INFLAMMATION OF THE TRACHEA. 263 



dually proceed up the neck with his ear still upon the windpipe. Perhaps he soon 

 begins to recognise a little gurgling, grating sound. As he continues to ascend, 

 that sound is more decisive, mingled with an occasional wheezing, whistling 

 noise. He can have no surer proof that here is the impediment to the passage 

 of the air, proceeding from the thickening of the membrane and diminution of 

 the passage, or increased secretion of mucus, which bubbles and rattles as the 

 breath passes. By the degree of the rattling or whistling, the owner will 

 judge which cause of obstruction preponderates in fact, he will have discovered 

 the seat and the state of the disease, and the sooner he has recourse to profes- 

 sional advice the better. 



Chronic laryngitis is of more frequent occurrence than acute. Many of the 

 coughs that are most troublesome are to be traced to this source. 



In violent cases laryngitis terminates in suffocation ; in others, hi thick wind 

 or in roaring. Occasionally it is necessary to have recourse to the operation of 

 tracheotomy. 



In acute laryngitis the treatment to be pursued is sufficiently plain. Blood 

 must be abstracted, and that from the jugular vein, for there will then be the 

 combined advantage of general and local bleeding. The blood must be some- 

 what copiously withdrawn, depending on the degree of inflammation the 

 practitioner never for a moment forgetting that he has to do with inflammation 

 of a mucous membrane, and that what he does he must do quickly He will 

 have lost the opportunity of struggling successfully with the disease when it has 

 altered its character and debility has succeeded. The cases must be few and far 

 between when the surgeon makes up his mind to any determinate quantity of 

 blood, and leaves his assistant or his groom to abstract it ; he must himself 

 bleed, and until the pulse flutters or the constitution is evidently affected. 



Next must be given the fever medicine already recommended : the digitalis, 

 nitre, and emetic tartar, with aloes. Aloes may here be safely given, because 

 the chest is not yet implicated. To this must be added, and immediately, a 

 blister, and a sharp one. The surgeon is sure of the part, and he can bring his 

 counter-irritant almost into contact with it. 



Inflammation of the lavynx, if not speedily subdued, produces sad disorganiza- 

 tion in this curiously formed and important machine. Lymph is effused, mor- 

 bidly adhesive, and speedily organised the membrane becomes thickened, con- 

 siderably, permanently so the submucous cellular tissue becomes oedematous ; 

 the inflammation spreads from the membrane of the larynx to the cartilages, and 

 difficulty of breathing, and at length confirmed roaring, ensue. 



INFLAMMATION OF THE TRACHEA. 



Inflammation of the membrane of the larynx, and especially when it has run 

 on to ulceration, may rapidly spread, and involve the greater part or the whole 

 of the lining membrane of the trachea. Auscultation will discover when this is 

 taking place. If the disease is extending down the trachea, it must be followed. 

 A blister must reach as low as the rattling sound can be detected, and some- 

 what beyond this. The fever medicines must be administered in somewhat 

 increased doses ; and the bleeding must be repeated, if the state of the pulse 

 does not indicate the contrary. 



Generally speaking, however, although the inflammation is now approaching 

 the chest, its extension into the trachea is not an unfavourable symptom. It 

 is spread over a more extended surface, and is not so intense or untractable. 

 It is involving a part of the frame less complicated, and where less mischief 

 can be effected. True, if the case is neglected, it must terminate fatally ; but 

 it is coming more within reach, and more under command, and, the proper 

 means being adopted, the change is rather a favourable one. 



