TUBERCULAR ULCERATION OJP THE LARYNX. 4| 



of the lung, if not very far advanced, are thrown into the background. 

 The sufferer declares " that he has nothing the matter with his chest," 

 ridicules the percussion and auscultation, and protests that the only evil 

 with which he believes himself to be afflicted, or which he fears, is the 

 " consumption of the larynx." 



It is rare for patients to complain of burning or smarting in the 

 larynx, and usually, too, they are but slightly sensitive to pressure 

 there, even though we push the organ back against the spine. The 

 feeling of crepitation perceptible upon this manipulation is also felt in 

 pressing upon this organ in a healthy person, and is of no diagnostic 

 significance. The expectoration is useless as a means of diagnosis 

 (unless, indeed, pieces of cartilage be ejected), since but a small portion 

 of it springs from the larynx. The shortness of breath, the hectic fever, 

 the night-sweats, the emaciation proceed equally from the coexisting 

 tuberculosis of the lungs. In one case only of pulmonary tubercle, 

 besides the symptoms just described, I have seen intense and gradually- 

 increasing stricture of the larynx. The patient died in a few weeks,' 

 after having been materially relieved by tracheotomy. At the autopsy 

 there were found in the larynx the thickening and induration of the 

 submucous tissue previously described as a cause of chronic stricture, 

 together with tuberculous ulceration. 



Examination of the pharynx almost always shows that chronic catarrh 

 exists there also. We find its blood-vessels varicose, and see small vesi- 

 cles, phlyctaenae, or small, shallow, rounded erosions. The sufferer hawks 

 a great deal ; deglutition is difficult. At last it is often impossible for 

 him to enjoy liquid food without choking himself, while solid food passes 

 down more easily. In these cases the closure of the glottis is incom- 

 plete. 



All of these symptoms, however, will not warrant a diagnosis of 

 tubercle of the larynx unless we are able to show that the lungs, too, 

 are affected. They are all capable of being produced by other kinds of 

 laryngeal degeneration. It is well, therefore, in every chronic affection 

 of this organ, at once to institute an accurate physical examination of 

 the chest, and not to pronounce an opinion until we may have been able 

 to avail ourselves of the revelations of percussion and auscultation. The 

 subjective manifestations often fail us, being frequently obscured by 

 those of the larynx. Hectic fever and emaciation are the only signs 

 capable of rendering the diagnosis almost certain without the aid of 

 physical investigation. By means of the laryngoscope we can easily 

 bring the ulcers on the epiglottis and arytenoid cartilages into view, 

 Of the posterior wall of the larynx above the transverse muscle, wo, ag 

 a rule, can see at least the upper edge, in form of a fringe, with a few 

 pointed jags of a dirty-whitish color (Tilrk). 



