OATARRHAL ULCERS OF TQE LARYNX. 31 



CHAPTER III. 

 CATAEEHAL TJLCEES OF THE LAEYNX. 



KTIOLOGY. When the cell-formation, which takes place upon the 

 surface of the mucous membrane in acute and chronic catarrh, en- 

 *roaches upon the tissue of the mucous membrane itself, producing in 

 it a solution of continuity, a superficial loss of substance occurs, con- 

 stituting the simple catarrhal ulcer or catarrhal erosion. The pathogeny 

 of this ulcer is easily understood, if we compare it with a very similai 

 process upon the skin. Where a plaster of cantharides has raised the 

 epidermis in a blister, the contents of the blister, in a few days, become 

 turbid from admixture of young cells. These are formed upon the sur- 

 face of the cutis, through the proliferation of the more deeply-situated 

 epidermic cells. The substance of the cutis is intact. If, however, 

 after opening the blister, we anoint the exposed cutaneous surface with 

 an irritating salve, the cell-formation extends to the substance of the 

 skin, causing its destruction, and forming a superficial sore completely 

 analogous with the catarrhal ulcer of the mucous membrane. 



In other cases, the numerous mucous glands which exist in the larynx 

 become the seat of a vast multiplication of cells. They enlarge consider- 

 ably ; their covering is finally perforated, their contents are discharged, 

 and, in place of the gland, there remains a round, crater-formed loss of 

 substance the second form of catarrhal ulceration, the follicular sore. 



Ulcers are rare in acute laryngeal catarrh. In the chronic form, how 

 ever, especially in the follicular variety, affecting the fauces and larynx 

 of preachers, singers, inveterate smokers, and immoderate drinkers of 

 spirits, there is a decided tendency to ulceration. 



This is still greater in the chronic laryngeal catarrh which almost 

 always accompanies pulmonary consumption, independently of tubercu- 

 lous disease of the larynx. Finally, TilrJc has repeatedly noticed catar- 

 rhal ulcers of the larynx, in the vicinity of which scarcely any trace of 

 catarrhal disease could be discovered. 



Special exciting causes render certain portions of the laryngeal 

 mucous membrane particularly liable to catarrhal ulceration, namely, the 

 posterior wall of the larynx, the aryepiglottic ligament, the anterior 

 and posterior ends of the vocal chords, and the epiglottis at the point 

 corresponding to the processus vocalis of the arytenoid cartilage. The 

 places first named are particularly rich in mucous glands, and the tissue 

 of the mucous membrane is loose, as it here contains a lesser quantity 

 of elastic fibre. At the latter-named spots the cause of ulceratiou 

 seems to be mechanical. In all loud talking the vocal chords are forced 

 toward one another, so that their edges almost touch. When their 



