and others have reported cases in which there were symptoms of hyperæsthesia or of reflex motor disturbances due to trouble in the nose or pharynx. The general health has much to do with the development of the local trouble. Asthenia is associated so frequently with hyperæsthesia of other parts that we should expect to find this relation also in the larynx. SYMPTOMS.--The symptoms of hyperæsthesia of the larynx are in part involved in the definition of the affection--exalted susceptibility to the touch, intolerance to the presence of mechanical irritants, a sensation of discomfort in the presence of chemical agents, such as gases or impure air, and, when the exaltation is excessive, positive pain. This pain may be only a soreness or tenderness or it may amount to neuralgia. This last form of exaltation is rare. When present it has been considered a special disease and treated as a separate affection. Von Ziemssen and Mackenzie regard it as a variety of hyperæsthesia. Schnitzler, Jones, Wagner, and Mackenzie report cases. The {63} pain is said to be not confined to the larynx, but to extend up toward the ear and along the course of the superior laryngeal nerve. In two cases observed by the writer the pain not only extended along the course of this nerve, but into the pharynx and posterior nares as well. In these cases the patients were both singers, and both had adopted with great enthusiasm a new method by which the abdominal muscles were brought into action at the expense of the muscles of the thorax. The pain was always aggravated by any effort to sing, but more especially by any return to the method noted. The pain not unfrequently extended to the face as well as to the ear. Neuralgia of hysterical origin, according to Thaon,[4] is more frequently met with on the left side than on the right. Instead of being general, it is not unfrequently limited to points or circumscribed patches. [Footnote 4: _Proceedings Laryng. Cong._, Milan.] COURSE AND TERMINATION.--The course of the affection is very uncertain. In the neuralgic variety the pain may be transient, passing away in a few days or hours even, but generally there are frequent recurrences extending through weeks or months. Simple exaltation of the common sensibility is much more persistent and more uniform in its character. Hyperæsthesia of the larynx is so largely dependent upon the general health that not only is it very irregular in its course and duration, but its termination is equally uncertain. It can hardly be said to be a cause of death, as it does not involve structures necessary to life. It disappears occasionally without treatment. When complicated with other affections, such as acute or chronic inflammation, alterations of the function of the pneumogastrics, with disease of the thoracic viscera or with general derangements of the nervous system, its course and termination must depend largely upon the persistence of these complications.