As in many other diseases of the respiratory organs, the patient suffering from acute laryngitis usually assumes the sitting posture,. he cannot lie down with ease, but shows more restlessness and anxiety than under any other affection : cough is never promi nent, perhaps rarely present, for the patient cannot fill his lungs sufficiently to produce it. His sensations point simply to the larynx, except that now and then there may be pain at the lower end of the sternum, caused by the labored inspiratory movements. The evidence derived from auscultation and percussion is entirely negative : wherever the stridulous laryngeal noise does not pre vent the breath-sound from being heard, the indications are those of health.
Besides this form of laryngitis, which may be termed the idio pathic, it is met with as a consequence of injury, such, for example, as the entrance of an irritant fluid or gas into the trachea : it supervenes, as already mentioned, on the chronic form ; or it as cends from the inflated trachea of croup, or descends from the inflamed fauces of quinsy. Its association with croup and the means of discriminating the two diseases will come under our notice in the next section : in each of the other cases, the history and symptoms are primarily those of the preceding affection; and a knowledge of its existence prepares us for the correct interpre tation of sudden dyspncea, raucous breathing, and symptoms of suffocation when the laryngitis supervenes.
There is also what may be termed a bastard laryngitis occa sionally met with, consisting of oedema of the glottis. It is prin cipally associated with the sorethroat of erysipelas, and with renal disease : and this would lead to the belief that it has the character of low phlegmonous inflammation rather than that of simple serous effusion. But the swelling of the vocal cords from this effusion is the dangerous circumstance, and that which brings it into association with laryngitis. The symptoms are less severe, and the inflammatory fever is absent ; the dyspncea, however, is sometimes equally urgent: the correct interpretation of the cha racter of the obstruction is chiefly inferential ; the coexistence of the other forms of disease excludes the idea of acute or sthenio inflammation ; and when disease of the kidney is present, even if unknown, there is generally external swelling of the throat, as well as internal oedema.
The absence of auscultatory phenomena, indicative of disease of the lungs, is most important in regard to treatment. I have more than once seen the opera tion of tracheotomy performed without even a transient relief to the sufferer ; with indeed, in one case, manifest injury, from the excitement and alarm it produced. In these cases the diagnosis was based on insufficient premises : there were, it is true, the sudden invasion after exposure, the rapid progress, the inflammatory fever, and the extreme dyspncea, with discoloration of the face ; but neither had there been sorethroat nor aphonia, and unmistakable signs in the lungs showed that if the larynx were implicated it was only secondarily : post-mortem examination revealed what is not inaptly called bronchopneumonia of the most extensive kind, in each of these patients. The propriety of the operation must entirely rest upon the correct interpreta tion of the causes producing the suffocation which it is intended to relieve ; but it is even more apt to be undertaken with a wrong-impression when urgent symptoms supervene in chronic cases, than when the disease is from the first acute.
Aphonia is a very good measure of the extent of the inflammation, or rather of its progress, and of the effects it has produced. When the hoarseness has passed rapidly into complete aphonia the affection is unquestionably a grave one. Feeling an inability to produce any laryngeal sound, the patient may be content to speak in a whisper ; but it is to be remembered that this does not of necessity imply the existence of aphonis ; and if no effort be made to pro duce articulate sound, we have at leaat the right to suspect that the patient may have the power to do so, but does not exercise it. This is one of the com mon manifestations of hysteria, but is not likely to be mistaken for acute laryn gitis ; it is rather the chronic affection which it simulates ; and along with the aphonis there may be an unnatural barking cough, which tends to make the counterfeit more complete : in such circumstances tracheotomy has been per formed without the very slightest necessity, in consequence of mistaken diag nosis. More commonly hysterical aphosia lasts for months or years, the patient all the time being able to speak aloud if she but made a real effort.