SYPHILITIC DISEASE OF THE LARYNX. 35 



trachea, the condition of the mucous membrane is normal, with the ex- 

 ception of a few trifling abrasions. 



SYMPTOMS AND COURSE. Owing to the position which it usually 

 occupies, the typhous ulcer of the larynx does not cause alteration of the 

 voice, unless there be a coexisting swelling and relaxation of the vocal 

 chords. Pain, or other sensation, is either slight or entirely absent. 

 At all events, the sick, as they He half slumbering, do not usually com- 

 plain of it. Hence, we see that, during life, the typhous ulcer is nol 

 recognized, nay, cannot be recognized, and is often only discovered by 

 accident upon the dissecting-table. Never neglect, therefore, in typhus 

 subjects, to examine the larynx post mortem, even though during life 

 no symptoms of disease of the larynx existed. In other cases the relax- 

 ation and swelling of the vocal chords are so great, that the voice becomes 

 rough and hoarse, and in cases where the stupor is not very great, there 

 may even be violent fits of coughing, or of harsh, hoarse, inaudible 

 " hacks." Although these symptoms are not so much signs of typhous 

 ulcer of the larynx as of disease of the mucous membrane causing the 

 ulcers, yet, from the fact of their appearance in the second or third 

 week of the fever, we may diagnosticate the so-called laryngo-typhus 

 from them. Although almost without importance of itself, this laryngeal- 

 typhous ulcer may occasion danger from cedema glottidis and laryngeal 

 perichondritis. 



Variolous ulcers necessarily give rise to symptoms identical with 

 those of severe laryngeal catarrh. The two diseases would not be dis- 

 tinguishable, did not the eruption upon the skin and the pustules in the 

 mouth and throat furnish a distinct criterion. 



The secondary (variolous) croup, like the genuine, causes hoarseness 

 and aphonia. The cough is generally moderate or entirely wanting. 

 Either because the false membranes are not thick enough materially to 

 occlude the passage of the glottis, or because cedema and palsy of the 

 muscles of the glottis (to which we ascribe a part of the dyspnoea of 

 croup) do not occur here, it is only on rare occasions that dyspnoea, like 

 that of genuine primary croup, is met with in this form of laryngitis. 



TREATMENT. Typhous and variolous ulcers usually heal with subsi- 

 dence of the primary disease, and need no particular treatment if uncom- 

 olicated by cedema glottidis, or by perichondritis laryngea. 



CHAPTER V. 



SYPHILITIC DISEASE OF THE LARYNX. 



ETIOLOGY. Our knowledge of syphilitic disease of the larynx lias 

 neen greatly extended and modified by means of laryngoscopy. Ger- 

 hardt and Roth have shown that this class of disorders is much more 



