6 AFFECTIONS OF THE LARYNX. 



Let us recall to mind the oedema about the aye during inflamed 

 wounds of that neighborhood, the post-horn-like swelling of the penis 

 when oedema besets a chancre of the fraenulum. This oedema, called by 

 Virchow collateral oedema, is the result of increased lateral pressure, 

 occurring in the capillaries in the region about a focus of inflammation, 

 through the capillary stasis at the inflamed point. The more yielding 

 the tissue is, so much the more does the serum transude. 



The mucous membrane of the larynx, at most points, is attached to 

 its cartilages and muscles by a close connective tissue. Upon the epi- 

 glottis alone, especially at its root, above all, over the bands which stretch 

 from the epiglottis to the arytenoid cartilages (therefore above the ary- 

 epiglottic ligament), and in lesser degree from these downward, to the 

 superior vocal chords, there is a loose submucous tissue particularly 

 prone to cedematous swelling. 



The exciting causes which usually produce the sudden serous transu- 

 dation into the submucous tissue, known as oedema glottidis, are some- 

 times acute morbid processes in the larynx, rarely acute catarrh, more 

 frequently the pustulous laryngitis of small-pox, and sometimes chronic 

 diseases, as syphilitic and tuberculous ulceration. Laryngeal perichon- 

 dritis often gives rise to sudden oedema glottidis, just as an oedema of 

 the prepuce suddenly associates itself to a long-standing chancre. 8 



Finally, in rare cases, a violent angina, an extensive inflammation 

 of the submucous tissue of the throat, or even facial erysipelas, may 

 occasion danger to life, from the supervention of this affection. In all 

 these instances we have to do with collateral oedema, and but very few 

 cases can be added to these, in which oedema glottidis is a partial mani- 

 festation of a general dropsy and accompanying Bright's disease, etc. 

 The above-named diseases (with the exception of variola) are more com- 

 mon in adults than in children, and thus it happens that oedema glottidi? 

 is observed almost exclusively among grown persons. 



ANATOMICAL APPEARANCES. The serous infiltration which takes 

 place at the points above described is often so great, that the swollen 

 epiglottis projects above the roots of the tongue ; and out from its base 

 two great loose pendulous rolls reach backward to the arytenoid carti- 

 lages and to the pharynx. They may attain almost the size of a pigeon's 

 egg, and lie so close together, that the entrance of air to the glottis be- 

 comes extremely difficult, or even impossible. In rare instances, and, as 

 it would seem, only when one half merely of the larynx is diseased, a 

 single puffy swelling is to be found, which projects inward, and more or 

 less contracts the entrance to the glottis. These swellings are some- 

 times pale in color, sometimes more or less reddened. If cut into, there 

 flows from the distended meshes of the connective tissue, at times, a 

 clear, serous liquid ; at others a turbid, yellowish matter ; the swellings 



