In chronic laryngitis the disease is not only of much longer duration, but of much less severity ; and except when an acute attack supervenes, there is at no time urgent dyspncea. The in spiratory act is sometimes noisy, and more labored than natural; but generally the voice is much more affected than the breathing: it becomes rough and harsh, or husky, or may be lost. Chronic laryngitis is connected especially with two other forms of disease, the tubercular and the syphilitic, and it is therefore important to make out from the history and symptoms whether either of those cachexies may exist as its cause. In some cases disease in the larynx and trachea has proceeded much further than in the lungs, where only a few miliary tubercles exist—phi/141S laryngea it used to be called ; and then its tubercular nature is not so readily made out : t,o one accustomed to watch all the indications of dis ease there is something very characteristic in the altered voice of phthisis, caused no doubt by the circumstance that such inflam mation of the glottis t,ends to ulceration rather than to thickening of the cords. In the syphilitic form we trust more to the exist ence of secondary symptoms of any sort than to the history of infection, which the patient may have an object in denying.
Besides these varieties, chronic laryngitis may be left after a more acute attack of the idiopathic kind has paeaed away ; and there would also seem to be some tendency to a recurrence of the disease in a chronic form, after any exposure, in a person who has once suffered from the acute disorder. In other instances we find it associated with disease of bone or cartilage.
The general symptonas depend more upon .the condition of the patient in other respects than upon the severity of the local ail ment, which is not such as to materially affect the health. There is frequently a feeling of aoreness, or dryness of throat, with some difficulty in swallowing; occasionally the act of deglutition excites cough, which may end in retching: m many cases these symp toms are wholly wanting. There is usually tendersess on pres sure over the krynx; any alteration in form, or any degree of fulness, would lead us to suspect disease of bone or cartilage.
Cough is very generally present, is harsh, and sometimes peculiar in tone ; but less so, as a general rule, than in affections of the trachea.
The disease most liable to be confounded with chronic laryn gitis is aneurism of the aorta : any tumor in the same situation would produce similar results ; but practically this is the cause which most commonly originates them. By some physiologists it has been assumed that the symptoms are produced by pressure on the laryngeal nerves, especially the recurrent; but no doubt much is due to the irritation produced by its actual contact with the trachea itself. The only conclusive evidence is the discovery of the tumor : a suspicion, indeed, that the dyspncea and cough may not be the effect of laryngitis, will probably be suggested by the absence of soreness in the throat, and the character of the voice, which is not absolutely hoarse, but has rather a cracked sound, and is wanting in power ; the sound of the cough is not so rough, but generally more harsh and clanging. Such circum
stances, however, only amount to bare suspicion : more value may be attached to the fact that while there is no soreness of the throat, there is often a peculiar disphagia—a sensation of the food stick ing fast in the gullet, which, like the changes in breathing and voice, may be partly due to interference with nerves, partly to pressure on the cesophagus.
§ 2. Tracheiti8, or inflam mation of the entrance of the air-passages in childhood is an affection quite Sul generic. It is not here our business to enter upon its pathology, but merely to point out that, while in the adult the inflammation is commonly limited to the larynx, or at least derives all its importance from the inflammation attaching itself to the opening of the glottis, in childhood the trachea is the chief seat of the inflammation ; the larynx and the fames are usually involved secondarily and to a less degree. The chief ex ception to this is found in the diphtheritis which often prevails epidemically on the Continent ; it clearly commences in the upper part of the pharynx, and very often terminates in true croup. (See Chap. XXIV. § 2.) In the historyof the case we either find that the child has been ailing for two or three days, with symptoms of cold attended by hoarseness, or that the antecedents have been so slight as to have escaped notice, and that the dhild was waked up, in the night in a state of high fever, with a loud clanging cough and considerable difficulty in breathing. The attendant phenomena always indi cate very marked febrile disturbance; the skin is•hot, the pulse quick, and the face flushed, and the progress of the symptoms is closely analogous to those already mentioned in laryngitis. Hoarseness is an indication which deserves a first place among the evidences of the disease, because it is one which so seldom attends the common colds of childhood ; next, if considered along with other circumstances, are the peculiar croupy inspiration which follows a fit of coughing, and the brassy or ringing noise of the cough itself; when taken alone, these signs have often led to mistaken diagnosis. As the disease proceeds, membranous shreds of lymph may be coughed up or expelled by vomiting, or patches of lymph may be seen on the fauces ; this renders the diagnosis of the disease quite certain ; but in some case no mem brane at all is found, the trachea and bronchi are simply inflamed and bathed in purulent secretion. Auscultation of the chest reveals noisy breathing, mixed with a variety of clacking or moist sounds, according to the character and extent of the se cretion.