HYPEILEMIA AND CATARRH. 7 



the mucous irritation as a reflex symptom, such as we shall describe by- 

 and-by as laryngismus stridulus. But there is another and more probable 

 explanation. These attacks take place almost solely during sleep, pass 

 off after the child has cried, coughed, and vomited awhile, to recur almost 

 as soon as he falls asleep again. Hence it is likely that the dyspnoea is 

 occasioned by a collection of tenacious secretion in the glottis,, and per- 

 haps also by a dryness of the rima glottidis, which tends, as it were, to 

 glue it up. At all events, this explanation likewise accounts for the 

 action of the remedies alluded to above, and so justly prized. Attacks 

 like these are often repeated for several successive nights, while during 

 the day the children play about gayly, and, with exception of a slight 

 cough, seem perfectly well. 



As regards the course, duration, and termination of laryngeal catarrh, 

 the sputa cocta generally appear after a few days, when the sensitiveness 

 of the larynx, the hoarseness, and the cough abate, the disease termi 

 nating by recovery at the end of about a week. In other cases the 

 complaint lasts for several weeks. During the day the patient is some- 

 what hoarse, but otherwise is well, save that in the mornings and evenings 

 he is troubled by violent and protracted fits of coughing. The sputa 

 remain crude, until at last, often upon some change of weather, the 

 disease subsides. In other cases again, after repeated relapses, chronic 

 laryngitis is the result. A fatal termination, uncomplicated by any other 

 cause of death, is one of the greatest of rarities. 



Chronic Catarrh of tJie Larynx. As, even in acute catarrh, the 

 sensitiveness of the mucous membrane abates with the appearance of 

 the sputa cocta, so in the chronic form we hardly ever find titillation, 

 burning, or soreness in the larynx. Hypertrophy of the mucous mem- 

 brane, however, and continued thickening of the vocal chords, as described 

 in the last section, produce a permanent deepening of tone in the voice, 

 and render it harsh and hoarse. 



In the cases alluded to above, in which the mucous membrane of the 

 posterior wall of the larynx close below the vocal chords is thickened 

 and swollen, hoarseness proceeds from the intrusion of a fold of mem- 

 brane between the posterior adjacent surfaces of the chords, whenever 

 the voice is raised, so that the glottis cannot contract properly. This 

 chronic hoarseness, the result of repeated acute attacks, is the chief and 

 often the sole symptom of chronic laryngitis. A cracked voice usually 

 accompanies long-standing chronic hoarseness. From time to time, a 

 slight aggravation or some acute irritation of the mucous membrane so 

 thickens the vocal chords, as to render the voice quite inaudible. 



In many instances, besides the aphonia, there is also a periodical 

 spasmodic cough, such as we have described as symptomatic of acute 

 laryngeal catarrh, although the attack seems to proceed rather from an 



