HYPEILEMIA AND CATARRH. 5 



becomes relaxed, and is covered by a secretion in more or less pro- 

 fusion. If the vocal chords also become involved in this conditioo, 

 the tension to which the laryngeal muscles can bring them is inadequate 

 so to increase the frequence of their vibrations as to produce a tone of a 

 pitch such as would result at the same tension in normal chords. Thus 

 the voice is rendered deeper. From the irregular swelling, and from 

 the presence of the mucus which covers the chords and makes their 

 surface uneven, the voice is hoarse and its tones are false (just as the 

 note of a violin-string is altered when smeared with grease). At last 

 the swelling and relaxation of the chords may so increase that the utmost 

 tension to which the muscles can bring them is insufficient to allow of 

 sonorous vibration. The voice then is noiseless or extinct. Extinction 

 of the voice may also depend upon swelling of the false vocal chords, as 

 the latter, when thus brought into contact with the true chords, render 

 their free vibration impossible. Frequently the hoarse voice of the 

 patient suddenly breaks into discord, or " cracks." This occurs when 

 the tumid chords, bathed in mucus, momentarily touch one another, so 

 as to produce vibratile nodes, a great increase in the frequence of vibra- 

 tion, and consequent elevation of pitch in the tone. 



Besides the titillation, burning, and hoarseness, there is also violent 

 cough. In the healthy larynx we see coughing-spells provoked as reflex 

 phenomena upon exposure of the organ to any undue irritation the 

 intrusion of a foreign body, for instance. When the laryngeal mucous 

 membrane has become the seat of catarrh, we find that analogous fits of 

 coughing are excited by the most trifling and unobservable causes, and, 

 to all appearance, spontaneously. Sometimes, in these paroxysms, so 

 severe a spasm besets the muscles of the glottis that, in the inspiratory 

 movement by which the fit commences, the air can pass but slowly 

 through the contracted rima glottidis, and with a wheezing sound, while 

 the expiratory effort consequent upon this long-drawn, sonorous inspira- 

 tion, is only capable of effecting momentary openings of the constricted 

 passage, thus producing the interrupted, rattling, short " hacks " of a 

 oough. The effect of vigorous expiration through a narrow glottis, such 

 as we make in blowing upon wind instruments or in straining, is to com- 

 press the thorax, and thus to check the influx to it of blood from the 

 veins, so that the jugulars distend and the face grows red, or even bluish. 

 In other cases of long standing the tone of the cough likewise deepens, 

 and grows harsh and hoarse from thickening and unevenness of the 

 chords. Quite frequently, from some powerful expiratory effort, the 

 thickened chords are made to bulge upward and are thrown into strong 

 tension. The hoarse cough then changes into a " bark," or, upon mo- 

 mentary contact of the chords, the sound of the cough is cracked. 



When catarrh is confined to the larynx, the expectoration is scanty 



