4.g APFECTIONS OF THE LAHYNX. 



The ctyspncea, wliich, in severe cases, increases from minute to min- 

 ute, is usually associated with a feeling of a foreign body or other im 

 pediment in the throat. " Here it lodges," " here in the throat " 

 " tighter and tighter." " It is strangling me." " I can't stand it ! " 

 " I'm choking ! " these are the words which, according to the classical 

 picture of Pitha, the frightfully-terrified sufferers gasp out with tremu- 

 lous haste and gestura Fear and desperation are depicted in their entire 

 being ; they dash themselves about, they spring up, groan and sob 

 until gradually the countenance grows livid and lead-colored, the ex- 

 tremities cool, the pulse small and irregular, the sensorium benumbed. 

 Then the patient falls into a stupor, rattlings in the chest begin to be 

 heard, and death sets in with the symptoms of oedema of the lungs. 

 These final manifestations, also, are the same which we studied in croup, 

 and depend not upon impeded evacuation of the cerebral veins, but 

 upon poisoning of the blood with carbonic acid (see above). 



TREATMENT. Blood-letting, leeches in large numbers to the throat, 

 blisters to the nape of the neck, emetics, drastic cathartics, hot foot- 

 baths, are the customary prescriptions which are usually applied, pele- 

 mele, as soon as tliis frightful malady has declared itself. We cannot 

 allay oedema of the prepuce by such measures, and they generally are 

 applied in vain in oedema glottidis. Only when the danger is not 

 urgent may we diminish the mass of blood by efficient blood-letting, 

 and by giving half a drop of croton-oil hourly, in order to decrease the 

 volume of the blood in the vessels, through copious transudation of serum 

 into the intestine. Experience teaches that, after great haemorrhage, and 

 after inspissation of the blood, through profuse loss of its water, the ves- 

 sels greedily take up liquid from the organs, and that, during cholera, 

 even large pathological effusions have thus been absorbed. There is, 

 therefore, some theoretical support for such treatment, although little suc- 

 cess can be ascribed to it in practice. As but little air passes the larynx, 

 in spite of the most forcible inspiratory efforts, that which the bronchi 

 already contains becomes rarified, and, just as in the skin upon wliich a 

 cupping-glass has been applied, so upon the mucous membrane intense 

 hypersemia arises, usually accompanied by increased secretion. The 

 dyspnoea is greatly augmented by this collection of bronchial secretion, 

 BO that loud moist rdles become audible. In cases like this, but only in 

 such cases, an emetic is indicated, and is often productive of the best re- 

 sults. It is sometimes necessary to repeat it. 



Local treatment is of far more value. The effect of slowly swallow- 

 ing small bits of ice is sometimes of remarkable benefit. Under this treatr 

 ment I once witnessed the recovery of one of my colleagues, in whom 

 suffocation seemed so imminent that we hardly dared to defer tracheot- 

 omy. The insufflation of pulverized nitrate of silver, or its application in 



