epiglottis, in every case that I have seen, more 
__ or less removed by ulceration. The who!e con- 
ation of the organ is lost or spoiled, and 
searcely bears a resemblance to the natural 
shape and appearance ofa healthy larynx. We 
aannot even form a conjecture of the causes 
that oceasion this formidable disease, or of the 
mstances that dispose to its production. 
_At some time beyond the middle period of life 
the cartilages of the larynx, except the epiglottis, 
d often of the trachea also, become converted 
into bone, and from the circumstance of carious 
ne being so constantly found in these ab- 
besses, it would appear that it is either during 
ocess of ossification or immediately after- 
yards that the disease commences. I have 
lways imagined that it was at the former of 
lese periods, and that the affection was pro- 
ced by some imperfection or irregularity in, 
deviation from, the ordinary and natural pro- 
-in a word, that this earthy unorganized 
material was formed instead of healthy bone. I 
had once an opportunity of seeing a case which I 
Tegarded as an example of the commencement of 
disease, in the person of a man who, having 
ed from laryngeal symptoms for some 
months, suddenly died in the Meath Hospital, ap- 
parently from the effects of spasm. “ Onslitting 
up the larynx, the cricoid cartilage appeared to 
highly vascular and organised. Its substance 
was internally as red as blood, and in three or 
fo places there were specks of an earthy white 
ubstance that crackled under the knife, and was 
dently of the same nature with that usually 
ound in caries of the laryngeal cartilages.” [ 
aware that one case can prove but little, 
articularly in pathological science, but oppor- 
nities of seeing the incipient stages of such 
n affection as this must be very rare, and every 
e ought to be recorded that will in any man- 
tend to throw light on a disease the etiology 
of which is so extremely obscure. 
_ However occasioned, this earthy degeneration 
Of the laryngeal cartilages is an extremely in- 
Sidious disease, its approach being so gradual 
S scarcely to alarm the patient, and its progress 
low. There is usually sore throat and difficulty 
swallowing, although this latter is not neces- 
Sarily a constant symptom; hoarseness, and at 
but triflingly impeded respiration. These 
‘inconveniences in the commencement are not 
Such as to produce much distress; for I have 
Known one patient suffer for three months and 
 anothernearlynine, beforeeitherapplied for relief, 
and in both the disease had a fatal termination. 
Afterwards, however, the symptoms become 
Thuch more aggravated, the difficulty of breath- 
F ig is exceedingly distressing, and there are exa- 
c rbations that bring the patient to the point of 
£ 
h by suffocation. I have already noticed 
One case in which dissolution took place at a 
very early period, and when .the occurrence 
could only be explained by the suddenness and 
Severity of the spasm. At length, as the dys- 
Ppnoea becomes extreme, the patient suddenly 
eat some partial relief; bis cough, which 
was before teasing and troublesome, now becomes 
$0! ter, and the expectoration free and copious. 
This latter has all the characters of purulent 
= 
of 
ABNORMAL ANATOMY OF THE LARYNX. 
121 
matter, and there are, mixed with it, particles 
of that white, gritty, earthy substance already 
described. Occasionally, pieces of the size of 
a pea of this unorganised substance are coughed 
up, and when they appear they leave very little 
doubt of the nature of the complaint. Towards 
the latter end of the disease the breathing be- 
comes loud and sonorous, with a whistling 
noise, so as to be heard at a considerable dis- 
tance. The cough is incessant ; the expectora- 
tion copious, with a peculiarly fetid gangrenous 
smell; the patient’s breath has this odour also, 
which may also be regarded as an unfavourable 
symptom. There is at all times convulsive 
struggling for breath, with occasional exacerba- 
tions. In most cases, but not in all, the chest 
becomes affected; thereis pain in some one 
part of it or other, with a Sensation of tightness 
round the thorax as if the patient could not 
draw a full inspiration. His strength seems to 
give way rapidly under these symptoms ; his 
body becomes emaciated ; he has night sweats 
accompanied with excessive restlessness ; and 
at last he sinks exhausted in the struggle and 
dies. 
Throughout the entire progress of the dis- 
ease there is seldom any well-marked paroxysm 
of fever, although the pulse is never much 
under 100; however, this may be attributed to 
the constant irritation under which the patient 
labours. The tongue is usually clean; the ap- 
petite cood—in some instances ravenous ; and 
the general functions of the body, with the 
exception of respiration, seem to suffer but 
little. The countenance is always pale, with 
that sickly dirty hue that characterises hectic 
fever. ‘The expression evinces great anxiety ; 
and this is so remarkable that patients suffering 
under this species of cynanche often seem to 
bear a strong resemblance to each other. 
It is now familiarly known to surgeons that 
even this dreadful condition is not utterly di- 
vested of hope, and patients in whom this dis- 
ease had wrought such ravages as to render the 
larynx quite unfit for the performance of its 
functions, nevertheless survived for years after 
an artificial opening had _ been practised in the 
trachea. Some of these patients have since 
died, and thus in a limited degree afforded op- 
portunity for examining the extent of destruc- 
tion produced, as well as proving the all-im- 
portant practical fact, that ulcerations here, how- 
ever extensive, are capable of being cicatrized 
if the organ is only left ina state of repose. In 
the Museum of the Royal College of Surgeons 
in Ireland is the larynx of a patient who lived 
for more than two years after having been o 
rated on by Mr. Purdon of Belfast, and the 
following are the appearances exhibited by the 
easy ae About half the epiglottis had 
en carried away, and the edge of the remnant 
is cicatrized. The space between the root of 
the epiglottis and the rima, rough on its sur- 
face, irregular and warty. The ventricles 
altered in shape, diminished in size, but not ob- 
literated. The dimensions of the rima greatly 
diminished. The canal of the larynx is not 
more than one-third of its natural size, and is 
lined by a thick uneven membrane, evidently 
