448 
ment, and the part is even painful on pressure 
externally; every attempt to swallow is so 
dreadfully distressing that patients will suffer 
to be half-famished rather than attempt to get 
down a spoonful of fluid. In attempting to 
examine the throat there is often great diffi- 
culty, because the patient either cannot, or 
from the pain it occasions, will not open his 
mouth; but if it can be seen, it is observed 
to be of a deep red colour, verging on purple, 
sometimes diffused over the surface, sometimes 
in patches, and even from an early period 
abundantly covered by a thick glairy tena¢ious 
mucus that it is difficult to wipe from it. If 
the disease is severe, the membrane soon be- 
comes sloughy: “ the colour of the slough is 
prey or ashey: in some few instances it appears 
rown; its edges are abrupt and well defined, 
and it is surrounded by inflammation of an 
intensely deep red colour. The slough is in 
general slow in separating, and when thrown 
off it appears to resemble a membrane of viscid 
ta not unlike the adventitious substance 
‘ormed in croup, and the surface underneath 
looks of a bright red colour, is nearly level 
with the adjoining parts of the membrane, and 
seems more like the blush of erythema than 
the relic of mortification. I believe that wher- 
ever croup has appeared to have been conta- 
gious it will be found that malignant scarla- 
tina has prevailed also; and that the occur- 
rence of the laryngeal or tracheal disease was 
eecasioned by the spreading of the inflamma- 
tion from the fauces to the windpipe, or per- 
haps by the actual presence of one of these 
sloughing ulcers in the immediate neighbour- 
hood of the glottis.”* 
Such is the description of the effects of an- 
gina maligna on the mucous membrane written 
in the year 1825, but without any suspicion on 
the part of the writer that it could ever be 
ranged by the side of the affection termed 
eroup: for besides the essentially opposite 
characters of the feyer in each, which by them- 
selves would be all-sufficient, there are the 
following differences. The angina maligna, 
diphtherite, or by what other appellation it is 
to be known,—for with respect to it we enjoy a 
most happy abundance of nomenclature,—com- 
mences always in the fauces, and when it at- 
tacks the windpipe, which is by no means very 
uent, it does so secondarily by spreading 
to it; whereas croup seldom or never com- 
mences in the fauces unless when it appears as 
the sequela of some serious injury, such as the 
swallowing of boiling water. cosinchs ma- 
ligna even locally is not confined to the mucous 
membrane, as is evidenced by the intense pain 
in swallowing, the difficulty of opening the 
mouth, the enlargement, suppuration, and even 
gangrene of some of the adjacent glands; and 
it occasionally exhibits something like a me- 
tastatic transfer of disease to some important 
organ, such as the brain or liver. And even 
when recovery takes place, the difference is 
still remarkable: it is slow, often imperfect, 
* Potter on the larynx and trachea, p. 17. 
ABNORMAL ANATOMY OF THE LARYNX. 
and followed by anasarca or some similar 
dence of a broken and cachectie habi: L 
is not the place to enter more fully into 
examination of these two diseases, whic 
reader will fmd admirably contrasted it 
W. Stokes’ work on diseases of the ¢ 
where the angina is spoken of under the 
of secondary croup. we 
There ons other on 
nx to be noticed accompanied by ai 
aa, in both of which eta he eal 
dition of the submucous tissue is of gre 
portance, viz. erysipelas and diffuse infla 
tion. I believe the larynx is very seldot 
primary or original seat of an erysips 
attack, at least such has not come und 
observation ; but I have not infrequently 
it seized either by the spreading of the di 
from the head and face, or by some speci 
metastasis. The constitutional symptoms d 
life are of a low and typhoid character: 
local, those of painful and difficult degly 
and respiration, and the termination (as 
I know) always fatal. Nor are the a 
ances after death always satisfactory, for, 
other cases of erysipelas, the tumefaction 
subsides and the colour fades very soon 
death. In most instances, however, we 
the mucous membrane of a pees low 
and apparently greatly thickened: the 
mucous tissue filled sometimes with s¢ 
sometimes with a gelatinous lymph, and si 
times with a sloughy and putrid matter; 
natural folds of the organ obliterated, an 
rima more or less blocked up and closed b 
thickening and tumefaction of the adjacent 
But one of the most curious affectio 
which the larynx is liable is that of diffs 
flammation. I say “ curious,” because iti 
necessary that the mucous membrane 
be inflamed or thickened or otherwise enga 
or that there should be any remarkable s 
ling of the parts, and yet the breathing is I 
sibilous, or eroupy, as if from the 
some mechanical obstruction. In these ¢ 
which are always fatal, the cellular tissue” 
seat of the disease, and is found filled 
offensive purulent matter and flakes of wi 
ganized lymph, sometimes around the lar 
trachea, and esophagus, sometimes at the’ 
of the throat, and not infrequently exte 
to a considerable distance down into the | 
rior mediastinum. a 
Chronic inflammation of the mucous 1 
brane of the larynx resembles in its ef 
similar form of disease in other structures, 
cept that as the aperture of the glottis is 
and its functions essential to life, the sam 
gree of alteration or of disorganization ¢ 
have place here that may occur in others 
tions without the patient generally experie 
a degree of distress that will at least dire 
attention to the subject. Still is this af 
sufficiently insidious, and its progress in| 
instances so slow, that often irremed 2 
chief is produced before assistance is s¢ 
for: and thus it happens that we are oblig 
speak of chronic inflammation, not will 
