GROWTHS IN THE LARYNX. 43 



lute silence of weeks' duration. When we reflect that, with every act 

 of speech, the vocal chords are subjected to friction from the air which 

 is driven past them, this direction must seem as rational as in practice 

 it will be found to be serviceable. 



CHAPTER VII. 



GROWTHS IX THE LARYNX. 



THE growths most commonly found in the larynx are fibrous tu- 

 mors. They attain the size of a hemp-seed or bean ; and, when attached 

 by a peduncle, they are called fibrous polypi. They consist of vascu- 

 lar connective tissue, whose texture may be dry and dense, or succu- 

 lent and open, and is covered by layers of tesselated epithelium. 

 Papillomata, which are likewise common and usually multiple, are 

 white transparent growths, either nodular, tufted, or of a mulberry 

 form, and proceed from the upper strata of the mucous surface. Of 

 the carcinomata, epithelial cancer is more common than medullary. 

 The latter appears as a cauliflower growth, prone to ulceration and 

 haemorrhage. Cysts are more rare ; occurring as little bladders of the 

 size of a pin's 'head or perhaps a pea, without peduncles. They con- 

 sist of mucous follicles whose mouths are occluded, and whose con- 

 tents have become a serous or colloid liquid. Very rarely lipomata 

 and myxomata are observed in the shape of globular or peduncu- 

 lated vegetations. Fibrous tumors, lipomata, and carcinomata, do 

 not generally spring from the mucous membrane itself, but rather 

 from the sub-mucous tissue. Among the great number of cases of 

 laryngeal tumor which Middeldorpf (1854) and Lewin (1862) have 

 collected, twenty-two had their seat upon the epiglottis, nine on 

 the aryepiglottic ligament, twenty-one on the ventriculus Morgani; 

 thirty-two on the true, five on the false vocal chords ; three on the 

 arytenoid cartilages ; eight on the anterior wall of the larynx ; while 

 in only two instances were pathological growths observed upon its 

 hinder wall, the most frequent seat of ulceration. Lewin seeks to ex- 

 plain this circumstance by the fact that the latter point is subjected to 

 alternate folding and extension during the motions of the glottis. 

 Such a position would therefore be the more prone to ulceration, while 

 commencing growths would soon break down ; so that, instead of 

 tumors, ulcers would form. It is a fact that tumors of the larynx, 

 and particularly polypi, which used to pass for pathological rarities, 

 have lately been observed and described in tolerably large numbers. 

 From the care with which autopsies are conducted at present, it is hard- 

 y to be supposed that hitherto most polypi of the larynx have been 



