y. AFFECTIONS OF THE LA.RYNX. 



overlooked in the cadaver. On the other hand, the numerous observa- 

 tions of polypous growths of the larynx come, in great part, from such 

 trustworthy investigators, that we cannot believe that insignificant 

 growths or folds of mucous membrane can have been mistaken for and 

 reported as polypi. Until the introduction of the laryngoscope, a 

 positive diagnosis was impossible, save in rare instances. It is true, that 

 sometimes we could surmise, with a certain degree of confidence, that a 

 tumor was growing in the larynx, when the symptoms of laryngeal 

 stricture began to supervene on those of laryngeal catarrh, and the 

 dyspnoea underwent fluctuations as the varying engorgement or deple- 

 tion of the growth made it vary in size. The probability became 

 greater, when, in the course of the disease, repeated attacks of suffo- 

 cation took place, which we could only attribute to contraction or 

 closure of the glottis caused by the sudden change of position of the 

 tumor. However, even the periodical return of such choking-fits, 

 which used to be considered pathognomonic of growths within the 

 larynx, by no means made the diagnosis sure. Certainty was possible 

 in those cases only in which the growth protruded, so as to become 

 accessible to palpation or to inspection, or where the patients coughed 

 up fragments of the tumor. 7 



To-day, the recognition of a tumor in the larynx presents no diffi- 

 culties ; but the majority of the polypi and excrescences so easily and 

 certainly detected by laryngoscopy have not produced the symptoms 

 hitherto described as pathognomonic. Most of the patients had suffered 

 merely from hoarseness, aphonia, or troublesome cough, and many of 

 them had in vain been sent to Obersaltzbriinnen, Ems, or even to Cairo 

 or Algiers, there to recover from then* supposed laryngeal catarrh or 

 consumption. It is just this class of cases which shows what high time 

 it is that a greater number of physicians should pay more attention to 

 the laryngoscope, so as not to leave this very important art, so 

 essential for the diagnosis of disease of the larynx, and which is not so 

 very difficult to learn, in the hands of a few specialists. With the aid 

 of the excellent books of Czermak, Tilrk, Bruns, Lewin, Halbertsma, 

 and by dint of assiduous practice, the necessary skill may be acquired to 

 enable us, in doubtful cases, to make use of laryngoscopy, to effectually 

 confirm our diagnosis. It is not necessary to examine all patients who 

 are suffering from an acute laryngeal catarrh ; and, as the procedure is 

 always a fatiguing one, it would be cruel to subject patients to it whc 

 have advanced pulmonary phthisis, with hoarseness and aphonia, and 

 who, in their desolate condition, so often turn to the specialists. If, 

 however, hoarseness, a harsh cough, and other symptoms which we had 

 supposed dependent upon a simple catarrh, persist in spite of sedulous 

 treatment, even though no signs of laryngeal stricture may exist, we 



