an exact and adequate description of the pa- 
logy of this organ, may probably find it ne- 
sary to bespeak a very considerable degree 
indulgence. 
Accustomed to consider laryngeal disease 
actically, and more particularly with refe- 
nce to operation, I find it difficult to bind 
_ myself down to mere pathological arrangement, 
or to attempt a satisfactory classification. True, 
ke other organs, the larynx is composed of 
dit t structures, in each of which disease 
fill assume the character peculiar to itself, and 
xhibit the appropriate appearances in an exa-. 
ination after Neath, but it rarely happens that 
rbid actions are so limited in extent, as to 
tist and produce their proper results in one 
Ssue without the participation more or less of 
the others. This will produce confusion, and 
fender it a matter of difficulty to connect symp- 
ns with the existing pathological conditions 
hat Occasion them, and may be adduced as an 
jection to any attempt at arrangement 
junded upon structure alone: yet there really 
an be no classification altogether exempt from 
1 Same or a similar observation, and there- 
_ fore I shall adopt this one as having the merit 
“of the greatest simplicity. Following this 
iew then, I find the larynx to be composed of 
he following structures, viz. :— 
_ 1. Mucous membrane, exhibiting all the va- 
eties of inflammation that are observed in that 
ue when situated in other organs. Thus 
lammation here may be acute or chronic, 
egmonous or erysipelatous, idiopathic or 
mptomatic, and attended by fever of a ty- 
phoid or an inflammatory type. And these 
varieties eompanid different effects or results. 
nus we have examples of acute idiopathic in- 
ammation with fever of a sthenic kind in the 
troup of children, producing the adventitious 
membrane, and in the laryngitis of adults, that 
terminates so frequently in edema; and of the 
same local disease with asthenic fever in the 
diphtherite and in erysipelas: whilst accident 
furnishes numerous instances of the results of 
ymptomatic inflammation in the consequences 
of burns, scalds, penetrating wounds, and the 
allowing of caustic poisons. As happens 
© constantly in other structures, chronic in- 
mmation is here best known by the changes 
, induces, and furnishes us with abundant 
yecimens of hypertrophy or thickening of the 
membrane, and of the different forms of ul- 
meer fon. 
2. Submucous tissue, which is the seat of 
edematous effusions, and of the sloughy and pu- 
trid matter produced by diffuse inflammation. 
3. Cartilage, in which we remark great and 
ant varieties of disease, such as inflam- 
mation, ulceration, mortification, degeneration 
into an earthy unorganized material, atrophy, 
pertrophy, and some alterations of shape 
aid structure probably depending on scrofula 
or other constitutional taint. 
__ 4. Muscle, the seat of those spasmodic ac- 
| tions so frequent and so perilous in laryngeal 
© one and perhaps occasionally of gout 
x 
SS 
se cee 
ape DOT 
Sook taeda 
3 
|< 
=. 
" im DO 
nd rheumatism also. 
ni} 
iif 
| 
a 
ABNORMAL ANATOMY OF THE LARYNX. 
113 
5. Ligaments. I know not whether disease 
ever originates in these structures, but there can 
be no doubt that they are sometimes removed 
by ulceration, and there is reason to believe 
that great inconvenience and even danger may 
be occasioned by a preternatural relaxation of 
some of them. 
1. Acute inflammation of the mucous mem- 
brane is always in the first instance attended 
by a change of colour more or less intense ac- 
cording to its situation, being comparatively 
pale where it is closely attached to a subjacent 
cartilage, but of a deep and concentrated red 
tint, verging on purple, where it is more loosely 
connected by the intervention of cellular tissue 
er muscle. The membrane is also swollen, 
soft and pulpy, these characters being likewise 
influenced by the“nature of its connection to 
subjacent parts, and I believe the usual 
symptom of inflammation, “ pain,” is not ab- 
sent, although the mental agony attendant on 
obstructed respiration renders this a secondary 
consideration to the patient: certainly in the 
laryngitis of the adult, pressure on the pomum 
Adami is verv sensibly felt. In connexion with 
these changes the functions of the organ are 
interrupted and impaired. The usual secretion 
of the membrane is diminished in quantity, or 
perhaps ceases altogether, and hence the sen- 
sation of dryness or huskiness in the throat, 
_and the peculiar solitary ringing cough that 
uniformly is present. The voice is also in- 
jured, being occasionally nearly if not altoge- 
ther lost, and there is difficulty of breathing 
accompanied by a harsh stridulous sound ; this 
latter being caused by the mechanical obstruc- 
tion to the passage of air produced either by 
tumefaction or by spasm. Having continued a 
given time,—and the first stage of inflammation 
of the larynx if very acute is usually but short,— 
certain results or effects are developed, which, 
differing in the child and the adult, require a 
brief separate notice for each. 
The acute laryngitis of the child, or croup, 
although generally commencing in the larynx 
alone, and sometimes altogether confined to it, 
is by no means uniformly so: on the contrary, 
it not only may commence in or extend to the 
trachea, but possibly have its origin in the 
bronchial cells, and pass thence upwards along 
the tubes. It may also perhaps not be strictly 
correct to arrange croup amongst the diseases 
that are preceded or accompanied by inflam- 
matory fever, for occasionally it makes its at- 
tack without any previous warning whatever, 
and a child that had retired in apparently per- 
fect health may arouse and alarm its attendants 
in the middle of the night with the sounds of 
that dry, harsh, and incessant cough, and that 
loud and stridulous respiration which afford to 
the practised ear the painful but unerring evi- 
dence of the nature of the mischief present. 
In either case, however, the disease hastens to 
its second pathological state, in which the evi- 
dences of increased vascularity begin to disap- 
pear, and are succeeded by the secretion or 
effusion of a viscid tenacious lymph, which, 
assuming the form of a membrane, has ob- 
1-2 
