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of the larynx is a not uncommon affection in childhood. The disease may occur as a simple catarrh of the larynx or as a more se vere inflammation resulting from a burn or scald. In these cases it is of course a primary lesion. It may also occur secondarily as a consequence of a constitutional disease, such as tubercle or syphilis. There is a special form of the primary affection which is accompanied by spasm and is pe culiar to early life. This complaint is often confounded with membranous croup, and is the " catarrhal croup " of the older writers. It is seldom a fatal disease, although it produces very alarming symptoms. In the pres ent chapter three varieties of laryngitis will be described, viz., simple laryngitis, stridulous laryngitis, and tubercular laryngitis. The lesions which affect the larynx in cases of inherited syphilis are referred to else where (see page 204).

Causation.—On account of the sensitiveness of scrofulous children to changes of temperature and their liability to catarrh, laryngitis is more common in them than it is in others who are free from this unfortunate dis position. In some the larynx seems to have a special proneness to suffer in the cold or changeable seasons of the year. No period of childhood is exempt from laryngeal catarrh, for although the disorder is more often seen in children over six years old, it may be met with as early as the end of infancy. In infancy, however, the complaint in the simple form is com paratively rare. At this period laryngitis is commonly the consequence of a syphilitic taint. Amongst the children of the poor severe laryngitis from burns and scalds is sometimes met with. This form of the disease is al most confined to children between two and three years old, and is due to an attempt to drink water from the spout of a kettle as this stands sim mering by the side of the fire. A violent inflammation results from this accident and may quickly end in death. An equally severe laryngitis with cedema of the glottis is sometimes met with as a secondary affection follow ing serious acute disease. It may occur as a sequel of small-pox, erysipelas,

or typhoid fever. (Edema of the glottis without inflammation is also sometimes a symptom of acute Bright's disease.

Chronic laryngitis is less common than the acute variety, but some times occurs in weakly children as the result of an acute attack. It may follow measles or membranous croup, and is apt to prove obstinate.

Morbid Anatomy.—The mucous membrane and submucous tissue be come congested and +oedematous, and their colour is redder than in health. In cases of simple laryngitis the change is probably confined to the epi glottis and ary-epiglottidean folds, leaving the true vocal cords unaltered.

Some thick mucous is secreted. Ulceration is very rare in early life, and probably never occurs in the primary form of the disease.

In the severe laryngitis which is the result of a scald the soft palate and fauces are white and swollen ; and the epiglottis and parts around are thickened and congested. A so-called false membrane often forms upon the surface. This to the eye appears to be identical with the false mem brane of diphtheria, but is said to differ from it in its microscopical char acters. It is probably, as Dr. Wallace long ago suggested, the natural epithelial layer altered in structure.

Symptoms.—In the mild form the child is hoarse and soon loses his voice more or less completely. His cough is hoarse and infrequent ; sometimes it occurs in paroxysms. There is little or no fever, and the breathing is not interfered with. If the hoarseness do not proceed to ac tual aphonia, it is often more marked in the evening. The cough, too, is generally worse at night when the child goes to bed. The hoarseness of the voice may be only noticed when the child is crying. If the patient be kept in a suitable temperature, the symptoms of catarrh subside after a few days, and seldom last longer than a week. If the indisposition is lightly treated, and measures are not taken to protect the child from fur ther exposure, the complaint may become more serious and may be com plicated with spasm (stridulous laryngitis).

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