g AFFECTIONS OF THE LARYNX. 



accumulation of secretion in the pouches of Morgani, and passes oU 

 after the expectoration of a small quantity of peculiar lumpy yellowish 

 mucus. Here too, for reasons already given, the cough may be harsh, 

 hoarse, and grating, swelling into a bark. 



The addition of a whistling, stridulous inspiration and expiration, as 

 it certainly does not proceed from mere swelling and hypertrophy of the 

 mucous membrane, denotes the presence of a complication either 

 thickening and induration of the submucous tissue above described, or 

 a morbid growth encroaching upon the cavity of the larynx, or else 

 syphilitic laryngitis. 



It is only by means of the laryngoscope that we can determine 

 positively with which of these three main forms of laryngo-stenosis we 

 have to deal On the other hand, the association of fever, emaciation, 

 and night-sweats, with chronic laryngeal catarrh (catarrhal laryngeol 

 phthisis being rare), should awaken our suspicion of latent disease of 

 the lungs, and induce repeated physical exploration of the chest. 



The course of chronic laryngitis is usually tedious. It is only by 

 most cautious and judicious treatment that a cure can be effected, and 

 there is nearly always a strong tendency to relapse. 2 



DIAGNOSIS. Catarrh of the nose and that of the pharynx, which 

 also produce alteration in the voice, are easily distinguishable from ca- 

 tarrh of the larynx. In the former, the resonance of the contracted nasal 

 and oral cavities, the " timbre " of the voice, is changed the speech is 

 nasal or guttural ; in the latter, the tone itself is modified, the voice is 

 deeper, cracked, and hoarse. 



Confusion with croup is more apt to occur. To anxious mothers, 

 mere hoarseness and a barking cough furnish evidence enough of the 

 presence of that dread disease, even although the child may be well 

 enough otherwise. The addition of a nocturnal paroxysm of dyspnoea 

 will often mislead the physician himself* Thus it is that we so often 

 hear of children who have suffered eight, ten, or even more, attacks of 

 croupous laryngitis. Croup is neither so frequent nor so innocent a 

 disease as to admit of the likelihood of such frequent recoveries. In 

 most of such cases there has been error of diagnosis. The points of 

 distinction between the two diseases will be more fully given while 

 treating of croupous laryngitis. For the present we call attention to 

 one point only, upon which the laity lay greater stress than the profes- 

 sion. Nasal catarrh is almost as surely symptomatic of the catarrhal 

 form of laryngitis as is croupous pharyngitis of true laryngeal croup. 

 The satisfaction of mothers at the " running nose " of their child is well 

 founded the rarity with which simple catarrh is complicated with 

 graver disease having given rise to the old custom of salutation aftei 

 sneezing. 



