HYPERJ3MIA AND CATARRH. 3 



which accompanies it, this epidemic bears great resemblance to the acute 

 exanthemata. In influenza, catarrh must be regarded as a constitutional 

 tf not an infectious disorder. 



Sixthly and finally, morbid growths and ulcers, particularly tubercu- 

 lous ulcers of the larynx, are accompanied by a catarrh. These symp- 

 tomatic cases, which, like the hyperaemia about ulcers and carcinomata 

 of the skin, are subject to exacerbations and remissions, form important 

 exponents of certain conditions, and in particular account for the fluctu- 

 ations in the symptoms of ulceration and malignant growths of the 

 larynx. 



ANATOMICAL APPEARANCES. In acute catarrh of the larynx, the 

 mucous membrane of the cadaver does not always reveal a degree of 

 redness and vascular engorgement such as the violence of the symptoms 

 during life would lead us to expect, and such as could then be demon- 

 strated by laryngoscopic observation. 1 This is due to tha richness of the 

 laryngeal mucous membrane in elastic fibres, which, remaining extended 

 by the blood contained in the vessels during life, after death contract, 

 and expel the contents of the capillaries. However, in very violent 

 catarrhs, apoplexies occur (ecchymoses) in the substance of the mucous 

 membranes, which after death present either a mottled or a uniformly 

 reddened aspect. 



On the surface of the mucous membrane the cylindrical-form ciliated 

 epithelial cells, which constitute the most superficial layer of the stratified 

 epithelium of the larynx, are wanting in places ; but under the microscope 

 we find in the slightly-turbid serum which adheres to the mucous mem- 

 brane numerous transparent cells, which are mostly uninuclear, and 

 are detached young epithelial cells of the deeper layers or of the 

 mucous follicles, and are called mucous corpuscles. The substance of 

 the mucous membrane itself is swollen, moister, and flabby. The sub- 

 mucous tissue may exceptionally be the seat of considerable serous infil- 

 tration, a condition to be treated of by-and-by as oedema glottidis. 



In chronic laryngeal catarrh the mucous membrane appears more or 

 less dark, dirty bluish-red, or brownish (from deposit of pigment in conse- 

 quence of previous ecchymosis). The vessels are sometimes varicose and 

 gorged with blood, the flabby mucous membrane having lost its elas- 

 ticity. Its tissue is generally thickened, firmer, and hypertrophied. The 

 surface appears, in many places, uneven and granulated, from the tume- 

 faction and distension of innumerable mucous follicles which exist in the 

 larynx. Sometimes it is covered by a scanty glairy mucus ; sometimes 

 with profuse yellow secretion. The young epithelial cells, upon the 

 copious admixture of which the opacity and yellow color of this " muco- 

 purulent " secretion depend, are indistinctly granulated, and their nuclei 

 are oft-en divided. They are quite analogous to the young cells foun 



