92 STRANGLES. 



with the imphcation of the connective and other structures 

 around the upper portion of the air-tube, all tend to render 

 respiration difficult of performance, giving rise to a loud and 

 distressing sound, emitted during inspiration or expiration, 

 according as the cartilages of the larynx have approached each 

 other and so narrowed the tube, or as the tumefaction is more 

 extensive in connection with the interior lining of the organ ; 

 generally, the sound is produced during both parts of the 

 respiratory act, and may be trifling in its nature, passing off 

 under a little judicious management, or the inflammatory con- 

 dition'may be so severe and so persistent as to endanger life 

 by suffocation. In such cases, also, there is a danger of the 

 formation of an abscess, not superficially in the submaxillary 

 space, but deep-seated in connection with the gland-structures 

 contiguous to the pharynx and larynx, which may, even when 

 progressing satisfactorily enough, endanger life, either by pres- 

 sure upon the great air-tube, or by discharge of its contents 

 into it. 



In this regular form of strangles the abscess is generally 

 single and well defined, and when matured and its contents 

 discharged it does not return ; occasionally there may be an 

 eruption of one or more smaller pustules, or an appearance of 

 a second and smaller growth on the subsidence of the pri- 

 mary one. 



2. Malignant or Irregular Strangles. — Rarely is the irre- 

 gular or complicated form associated Avith, or connected as a 

 sequel to, the ordinary and regular ; it generally appears and 

 is developed 'per se ; it is irregular and complicated from the 

 first. 



By the term ' irregular ' is meant that departure from the 

 ordinary and recognised features of the disease both as to 

 pyrexial symptoms and local manifestations. The most fre- 

 quent forms of irregularity and complication are those where 

 the fever is still of the ordinary type, it may be more severe, 

 but where the local inflammatory action and pus-production 

 are removed from the submaxiliary space, and attached to 

 other gland-structures or their connective tissue, most 

 frequently the intimate or contiguous structures of the 

 parotid gland, the lymph-glands at the inferior part of the 

 neck, under the levator humeri muscle, and less frequently 



