38 



AFFECTIONS OF THE LARYNX. 



fuse and not unfrequently bloody expectoration, but these symptoms 

 are always combined with a more or less intense dyspnoea. We mark 

 the laborious, long-drawn breathing, so characteristic of stricture of th 

 larynx, with its stridor audible even at a distance. This narrowing 

 of the larynx may gradually become so extreme, from contraction of 

 cicatrices and development of exuberant growths in then- vicinity, that 

 respiration becomes insufficient, and poisoning by carbonic acid sets in. 

 In other cases, the dyspnoea suddenly rises to an alarming pitch from 

 the occurrence of oedema of the glottis. The fact that the ulceration 

 spreads gradually into the larynx from the root of the tongue and 

 fauces, and there begins its ravages upon the epiglottis, makes it a duty 

 carefully to examine the region of the larynx of all patients suffering 

 from laryngeal stricture, and to press with the finger upon the epiglot- 

 tis, in order to ascertain if it have suffered any loss of substance. In 

 fact, the positive or negative result of this examination gives almost 

 certain ground for diagnosis for or against the malady, although a closer 

 insight as to the extent of the process is only to be obtained by means 

 of laryngoscopic examination. 



In condylomata and simple catarrh the prognosis is good. It is not 

 so good in the simple ulceration, from which sometimes the grave forms 

 last described seem to develop. In the latter, the prognosis is a very 

 unfavorable one. Most patients die, sooner or later, with symptoms of 

 increasing marasmus, even although the respiration remain sufficient, or 

 be made so by tracheotomy. However, in some cases, a partial improve- 

 ment at least takes place. Thus, in one far-advanced instance, in which 

 the relatives of the patient were confidently awaiting her speedy disso- 

 lution, I have seen an almost complete recovery. In this patient, now 

 a blooming female, there is nothing, save a slight stridor and a deficience 

 in the soft palate, to recall to mind the once terrible malady under which 

 for weeks she lay utterly emaciated, without voice, with racking cough, 

 with profuse and often bloody sputum, and bereft of all hope of im- 

 provement. 



TREATMENT. For the treatment of syphilitic disease of the larynx, 

 the same rules apply which are laid down for the general management 

 of syphilis. In extreme contraction of the orifice, tracheotomy is indi- 

 sated. 



CHAPTER VI. 



TUBERCULAR ULCERATION OF THE LARYNX. 



ETIOLOGY. Prominent authors utterly deny the existence of a tu- 

 berculous laryngeal consumption, and ascribe the ulcers so often found 

 in the larynx of a consumptive to corrosion of the laryngeal mucous 



