~ 
ain are supported and restrained by resisting 
cartilages externally, so that if the submucous 
‘tissue which is here so loose as to allow the 
nembrane to be thrown into natural folds, 
‘should become the seat of infiltration, the 
swelling so pees cannot take a direction 
' outwards, but must tend to compress and 
’ close the aperture of the glottis. This is the 
__ @dema of the glottis, a formidable and too 
i often a fatal affection, but nevertheless present- 
. very considerable pathological varieties. 
us it is sometimes attended by fever, and 
ms only part of a more extended infamma- 
on, involving tonsils and fauces, pharynx and 
arynx: again, it is purely local, confined to 
e larynx alone, and so entirely free from any 
ecompanying fever, that the patient only com- 
s of the difficulty of breathing and the 
. It is often idiopathic, but may be 
roduced by injury, and is a common result of 
wallowing caustic poisons and boiling water ; 
or is it in this latter respect confined to the 
dult, for I have thus seen the superior aper- 
re of the glottis, in a very young child, 
marsed up and closed as if by the drawing of 
running string. It may be situated only in a 
of the larynx, the rest remaining free ; thus 
t is no uncommon occurrence to see only one 
ide of the glottis puffed and swollen, and the 
slit-like aperture thus converted into a curve; 
but the most interesting because the most prac- 
tical illustrations of partial edema will be 
found in cases published by Sir Henry Marsh, 
‘im which the disease appeared to be confined 
‘to the epiglottis alone.* Lastly, I believe it is 
ssible to have this eedema produced without 
external evidence of inflammation. In 
Museum of the School of Park-street there 
preparation shewing it as apparently occa- 
} the vicinity of a large carcinomatous 
she 
ned 
mour. 
_ Considering the pathology of this affection, 
the degrees of inconvenience and of danger 
likely to result from it will be easily under- 
stood. The symptoms will be, a loss or imper- 
ection of voice, which is generally very well 
narked, the utmost effort at articulation amount- 
ing to no more than an indistinct whisper ; and 
difticulty of respiration, including cough and 
ther signs of local irritation. The danger will 
robably be in proportion to the rapidity with 
ich the effusicn is formed, for life may be 
“Mnaintained with a wonderfully diminished 
supply of air to the lungs, provided the dimi- 
ution takes place gradually and slowly: but 
“it may not arise solely from this cause, for here, 
as in every other form of laryngeal disease, spas- 
odie exacerbations are painfully frequent, and 
ace the patient’s life in momentary danger. 
; ion; therefore, developes three different 
causes of death. 
™ 
ny) 
glottis, although swollen, is still pervious— 
perhaps apparently sufficiently so for the ordi- 
_* See Dub. Journ. of Med. Science, March 
1838, v. 13, no. 37. This excellent paper of Sir 
H. =. contains many illustrations of the 
‘Same fact. 
«| 
ABNORMAL ANATOMY OF THE LARYNX. 
117 
nary purposes of respiration; but in order to 
observe the relaxation after spasm, several hours 
must be allowed to elapse between death and 
the post-mortem examination, for the bodies of 
those who die of laryngeal disease become ex- 
tremely rigid, and remain in this state a consi- 
derable time. A second, in which the effusion 
having been poured out with great rapidity, the 
rima is found mechanically blocked up, and 
immediate suffocation occasioned: in this case 
neither the lungs nor brain are engaged, at least 
not necessarily. The third is, where the dis- 
ease has lasted three or four days or more, the 
cedema has been developed but slowly, and 
the diminution of the supply of air been less 
sudden: in these cases, besides the symptoms 
of strangulation;-6thers, indicative of a con- 
gested condition of the lung and brain, are 
observed during the latter periods of existence, 
and corresponding morbid appearances are dis- 
coverable after death. 
Very severe inflammatory affections of the 
mucous membrane of the larynx are unfortu- 
nately too frequent to admit of doubt or to 
create difficulty; but a good deal of confusion 
has arisen from an attempt to identify them, or 
some of them, with croup, because an exuda- 
tion takes place from the surface in some re- 
spects resembling the adventitious membrane 
formed in the latter disease. One of these has 
been described with graphic accuracy by M. 
Bretonneau of Tours, by him supposed to be 
the same with croup, and named Diphtherite : 
but although the differences between these af- 
fections have been observed and pointed out, 
the name is still frequently applied (I fear) 
without very precise ideas attached to it. The 
exact disease described by Bretonneau I do not 
profess to have ever seen, neither have I heard 
of it, unless in one instance in a family in this 
country which lost four of its young and inte- 
resting members by a visitation at least bearing 
some resemblance to it. In hospital I have 
heard the name applied to some throats which 
I never should have thought of identifying 
with that described by the French writer, and 
I feel satisfied that the attempt to mix up 
different and it may be opposite diseases 
under one generic name has done anything but 
simplify the study of pathology. If, however, 
by asthenic croup or diphtherite is meant the 
peculiar local disease which accompanies the 
eruption of scarlatina anginosa, or which is 
frequently met with without any cutaneous 
eruption, especially in adults—which is ac- 
companied throughout by low and typhoid 
fever, and is often propagable by contagion— 
then is the affection well known and its de- 
scription easy: but it bears no similitude what- 
ever to inflammatory croup. For besides that 
the constitutional affections are totally oppo- 
site, a circumstance of the greatest importance 
as influencing the progress of the respective 
cases, the local symptoms and appearances have 
marked and distinct characters. Thus the as- 
thenic angina is always ushered in by shivering 
and other precursors of fever; the soreness of 
the throat is intense from the very commence- 
