequate description of the pa- 

 thology of this organ, may probably find it ne- 

 cessary to bespeak a very considerable degree 

 of indulgence. 



Accustomed to consider laryngeal disease 

 practically, and more particularly with refe- 

 rence to operation, I find it difficult to bind 

 myself down to mere pathological arrangement, 

 or to attempt a satisfactory classification. True, 

 {ike other organs, the larynx is composed of 

 different structures, in each of which disease 

 will assume the character peculiar to itself, and 

 exhibit the appropriate appearances in an exa- 

 mination after death, but it rarely happens that 

 morbid actions are so limited in extent, as to 

 exist and produce their proper results in one 

 tissue without the participation more or less of 

 the others. This will produce confusion, and 

 render it a matter of difficulty to connect symp- 

 toms with the existing pathological conditions 

 that occasion them, and may be adduced as an 

 objection to any attempt at arrangement 

 founded upon structure alone: yet there really 

 can be no classification altogether exempt from 

 the same or a similar observation, and there- 

 fore I shall adopt this one as having the merit 

 of the greatest simplicity. Following this 

 view then, I find the larynx to be composed of 

 the following structures, viz. : 



1. Mucous membrane, exhibiting all the va- 

 rieties of inflammation that are observed in that 

 tissue when situated in other organs. Thus 

 inflammation here may be acute or chronic, 

 phlegmonous or erysipelatous, idiopathic or 

 symptomatic, and attended by fever of a ty- 

 phoid or an inflammatory type. And these 

 varieties producing different effects or results. 

 Thus we have examples of acute idiopathic in- 

 flammation with fever of a sthenic kind in the 

 croup of children, producing the adventitious 

 membrane, and in the laryngitis of adults, that 

 terminates so frequently in oedema ; and of the 

 same local disease with asthenic fever in the 

 diphtherite and in erysipelas: whilst accident 

 furnishes numerous instances of the results of 

 symptomatic inflammation in the consequences 

 of burns, scalds, penetrating wounds, and the 

 swallowing of caustic poisons. As happens 

 so constantly in other structures, chronic in- 

 flammation is here best known by the changes 

 it induces, and furnishes us with abundant 

 specimens of hypertrophy or thickening of the 

 membrane, and of the different forms of ul- 

 ceration. 



2. Submucous tissue, which is the seat of 

 cedematous effusions, and of the sloughy and pu- 

 trid matter produced by diffuse inflammation. 



3. Cartilage, in which we remark great and 

 important varieties of disease, such as inflam- 

 mation, ulceration, mortification, degeneration 

 into an earthy unorganized material, atrophy, 

 hypertrophy, and some alterations of shape 

 and structure probably depending on scrofula 

 or other constitutional taint. 



4. Muscle, the seat of those spasmodic ac- 

 tions so frequent and so perilous in laryngeal 

 affections, and perhaps occasionally of gout 

 and rheumatism also. 



5. Ligaments. I know not whether disease 

 ever originates in these structures, but there can 

 be no doubt that they are sometimes removed 

 by ulceration, and there is reason to believe 

 that great inconvenience and even danger may 

 be occasioned by a preternatural relaxation of 

 some of them. 



1. Acute inflammation of the mucous mem- 

 brane is always in the first instance attended 

 by a change of colour more or less intense ac- 

 cording to its situation, being comparatively 

 pale where it is closely attached to a subjacent 

 cartilage, but of a deep and concentrated red 

 tint, verging on purple, where it is more loosely 

 connected by the intervention of cellular tissue 

 or muscle. The membrane is also swollen, 

 soft and pulpy, these characters being likewise 

 influenced by the nature of its connection to 

 subjacent parts, and I believe the usual 

 symptom of inflammation, "pain," is not ab- 

 sent, although the mental agony attendant on 

 obstructed respiration renders this a secondary 

 consideration to the patient : certainly in the 

 laryngitis of the adult, pressure on the pomum 

 Adami is very sensibly felt. In connexion with 

 these changes the functions of the organ are 

 interrupted and impaired. The usual secretion 

 of the membrane is diminished in quantity, or 

 perhaps ceases altogether, and hence the sen- 

 sation of dryness or huskiness in the throat, 

 and the peculiar solitary ringing cough that 

 uniformly is present. The voice is also in- 

 jured, being occasionally nearly if not altoge- 

 ther lost, and there is difficulty of breathing 

 accompanied by a harsh stridulous sound ; this 

 latter being caused by the mechanical obstruc- 

 tion to the passage of air produced either by 

 tumefaction or by spasm. Having continued a 

 given time, and the first stage of inflammation 

 of the larynx if very acute is usually but short, 

 certain results or effects are developed, which, 

 differing in the child and the adult, require a 

 brief separate notice for each. 



The acute laryngitis of the child, or croup, 

 although generally commencing in the larynx 

 alone, and sometimes altogether confined to it, 

 is by no means uniformly so : on the contrary, 

 it not only may commence in or extend to the 

 trachea, but possibly have its origin in the 

 bronchial cells, and pass thence upwards along 

 the tubes. It may also perhaps not be strictly 

 correct to arrange croup amongst the diseases 

 that are preceded or accompanied by inflam- 

 matory fever, for occasionally it makes its at- 

 tack without any previous warning whatever, 

 and a child that had retired in apparently per- 

 fect health may arouse and alarm its attendants 

 in the middle of the night with the sounds of 

 that dry, harsh, and incessant cough, and that 

 loud and stridulous respiration which afford to 

 the practised ear the painful but unerring evi- 

 dence of the nature of the mischief present. 

 In either case, however, the disease hastens to 

 its second pathological state, in which the evi- 

 dences of increased vascularity begin to disap- 

 pear, and are succeeded by the secretion or 

 effusion of a viscid tenacious lymph, which, 

 assuming the form of a membrane, has ob- 



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