58 AFFECTIONS OF THE LARYNX. 



tion as to impede the passage of air through the larynx (oedema 

 ylottidis). 



2. P. 8. 



The chief and often the sole symptom of chronic catarrh of the 

 larynx consists in a change in the voice, varying from slight hoarse- 

 ness, which only comes on after long-continued talking or singing, 

 to complete and permanent aphonia. The immediate cause of this 

 hoarseness is complex. It is jointly due to debility and fatigue of 

 the vocal muscles, to deranged vibration, to clogging of the chords 

 by viscid mucus, or to other mechanical impediment to their move- 

 ments. Pain and tickling, aggravated by coughing or talking, is 

 now and then complained of. There is nearly always a hoarse, 

 barking cough, which is sometimes of a paroxysmal character. The 

 expectoration has no special characteristics . There is a peculiar 

 form of chronic catarrh of the larynx which shows no further anom- 

 aly than a continual over-secretion of mucus, which keeps the pa- 

 tient constantly trying to clear his throat, a habit most disagreeable 

 to his neighbors. An injunction against such " hawking " is most 

 timely in these cases. Very severe chronic catarrhs are complicated 

 by signs of obstruction of the larynx, by panting, strident respira- 

 tion, and dyspnoea. 



3. P. 18. 



The deeper air-passages and the lungs themselves exhibit im- 

 portant alterations. Very commonly the croupous coagula are pro- 

 longed into the larger or even into the smaller bronchi, forming 

 solid plugs in the latter, and thus setting up fresh hindrance to 

 respiration after the obstruction at the larynx has been obviated by 

 tracheotomy. Other bronchial twigs are found in a state of hyper- 

 aemia and catarrh. The lungs are gorged with blood. This is a 

 result of the abnormally rarefied condition of the air within the 

 chest, in consequence of which an undue afflux of blood into the 

 branches of the vena cava takes place with each forced respiration. 

 This hyperaemia, however, is not uniform. According to BarteU, 

 it is nearly always in the lower and back parts of the lung, which, 

 though full of blood, are shrunken and void of air, and sometimes 

 studded with spots of lobular pneumonia. Now these are the portions 

 of the lung which do not expand upon inspiration during the ab- 

 normal respiratory movement of croup, but rather are condensed. 

 On the other hand, the upper parts of the lungs, which during res- 

 piration are compelled to move with the forcibly-distended front 

 wall of the chest, are pale and bloodless, and their air-vesicles are 

 dilated or even burst and emphysematous. 



