30 AFFECTIONS OF THE LARYNX. 



common than had hitherto been supposed. By means of laryngoscopic 

 examination, they have discovered laryngeal disease in a large number 

 of syphilitic patients who evinced no outward signs of it, and have 

 shown that, besides the grave and destructive disorders already known 

 as tertiary syphilis, the so-called secondary forms the catarrh, condylo- 

 mata, and simple ulcer also occur in the larynx with unexpected fre- 

 quence. I prefer to base my description of this class of syphilitic affec- 

 tions upon the work of these observers, who state that some of the 

 patients dated then: laryngeal affection from a " cold ; " and hence think 

 it probable that the localization of syphilis in this organ is, in some 

 degree, determined by fortuitous catarrhal inflammation. 



ANATOMICAL APPEARANCES. The anatomical lesions, arising from 

 syphilitic laryngitis, are often merely those of catarrh, and are quite 

 analogous with those of simple syphilitic angina. Although syphilitic 

 laryngeal catarrh is not distinguishable from other laryngeal catarrhs by 

 any palpable anatomical peculiarity, yet the time of its occurrence, after 

 a primary syphilitic ulcer, its duration, its disappearance upon mercurial 

 treatment, testify as to its specific nature, and to its dependence upon 

 syphilitic infection. 



Condylomata and plaques muqueuses are much more frequently ob- 

 served. They form flattened, reddish projections, and some of them 

 show upon their surface the whitish thickening and loosening of the 

 epithelium, which we see in the condylomata of the pharynx and 

 mouth. The most common situation of condylomata is on the vocal 

 chords, although they also occur at other points, particularly the pos- 

 terior wall of the larynx, and on the arytenoid cartilages and on the 

 aryepiglottic fold. 



Simple (secondary) syphilitic ulcers are, on the whole, rare. No 

 ulcers, accompanying the condylomata in the larynx, existed in any of 

 the cases reported by G-erhardt and Both. These authors declare the 

 diagnosis of this form of ulcer to be altogether uncertain, as both the 

 yellow coating upon their base and the luxuriant condition of the 

 Deighlx)ring parts are found in other forms of ulcers. Simple syphilitic 

 ulcers occur in most varied positions in the larynx, upon the epiglottis, 

 the true and false chords, or in the lower pail of the organ. They are 

 not always, nor even frequently, complicated with ulceration of the 

 fauces. 



Finally, there are the well-known extensive and profound tertiary 

 ulcers, which coexist with syphilitic lupus of the skin, and, like the lat- 

 ter, are probably due to the breaking down of syphilitic tubercle. Such 

 ulcers almost always begin upon the epiglottis, which they destroy more 

 or less completely, not unfrequently spreading thence throughout the 

 entire larynx. As a rule, these ulcers have a dentated, ragged shapr;, 



