ference to its commencement or the early pe- 
riods of its progress, but to its effects or pro- 
ducts, which, exhibiting various forms of de- 
rangement and disorganization, shew to the 
morbid anatomist the length of time the work 
f destruction must have been in operation, 
and the extraordinary changes of shape and 
orm and structure that may occasionally be 
ndured consistently with the maintenance of a 
miserable existence. 
_ The simplest form of altered structure in the 
_ Mucous membrane that I am aware of is that 
ed by a slow but progressive deposit (pro- 
ibly of lymph) within its substance, which 
enders it firmer, thicker, and more solid ; and 
though this must occasion inconvenience and 
ifficulty of respiration to a certain extent, and 
ublesome from the dry cough and occa- 
al spasmodic exacerbations that accompany 
» yet perhaps, whilst restricted to this stage, 
{is seldom perilous to life. But these altera- 
ions of structure, particularly if neglected, are 
eldom quiescent, and however slow in their 
progress have a tendency to move forward 
ither to a morbid or perhaps malignant change 
of the tissues, or to the partial removal of these 
by the process of ulceration. Thus, ulcers of 
e 
he larynx, however heretofore overlooked by 
pathologists, are now found to be extremely 
common, and I| know of nothing more diffi- 
sult than to subject the numerous varieties of 
them to any form of classification. They cannot 
be arranged according to structure, for they are 
very seldom so superficial or so insulated as to 
engage the mucous membrane alone ; neither 
ean they be classed according to the symptoms 
they occasion, for the suffering of the patient 
even his ultimate danger does not seem 
entirely to depend on their extent or character. 
The most practically useful division of these 
ulcers would be as to their exciting cause if it 
could always be discovered; yet even here 
there is so much uncertainty of symptom 
during life and such diversity of appearance 
after death as to render the subject obscure and 
unsatisfactory. 
In some instances the larynx becomes the 
seat of idiopathic ulceration, that is, the dis- 
ease seems to have been occasioned by cold or 
other causes of local irritation—at least such is 
he only explanation to be offered. “ Thus the 
laryngeal surface of the epiglottis and the in- 
ernal parts of the organ itself may be studded 
over with numerous minute aphthous ulcera- 
tions ; sometimes the edges are marked bya 
ellow line of superficial excoriation, bordered 
by a deep blush of inflammation; and in these 
cases I have always observed, during life, that 
great pain and difficulty of deglutition accom- 
per the symptoms of dyspnea, and often 
ormed the most prominent feature of the case. 
_ Occasionally the ulceration is deep and foul, 
and spreads with an almost phagedenic de- 
 Structiveness: these sporadic sores, usually 
ommencing above, either in the soft palate or 
_ the back of the pharynx and spreading down- 
_ wards, too often involve the destruction of the 
‘patient. Occurring as they constantly do in 
_ bad and cachectic habits, they are little under 
} 
om 
ia 
b 
te. 
ABNORMAL ANATOMY OF THE LARYNX. 
1192 
the control of medicine, and operation, how- 
ever it may prolong existence, scarcely holds 
out a hope of ultimate recovery.” 
In other cases the ulceration seems to be 
sympathetic, and either precedes or follows 
certain affections of the lung. Thus in cases 
of tubercular consumption, aphonia is often a 
very distressing symptom, sometimes accom- 
panied by difficult respiration, and occasionally 
by painful deglutition. In these instances not 
only is the larynx studded over with specks of 
ulceration, but the trachea and bronchial tubes 
leading to the cavity in the lung present a 
similar appearance, as if the matter possessed 
some corrosive quality and its passage over the 
mucous membrane became the cause of its 
ulceration. These appearances have been too 
frequently observed not to have attracted the 
notice of the morbid“mnatomist, but still it is 
extremely difficult to connect them with dis- 
ease of the lung in the relation of cause and 
effect, for sometimes the loss or imperfection 
of voice precedes or at least is amongst the 
earliest symptoms of consumption, and in other 
instances it only becomes manifest in the very 
latest stages. It is easy to conceive that the 
presence of an ulcer in the larynx, by pro- 
ducing difficult breathing and occasioning a 
diminution of the supply of air, may deter- 
mine the development of an abscess in a scro- 
fulous lung already well disposed to such dis- 
ease; but when the ulceration has occurred at 
a late period, and the difficulty of swallowing, 
the aphonia, and stridulous breathing appear 
among the closing symptoms of consumption, 
it will be difficult to account for the appear- 
ances observed, unless by supposing them to 
be sympathetically produced. 
But of all the causes from which ulcerations 
of the larynx are known to proceed, some 
specific or constitutional taint seems to be the 
most influential, such as syphilis, scrofula, mer- 
cury, or a combination of two or more of these. 
As far as my own observation extends, I cannot 
say I have ever seen the larynx engaged ina 
case of venereal where no mercury had been 
used, but on the other hand there is scarcely any 
organ more likely to be attacked where the me- 
dicine has been imperfectly or improperly used, 
or in which the attack is more perilous and 
unmanageable. Sometimes the larynx becomes 
ulcerated in consequence of phagedena or other 
destructive form of the disease spreading down- 
wards from the throat or fauces, but more fre- 
quently is it engaged alone. The ulcers here 
are seldom solitary, but present several spots of 
ulceration, and in some cases are so extensive 
that the whole configuration of the organ is 
spoiled and lost, the epiglottis being partially 
or entirely removed, and the chorde vocales and 
ventricles carried away. The surface of this 
extensive ulceration is irregular, warty, and 
gives the appearance of uneven granulation, 
and there are chaps and fissures that pass 
deeply into the substance of the subjacent car- 
tilage, portions of which are removed. When 
.the ulcers are more superficial they very often 
exhibit the herpetic appearance and the ten- 
dency to spread observed in mercurial sores, 
