4 AFFECTIONS OF THE LARYNX. 



in abscesses. We now no longer call them mucous, but pus corpuscles, 

 although it is not easy in all cases, to distinguish between the two forms. 



The anatomical changes which the laryngeal mucous membrane 

 undergoes can be better ascertained by means of the laryngoscope dur- 

 ing life than by post-mortem dissection. We find that catarrh of the 

 larynx does not always involve the whole surface of the organ, but is 

 often confined to particular sections. Thus there may be catarrhs, lim- 

 ited to the region of the epiglottis, the arytaeno-epiglottidian fold, the 

 arytenoid cartilage, the true or the false vocal chords. There is one very 

 interesting form of circumscribed swelling of the membrane between the 

 arytenoid cartilages and a little beyond, which Lewin has repeatedly 

 ascertained to be a cause of the chronic hoarseness among officers who 

 have been much in the habit of shouting the word of command. 



Apart from the catarrhal sores, and the polypous growths of which 

 we are to treat in a separate chapter, chronic laryngeal catarrh, and 

 chiefly that form of it which accompanies syphilitic and tuberculous ul~ 

 Derations, sometimes leads to a thickening and induration of the sub-mu- 

 cous tissues. Its metamorphosis into a brawny fibrous mass, which often 

 greatly contracts the larynx, and renders the vocal chords stiff and im- 

 movable, takes place in a manner quite analogous to that in which indu- 

 ration of other organs arises, especially of the stomach. The process is a 

 mere hypertrophy of the connective tissue, and has nothing in common 

 with the so-called lardaceous or amyloid degeneration of other organs. 



SYMPTOMS AND COURSE. Acute catarrh of the larynx rarely begins 

 with shivering ; indeed, in most cases, when it does not spread into the 

 bronchi, catarrhal fever is also absent throughout the whole course of 

 the attack. The general condition is untroubled, and the symptoms of 

 disease alone refer to the functional derangements of the suffering organ. 



The patients first complain of a feeling of titillation, or, in more 

 severe cases, 'of a sensation of burning or soreness in the throat, which 

 is aggravated by speaking or coughing. Sensation in these parts ex- 

 tends as far down as the bronchi of the second magnitude. If, therefore, 

 the covering of the epiglottis, the arytenoid, or arytseno-epiglottic liga- 

 ment be the seat of catarrh of some intensity, deglutition becomes painful 

 In addition to these symptoms, alteration of the voice furnishes a charac- 

 teristic sign of disease of the larynx. The voice grows deeper, hoarse, 

 cracked, and may finally become inaudible. The vocal sounds, as we all 

 know, originate entirely in the larynx, which is formed like a reed-pipe, 

 with membranous reeds. In the act of speech, the lower vocal chords 

 approach one another so closely as to project into the organ as vibrating 

 membranes. If thrown into vibration by the current of a strong expira- 

 tion, a tone results whose elevation or depth of pitch depends upon the 

 degree of tension in which they are set. Now, we have stated above 

 that in catarrh of the larynx the mucous membrane swells UD and 



