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 good—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 in a 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 ope rated on by Mr. Purdon of Belfast, and the following are the appearances exhibited by the preparation. About half the epiglottis had been 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 the product of cicatrization, and the place which should have been occupied by the broad por tion of the cricoid cartilage exhibits an empty cavity, as if that structure had been removed by absorption or some other process, and nothing deposited in its room. One of the pa tients on whom I operated in the year 1829 died about a year since in the Fever Hospital, and the larynx was examined by the surgeon of that institution, Mr. Trant ; it presented ap pearances so nearly similar to the above as not to require particular detail, and quite sufficient to show that the original destruction had been such as totally to preclude the possibility of the organ ever being capable subsequently of performing the ordinary function of respi ration.
The cartilages of the larynx are also liable to mortification following on inflammation, and apparently produced by the causes that induce gangrene in other structures. I suppose this affection to be extremely rare, as I have met with but two cases, and have not heard of its being observed by others. In one of these cases a large abscess existed in front of the larynx and upper part of the trachea, in which the thyroid cartilage lay like a foreign substance entirely denuded, mortified, and abominably offensive, its appearance resembling that of wetted rotten leather. The front of the cricoid cartilage and of the two upper rings of the trachea had been removed by mortification also. The lining membrane of the larynx was thickened, corru gated, and had a granular appearance ; part of it was ulcerated, through which the abscess had communicated with the pharynx. The remnant of this larynx is preserved in the pathological collection of the School in Park-street, and spews that at least five-eighths of the organ had been totally and entirely destroyed. It proves that such a disease must be utterly hopeless and irremediable, and that, quite independent of the constitutional derangement that must lead to its formation and accompany its progress, no chance could exist of cicatrization and subse quent recovery.
Occasionally, although I should suppose very rarely, the cartilages of the larynx are the sub jects of an alteration of structure strongly re sembling the ordinary product of scrofula. Of this I have seen but one specimen, for which I am indebted to the kindness of my friend Dr. Benson. December, 1838. A man, wt. 39, was received into the City of Dublin Hospital, under the care of Dr. B. for the treatment of what was considered to be chronic rheumatism. It was soon discovered that the pains were not rheumatic, but most probably depended on cerebral disease. The larynx presented a firm tumour externally, and there was an almost total loss of voice. lie died, and after death scrofulous tubercles were discovered in the brain. The larynx was of a healthy structure in every part except in the thyroid cartilage, the aim of which were converted into a firm scrofu lous mass, about the size of a large cliesnut on each side. The scrofulous or tubercular matter appeared to have been deposited originally in the centre of each ala. The margins and cor nua of the Cartilage were unaltered, and the cartilaginous structure seemed to lose itself in sensibly on the surface of the tumour.