SYPHILITIC DISEASE OF THE LARYNX 37 



and a smooth base, covered with a yellow coating. They show a ten- 

 dency to cicatrize at the point first attacked, while the destruction ad- 

 vances at other places. The very voluminous papillary and bulbous 

 growths, which surround the sore, and its deeply-retracted scars, are 

 especially characteristic. 



SYMPTOMS AND COTJKSE. The simple catarrh and the condylomata of 

 the larynx are among the earliest manifestations of constitutional syphilis 

 which appear. If, then, a person, who, some months previously, has 

 contracted a primary syphilitic ulcer, should begin to complain, without 

 assignable exciting cause, of a feeling of tickling in the throat, should 

 his voice become deep and hoarse, should he acquire a harsh, barking 

 cough, and should these symptoms persist in spite of the most careful 

 management, or should the hoarseness gradually increase to complete 

 aphonia, we may suspect that the symptoms are not dependent upon a 

 simple laryngeal catarrh, but upon syphilitic catarrh, or upon the devel- 

 opment of condylomata in the larynx. Thus, it appears, from what we 

 have stated in the previous chapters about the origin of hoarseness, apho- 

 nia, and harsh, barking cough, that both syphilitic and simple catarrhs, 

 condylomata, as well as mucous accumulations upon the chords, are ca- 

 pable of modifying the tone of the voice and of the cough, and of pre- 

 venting the occurrence of sonorous vibrations of the vocal chords. 



The fact, therefore, that condylomata, so situated as not to disturb 

 the vibrations of the chords, do not give rise to hoarseness, needs no 

 further explanation. As, in almost all the cases reported by Gerhardt 

 and Roth, condylomata of the larynx have been accompanied by con- 

 dylomata upon other parts, especially upon the mouth and throat, the 

 existence of such growth should awaken our suspicions as to their pres- 

 ence in the larynx, while their non-existence permits us to regard the 

 case as probably one of simple catarrh. 



Simple (secondary) syphilitic ulceration seems to belong to a some- 

 what later period, as its appearance does not coincide with that of sim- 

 ple syphilitic ulceration of the fauces. Its presence should be suspected 

 when, in an individual who, one or two years before, has had primary 

 syphilis, and who has since had secondary symptoms, there arises a dis- 

 ease of the larynx, which neither encroaches upon the cavity of the 

 organ nor exhibits characteristics of other forms of laryngeal disease. 

 Here, too, laryngoscopy affords the surest means of diagnosis. 



The extensive and profound (tertiary) ulcerations are the easiest to 

 recognize. They form one of the later links in the chain of syphilitic 

 disorders, and almost exclusively attack patients who have for a series 

 of years suffered first from one form of it, then from another, and have 

 resorted to the various methods of treatment by mercury. The sufferers 

 are here not simply hoarse and voiceless, with harsh cough, with pro- 



