50 AFFECTIONS OF THE LARYNX. 



ANATOMICAL APPEARANCES. The point of preference of this dis- 

 order is the perichondrium of the cricoid cartilage ; but from this point 

 it spreads rapidly to the coverings of the other cartilages. At first 

 there is only a small abscess between the latter and its sheath. Very 

 soon, however, the cartilages are floating in a sack of pus, formed by 

 the perichondrium. They become rough, degenerate, discolored, after- 

 ward thinned and softened, and then, not unfrequentiy, fall to pieces, 

 fragment by fragment. At last, the pus bursts through the perichon- 

 drium, and runs into the submucous tissue of the larynx. At times, 

 too, the mucous membrane is perforated ; pus and fragments of carti- 

 lage fall into the larynx and are coughed up ; or else the pus forces its 

 way to the external surface. Abscesses and sinuses of the neck are 

 thus formed, and the pus and fragments of cartilage are discharged ex- 

 ternally or into the pharynx. In rare instances recovery has taken 

 place, the lost cartilage being replaced by dense fibrous tissue. 



SYMPTOMS AND COURSE. As a rule, the symptoms of a disease are 

 not rendered easier of comprehension by any arbitrary and artificial 

 classification according to stages, but rather the reverse. When, how- 

 ever, as in perichondritis laryngea, very distinct phases form natural 

 divisions in its course, the study by stages is both commendable and 

 practical, 



In its first stage the symptoms are obscure, but, as in ah 1 inflamma- 

 tion of dense unyielding structures, the disease is attended by greater 

 pain than occurs in other affections of the larynx ; and, as the inflamma- 

 tion generally begins at an insignificant point, the painful region is also 

 quite limited in extent. One might readily be led to suppose that a for- 

 eign body were lodged in the larynx ; the more so, as the pain is com- 

 bined with an irrepressible cough. 



In the second stage, hoarseness, aphonia, harsh cough, and character- 

 istic symptoms of intense dyspnoea and laryngeal stricture set in, arising 

 either gradually, as the perichondrium becomes more and more dis- 

 tended by the increasing volume of pus, and is pushed further into the 

 cavity of the larynx, or suddenly, by its perforation and by effusion of 

 the matter below it, into the submucous tissue. Many patients perish in 

 this stage. 



In some cases a third stage is added. The pus which has accumu- 

 lated under the perichondrium, or the submucous tissue, bursts through 

 its confines. The symptoms of laryngeal stricture disappear. I have 

 seen a young girl in the most frightful danger of suffocation relieved 

 on the instant, and rendered completely convalescent, after expectora- 

 ting quantities of pus, and with it the entire left arytenoid cartilage, in 

 a state of maceration. 



But, even in such cases, after a time, the patients usually perish in a 



