32 AFFECTIONS OF THE LARYNX. 



raucous integument is swollen by catarrh, a constant friction takes place 

 during speaking, which results in excoriation and ulceration. (Lewin.) 



ANATOMICAL APPEARANCES. In the beginning catarrhal erosions 

 bave either a rounded or an elongated shape, according to the arrange- 

 ment of the elastic fibres ; but they afterward coalesce, forming an ex- 

 tensive loss of substance of irregular contour. The follicular ulcers, how- 

 ever, retain their circular form, even when of long standing, and show 

 less tendency to increase in width than in depth. They readily lead to 

 disease of the cartilage, and, exceptionally, several of them run to- 

 gether, and produce extensive destruction of the mucous membrane, 

 the " catarrhal consumption of the larynx." 



The ulcers originating at the anterior and posterior ends of the vocal 

 chords spread lengthways over the greater part of one, or still oftener 

 of both chords. In many cases the loss of substance is so shallow that 

 the chords appear as if they had been only superficially shaved off ; io 

 other cases the destruction is more considerable. Lewin describes ca- 

 tarrhal ulcers upon the lower surface of tho vocal chords, of which, during 

 life, we can only make out the outer border, as a minute fold of mucous 

 membrane, which seems to be inserted under the level of their upper 

 membrane. 



In phthisical patients this author has so often found catarrhal ulcera- 

 tion in that portion of the laryngeal mucous membrane where the vocal 

 processes cover the arytenoid cartilages that he describes this laryngo- 

 scopic appearance, which hardly ever is met with in persons with healthy 

 lungs, as almost pathognomonic of pulmonary consumption. 



SYMPTOMS AND COUKSE. The general symptoms of a chronic laryn- 

 geal catarrh are not materially modified when accompanied by ulceration. 

 True, we may suspect the existence of an ulcer when a patient with a 

 harsh, barking cough, of long standing, and chronic hoarseness, running 

 from time to time into aphonia, complains of a sensation of burning, or 

 soreness upon speaking or coughing; but these symptoms (although 

 sometimes so distressing that the sufferer, in order to avoid pain, speaks 

 without moving the vocal chords, that is to say, in a whisper) are often 

 entirely absent, even when very extensive ulceration exists. The addi- 

 tion of painful and difficult deglutition to the other symptoms renders the 

 presence of an ulcer still more probable ; and when the epiglottis, the 

 aryepiglottic ligament, or the arytenoid cartilage is involved, this 

 symptom is rarely absent. But as painful deglutition also occurs in a 

 severe case of simple catarrh at this point, no positive inference can be 

 drawn from this symptom alone. Next to the objective signs of ulcera- 

 tion, the admixture of small streaks of blood in the* sputa furnishes the 

 most reliable token of its existence. 



Among objective signs, the condition of the fauces and gullet is of 



