34 AFFECTIONS OF THE LARYNX. 



This mode of origin, however, if it occur at all, is certainly not the 

 sole, nor even the most frequent, source of typhous laryngeal ulcera- 

 tion. Rokitansky himself, in the last edition of his " Pathological 

 Anatomy," attributes typhous ulcer of the larynx to diphtheritic in- 

 filtration of the mucous membrane ; and, indeed, it is entirely in har- 

 mony with this view of the matter that typhous ulcers appear upon 

 the most dependent portions of the larynx, in which hyperamia from 

 gravitation is easily developed, after long-standing disease ; and, as 

 is also the case in the lower parts of the lungs, and of the integument 

 of the back and loins, at points most exposed to pressure or mechan- 

 ical irritation. The most striking observation, however, is that of 

 Rtihle, according to whom, even in exanthematic typhus (a disease 

 entirely foreign to abdominal typhus, which runs its course without 

 medullary infiltration of the intestinal glands), besides the products 

 of catarrhal, croupous, and the diphtheritic processes, we find ulcers 

 of the larynx exactly similar to those of abdominal typhus. 



While the infection of measles is followed by catarrhal, or, in rare 

 cases, by croupous laryngitis, and while the poison of scarlatina does 

 not localize itself in the larynx, excepting by propagation of diphtheritic 

 inflammation from the fauces, the virus of small-pox, in a majority of cases, 

 causes pustular inflammation of the mucous membranes of this organ. 



The variolous ulcer has its origin in the propagation of the exan- 

 thema from the skin, and from the mucous membrane of the mouth and 

 pharynx. We thus have to do with an eruption of small-pox in the 

 larynx, which, however, as a rule, is complicated by a diffuse croupous 

 inflammation a secondary croup. 



ANATOMICAL APPEAKANCES. The typhous ulcer presents a loss of 

 substance of the mucous membrane, bounded by relaxed discolored 

 edges. Its most common seat is the posterior wall of the larynx above 

 the transverse muscle, and on the lateral edges of the epiglottis. As a 

 rule, it only has a circumference of a few lines. In some cases, however, 

 it extends so as to involve the entire free edge of the epiglottis. In 

 others it is more disposed to penetrate deeply, and thus may lead to 

 laryngeal perichondritis, and to exposure and consequent necrosis of the 

 cartilage. 



The variolous ulcer commences by the formation of a soft, flattened, 

 non-umbilicated pustule, which soon bursts, forming a shallow, rounded 

 sore, which readily heals. The croupous exudation which accompanies 

 the small-pox eruption, and which, according to JRUkle, is often found 

 there when the pustules are wanting, consists of a somewhat thin film, 

 spreading over the swollen mucous membrane. The latter is at first 

 somewhat reddened, but afterward grows paler. After the fall of the 

 false membrane, which usually extends as far as the bifurcation of thp 



