TUBERCULAR ULCERATION OF THE LARYNX. 39 



membrane by contact with the acrid sputa passing over it. Vir- 

 chow, however, holds diametrically opposite views, and recommends 

 the larynx as the very place in which to study true tuberculosis. 

 He attributes the non-recognition of the tuberculous origin of 

 these ulcers to the fact that the tubercles are superficial, and be- 

 ing, therefore, very liable to accident from without, soon break down 

 into shallow ulcers, and never become caseous nor form appreciable 

 tumors. 



Tuberculous laryngeal consumption, though rarely arising as an in- 

 dependent and primary malady, is one of the most common complica- 

 tions of consumption of the lungs. Not only does it accompany the 

 tuberculous form of pulmonary disease, but it is seen quite as often, 

 if not oftener, in that form of consumption which we regard as the re- 

 sult of inflammation (see chapter upon consumption). Since numerous 

 experimenters have now succeeded in inducing an artificial generation 

 of tubercle by inoculation, the frequent association of a tuberculous 

 laryngitis with a pulmonary consumption of non-tuberculous origin 

 will not appear extraordinary. Plentiful opportunity for such inocu- 

 lation is afforded in the larynx of a phthisical patient ; for the mucous 

 membrane must suffer many small breaches of continuity through the 

 strain of coughing, and these are constantly exposed to the contact of 

 the passing caseous material. 



ANATOMICAL APPEARANCES. The most frequent seat of laryngeal 

 tuberculosis is that part of the mucous membrane which covers the 

 transverse muscles of the larynx. The process, however, not uncom- 

 monly begins at other spots, especially at the posterior wall of the 

 epiglottis, and at the covering of the arytenoid cartilages. 



Small flattened elevations of a dull-gray hue are first observed at 

 the spot just mentioned. They are situated upon a base which is 

 either reddened and swollen, or else of a pale, flabby appearance. The 

 early disintegration of these nodules results in small rounded cavities, 

 bounded by hard, everted edges. The growth and decay of new nod- 

 ules in the vicinity of those first formed, and the confluence of several 

 ulcers, finally result in a loss of substance of irregular form. The mu- 

 cous membrane in the vicinity of the ulcers shows various degrees 

 of redness and swelling. 8 



Often, too, it is the seat of papillary growths with excessive 

 formation of epithelium. Posteriorly the destruction often extends 

 to the vocal chords, whose edges then seem corroded, and, as it were, 

 worm-eaten by shallow sores. Sometimes penetrating more profound- 

 y, the posterior insertion of the chords is destroyed. Finally, the 

 ulceration may involve the whole larynx, and spread to the root of the 

 tongue and soft palate. 



