(EDEMA GLOTTIDIK. 47 



collapse, and now the mucous membrane appears to be wrinkled and 

 thrown into folds. A similar evacuation and collapse of the swelling, 

 with folding of the mucous membrane, sometimes occur post mortem, 

 when there has been no scarification, and the post-mortem appearances 

 correspond but in small degree with the anatomical changes which, a 

 few hours before death, we have had under our finger. In the upper 

 section of the larynx, in which, as we saw, the submucous tissue is 

 lighter and closer knit, the swelling is less visible. We find the mu- 

 cous membrane itself covered with flakes, or plastic layers, the laryngeal 

 muscles pale, discolored, and sodden. 



SYMPTOMS AND COUESE. (Edema glottidis commences with the 

 usual symptoms of an acute or chronic laryngeal ulcer. There is a 

 rapidly-increasing hoarseness, which soon passes over into aphonia, and 

 a harsh, barking cough (symptoms which prove that the vocal chords, 

 too, are swelled, or that the infiltrated laryngeal muscles are not in con- 

 dition to render the chords tense). But, simultaneously with these 

 symptoms, there arises the most frightful dyspnoea. As soon as the air 

 in the trachea becomes rarefied, the swellings described above settle 

 themselves over the upper aperture of the larynx, and the laborious, 

 long-drawn, whistling respiration can bring but little air into the lungs. 

 This inspiration, audible at a distance, and only practicable with body 

 bent forward, arms planted, and by cooperation of all the auxiliary 

 muscles of respiration, is followed by an expiratory movement, which is 

 almost free, although sometimes noisy ; for the exit of the air drives 

 asunder the obstructing swellings just as the inspiration sucks them to- 

 gether. Pitha describes the inspiration as "protracted, forced, sharp, 

 resonant, whizzing, and hissing ; the expiration as short, easy, inaudible, 

 scarcely perceptible." 



The symptoms of oedema glottidis, then, are very similar to those 

 which we have described as belonging to croup, a similarity which, after 

 a physiological explanation of the symptoms, is seen to be a natural con- 

 sequence. Nevertheless, we shall seldom mistake the two diseases, 

 when we bear in mind that croup occurs almost exclusively during 

 childhood oedema glottidis almost as exclusively among adults ; that 

 croup almost always attacks individuals previously in good health, 

 oedema glottidis scarcely any, save such as have already suffered from 

 acute or chronic disease of the larynx. Moreover, the distinction be- 

 tween the two diseases is facilitated by the great disproportion between 

 inspiration and expiration in oedema glottidis, which, in croup, is neither 

 30 pronounced nor of so long duration. Finally we may, in many 

 cases, succeed in seeing the swollen epiglottis as a reddened, pear- 

 shaped tumor behind the root of the tongue, and in almost every 

 instance, if we introduce the finger with sufficient boldness, we may 

 manage to feel the two swellings. 



