In cases such as these, if tracheotomy has to be performed on account of the intensity of the clyspneea, the patient often dies from a secondary inflammation of the lung. The ordinary non-traumatic laryngitis in the child, if at all severe, is also usually associated with bronchitis, pneumonia, or pleurisy.
The chronic form of laryngitis is sometimes seen in connection with follicular pharyngitis. It is indicated by an altered quality of the voice, which becomes thick and veiled, and is sometimes quite hoarse in the even ing. There is also a hard cough, which may be paroxysmal, and is often accompanied by pain shooting up into the sides of the head or the ears. I have occasionally met with a simple chronic laryngitis unconnected with any abnormal state of the fauces, and apparently not the consequence of a constitutional caohexia. One such case, occurring in a child aged one year and eleven months, will be afterwards referred to.
. Diagnosis.—The simple form of the disease, where there is much hoarseness of the voice and cry, a thick cough, and some redness of the fauces, without fever, or with only moderate pyrexia, cannot be mistaken. If the symptoms become more urgent, and there is laboured breathing, pneumonia and bronchitis may be excluded by the absence of the charac teristic physical signs about the lungs, and the normal or only slightly elevated temperature. Still, it must be remembered that these cases, whether clue or not to a traumatic cause, are often complicated by acute chest disease.
In the case of scald of the larynx, the history will usually be sufficient to decide the nature of the illness. It must not be forgotten that in this variety of laryngitis the symptoms seldom come on directly after the acci dent, but that there is almost invariably an interval of some hours before the signs of dyspncea begin to be noticed. In every such case, then, we must be on our guard, and must not conclude that all danger has passed because the child appears at first to have escaped serious injury.
In epidemics of diphtheria a slight scald of the larynx may predispose a child to fall a victim to the zymotic disease. Mr. Parker has published the case of a little girl, aged three years, in whom " croupy " symptoms came on three days after an apparently trifling scald of the throat, and in spite of tracheotomy the patient died on the sixth day of the illness. On
examination of the air-passages, the epiglottis and ary-epiglottidean folds were covered with membrane ; the tracheal mucous membrane was in tensely injected and coarsely granular in appearance, and this condition was seen to extend as far as the tertiary bronchi. Pieces of thinnish, red, well-formed membrane were also found on the pharynx and in some of the tubes. In this case the illness came on at too late a period after the acci dent to be fairly attributable to the scald ; the symptoms were those of laryngeal diphtheria, and the anatomical characters were indicative of a specific and not of a simple inflammation of the larynx and trachea.
In all cases of chronic hoarseness it is as important in the child as it is in the adult to use the laryngoscope wherever practicable. Children, un fortunately, are usually troublesome subjects for this method of investi gation ; but if the child is old enough to understand the object of the ex amination, we can often, by perseverance and by making him suck lumps of ice before the instrument is applied, succeed in getting a view of the vocal cords. By this means we can sometimes exclude the presence of chronic inflammation and obtain a valuable hint for treatment. It must be remembered that hoarseness may be the consequence of the imperfect approximation of the vocal cords. Dr. Vivian Poore has referred to the case of a little boy who had been long under treatment for laryngitis. In this case the hoarseness was found by the laryngoscope to be clue to exces sive arnmia of the larynx, with failure in the power of the adductors ; and fresh air, good diet, and iron soon restored the lad to health.
Chronic laryngitis must not be confounded with the alteration of voice which occurs as a consequence of enlarged and caseous bronchial glands. In that disease hoarseness is a late symptom, and does not appear until general pressure signs have been developed in the chest (see page 182).