2 AFFECTIONS OF THE LARYNX. 



The fact, also, is inexplicable, that an agent which, in one subject, 

 will almost always cause catarrh of the larynx, in another will, as inva- 

 riably, give rise to coryza, catarrhal diarrhoea, or to a bronchial catarrh. 

 Of one thing alone we may be sure that, after repeated attacks, the 

 laryngeal mucous membrane remains more vulnerable, becomes a weak 

 place, as it were, and that trifling causes serve to excite fresh disease of 

 the organ. 



The exciting causes are first, local irritants which act upon the 

 larynx. Among these are the breathing of very cold air ; the inhalation 

 of dust and acrid vapors ; loud screaming too, and shouting, singing, and 

 violent coughing. In the latter procedure the air is driven forcibly 

 through the narrow .chink of the glottis, causing severe friction upon its 

 free edges, an injury quite as great as that occasioned by other agencies. 

 If acrid liquids or hot water penetrate into the organ, the most intense 

 form of laryngeal catarrh ensues. 



Secondly, chilling of the skin, particularly that of the neck and feet, 

 will give rise to this disease. We are constantly seeing some one who, 

 having left off his neckcloth or woollen stockings, suffers next day from 

 laryngeal catarrh. Difficult as it may be to give a physiological expla- 

 nation of the occurrence, a genetic connection between the two events 

 is not to be denied. 



Thirdly, catarrh not unfrequently spreads from neighboring organs 

 to the laryngeal mucous membranes. We often see it extend thus from 

 the nose or bronchi without the supervention of any new irritant. The 

 pharynx is sometimes the point of origin. This is especially the case in 

 that form of the malady induced by the abuse of spirituous liquors, which 

 have a direct action upon the pharyngeal mucous membrane. Indeed, 

 we may often notice a hoarse, stridulous voice, or other sign of acute la- 

 ryngeal catarrh, coming on in consequence of a debauch, although the 

 person affected may not have shouted or sung much. Habitual topers 

 almost always have catarrh of the pharynx, in which the laryngeal mu- 

 cous membrane takes part 



Fourthly, laryngeal catarrh is a common symptom of constitutional 

 disease resulting from infection or contagion. Among the acute affec- 

 tions, measles and exanthematic typhus ; among the chronic, syphilitic 

 disorders are the maladies especially prone thus to localize themselves 

 upon the larynx. We still lack a thorough insight into the physiologi- 

 cal connection between the blood-changes at the root of the disorders 

 and the nutritive derangements visible upon the skin and mucous mem 

 branes in these complaints. 



Fifthly, those cases in which the disease forms a portion of a very 

 extensive and severe catarrhal affection, the " grippe," or influenza. In 

 its onset, in its extent, and in the severe constitutional disturbance 



