420 
healing in one situation whilst fresh ones break 
out in the neighbourhood, and cicatrizing with 
a depressed surface and evident loss of sub- 
stance. With respect to symptoms, the loss or 
imperfection of voice will very much depend 
on the situation of the ulcers; but the diffi- 
culty of breathing and general distress are by 
no means criteria by which the extent of de- 
struction of parts can be estimated, for some- 
times there is uncommon sufiering where the 
ulceration is extremely limited. Very fre- 
quently these ulcers (particularly if the epi- 
glottis is engaged) a er symptoms of diffi- 
cult deglutition, exactly resembling those of 
Stricture of the esophagus: but this is only 
during the time the sores are actually open, 
for, when healed, swallowing is performed 
with astonishing facility, even although the 
greater part of the epiglottis may have been 
carried away. 
But the most interesting fact in connexion 
with these ulcers is, that by rest and proper 
treatment they are susceptible of cure, and for- 
tunate it is that by means of operation we are 
enabled to afford this important organ the requi- 
s.ite degree of repose. Mr. Carmichael ia 
published two most interesting cases illustrative 
of this fact ; in which the patients recovered, and 
in which we have consequently a right to infer 
that the ulcerations healed. In the summer of 
1838 I operated on a woman in the Meath 
Hospital, who had symptoms of such extensive 
destruction of parts as must have proved fatal, 
but who nevertheless recovered with a complete 
capability of breathing through the rima, but 
with nearly a total loss of voice. The healing 
of this kind of ulceration may be inferred from 
that case also, but it is proved by the following 
observation : “In the Museum of the School 
of Park-street, Dublin, is a preparation taken 
from a poor woman who had been an inmate 
of the Meath Hospital ten or eleven different 
times for venereal ulceration of the larynx, and 
finally died there quite suddenly, as if from the 
effects of spasm. It shews where a large por- 
tion of the epiglottis had been removed, the 
ulcer having healed by a puckered cicatrix. 
From below the left ventricle a longitudinal 
scar extended a full inch and a half down into 
the trachea, the contraction of which had di- 
minished the calibre of that part of the tube 
very sensibly. The right ventricle was totally 
obliterated, and on different spots about the 
superior part of the trachea there were several 
small pale depressed cicatrices, evidently the 
results of former sores that had been open at 
different periods at which she had been in the 
hospital. The only ulcer that existed at the 
time of her death was a very small one, with 
ragged irregular edges, situated midway be- 
tween the natural position of the right ventricle 
and the root of the epiglottis.” 
The softer tissues of the larynx are also occa- 
sionally liable to gangrene, cireumscribed—con- 
fined to the organ itself and not exhibiting any 
tendency to spread. Of this I have as yet seen 
but one example, and that one under circum- 
stances that rendered it doubtful whether the 
disease should not be considered as sympathetic 
ABNORMAL ANATOMY OF THE LARYNX. 
with a similar affection of the lung. It" 
the case of a man who died in hospital of 
grene of the lung supervening on acute pr 
monia. Seven days before his death he 
attacked with symptoms of Tabi 
hoarseness, with ditficult and laborious 
ing, which gradually increased until 
was nearly lost and respiration quite stridu 
After death, besides the gangrene of th 
a gangrenous ulcer was found, inve 
chord vocales at the left side: its 
about the size of a shilling, and of 
green colour ; its edges quite stough Ys 
centre excavated to a considerable 
mucous membrane around highly 
covered with a pellicle of lymph. 
3. The peter of the larynx are 
very important diseases, some of 
to be peculiar to fibro-cartitage in this par 
situation, and all of which are attende wi 
convenience ‘and danger by reason of | 
interfering with the function of the orga 
shall commence with that which I belie 
be the most frequent, the most importa 
the most fatal ; indeed, when allowed tor 
own course it is always destructive, 5 
the patient’s life is preserved by art, it is 
the alternative of breathing for ever af 
through an artificial aperture. In cor 
of the similarity of symptoms between 
phthisis pulmonalis, it has obtained the né 
phthisis laryngea. { 
The exact manner in which this dise 
mences and the causes that lead to its prot 
tion have not yet been so accurately ascerta 
as to admit of no farther doubt or question: 
instance, Mr. Ryland seems to think that 
most instances it is secondary to some if 
matory affection of the laryngeal mucous 
brane or its subjacent tisssue,” whereas I 
ventured to believe that the original mo 
action was set up in the cartilage itself and” 
proper and peculiar to it; at the same til 
toust be confessed that I have seen it appare 
produced by the presence of an abscess in 
immediate vicinity, and I believe there 
no doubt of its being an occasional sequel 
typhus fever. Theessence of thedisease seem 
be a change of structure in some of thee 
followed by the death and disorganizati 
the newly formed material, and an atte 
its removal by abscess and ulceration. — 
on a post-mortem examination of one of 1 
cases an abscess is always found in the situa 
of some of the cartilages—very generally 0 
broad posterior part of the cricoid: and 
abscess has burst by one or more openit 
of them being very frequently just behind 
above the rima. On cutting into the cay 
the abscess, besides the matter, which is g 
ish, putrid, and abominably fetid, partiel 
a grey or white earthy material are foun 
there are always portions of bone, thin, 1 
at the edges, white and perfectly dead. — 
the disease has so far progressed, there is alw 
other and more extensive mischief; the extel 
parts in the neighbourood are swelled and thi 
ened, the mucous membrane ulcerated; 
arytenoid cartilages often detached; and 
7 
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