g AFFECTIONS OF THE LARYNX. 



At first it is either absolutely wanting, or else it is clear or glairy. This 

 mucous sputum, " sputum crudum " of the ancients, does not often con- 

 tain detached ciliary epithelium. There is much more commonly a 

 moderate admixture of young cells from the deeper layers of the epi- 

 thelial covering, or of mucous corpuscles from the follicles. As the 

 disease progresses and begins to abate, the expectoration becomes thicker 

 and more rich hi young cells, which rather resemble pus-cells. This 

 form of expectoration, the " muco-purulent," is the " sputum coctum *' 

 of the older physicians. 



As the submucous tissue is seldom much swelled or infiltrated, save 

 in rare cases, dyspnoea in simple acute laryngeal catarrh of adults is of 

 exceptional occurrence. In grown persons the glottis, especially the 

 posterior part of it, the pars respiratoria of Longet, is a tolerably roomy 

 triangular space, bounded by the base of the arytenoid cartilage, and 

 does not become impervious to air by reason of swelling of its mucous 

 membrane alone. Even among children it is rare for the dyspnoea of 

 simple laryngeal catarrh to be continuous. Although in the latter the 

 glottis is smaller, its entire space forming but a narrow chasm, yet the 

 swollen chords are generally separated from one another by the free 

 action of the posterior crico-arytenoid muscles, which act with every in- 

 spiration, so that there is no hinderance to the entrance of air. A glance 

 at the laryngoscope is enough to convince any one that the rima glottidis 

 gapes during inspiration so widely that a moderate swelling of the mucous 

 membrane cannot materially obstruct the passage of air or produce 

 symptoms of dyspnoea. In certain well-authenticated cases of intense 

 catarrhal laryngitis, however, there has been such serious swelling of the 

 true chords, or of the false ones, which cannot be drawn asunder by 

 muscular action, as to place the patient in danger of suffocation. 



Not at all rarely we see a child who has been coughing a little during 

 the day, and been hoarse without feeling ill, wake up suddenly in the 

 night with great oppression of breathing. The inspiration is troublesome 

 and protracted ; the terrified child throws himself about in bed, or springs 

 up, clutches anxiously at the throat ; the cough is hoarse and barking. 

 These attacks, which are often confounded with croup, or called pseudo- 

 croup, usually vanish completely after a few hours often much sooner. 

 It is to these that the warm milk, the hot sponge laid upon the throat, 

 the judiciously-administered emetic owe their reputation as panaceas 

 against croup, sure to cut it short if given in time. One might suppose 

 that these accidents arose from an unusually aggravated but transient 

 swelling of the mucous membrane, and from a narrowing of the glottis, 

 which could not be compensated for by muscular action, just as in coryza 

 we see sudden absolute closure of one or other of the nostrils ; or we 

 might think that a spasmodic closure of the glottis had allied itself to 



