A text-book on diseases of the ear, nose and throat . xclusive view, stating that they are quite as often 630 DISEASES OF THE LARYNX. seen in connection witli syphilis or even in clironic laryngitis indepen-dently of any specific dyscrasia. Tuberculomata of the trachea havebeen described by Ariza and J. X. Mackenzie. Symjjtoms.—The most common initial symptom is impairment of vocalintegrity. At first, speaking may be simply difficult without noticeablealteration of tone, and apparently due only to im^Dairment of thoracic ex-pulsive power. [Nothing abnormal is found on examination. Such slights
A text-book on diseases of the ear, nose and throat . xclusive view, stating that they are quite as often 630 DISEASES OF THE LARYNX. seen in connection witli syphilis or even in clironic laryngitis indepen-dently of any specific dyscrasia. Tuberculomata of the trachea havebeen described by Ariza and J. X. Mackenzie. Symjjtoms.—The most common initial symptom is impairment of vocalintegrity. At first, speaking may be simply difficult without noticeablealteration of tone, and apparently due only to im^Dairment of thoracic ex-pulsive power. [Nothing abnormal is found on examination. Such slightsymptoms are of significance with reference to tubercular disease only inconnection with evidence of lesions elsewhere. Instances of eunuchoidvoice have been reported by Castex ^ and others. If the local process hasgone on to actual infiltration sufficient to prevent perfect approximationof the posterior ends of the cords, there are varying degrees of hoarse-ness corresponding in a general way to the extent of the lesion. Browne Fig. 256. Fig. Tubercular infiltration and ulceration. (Grun- Diffuse tuberculous infiltration of the entire wald.) larynx, and tuberculous tumor formation. (Griin- wald.) calls attention to a vocal condition not generally described. This isfound in the rapidity with which the voice changes in character during ashort conversation from a gruff hoarseness to a high falsetto, which asquickly passes into a toneless whisper. This variation is doubtless dueto lodgement and dislodgement of secretion and also to peripheral nerveirritation affecting the tension of the cords. Minor vocal changes are thesame as in congestion from any cause, and the voice may show periods offreedom from any impairment. Another early symptom is cough, at firstdry, and coming on in a jerky manner whenever the patient attemptsto speak. At times it is like that of pertussis, followed or not by ex-pectoration and frequently by vomiting. This stage is often associatedwith intralar
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