Diseases of the nose and throat . oms even at the beginning isrough. The cough of laryngeal tuberculosis is most marked in the TUBERCULOSIS OF THE LARYNX. 367 morning and when the patient first assumes the recumbent positionat night. The diagnosis of laryngeal tuberculosis in typical cases is free fromdifficulty. There is hardly any laryngeal disease, however, whichpresents so many variations from what we are accustomed to call thetypical form. In the early stages of the disease, a feature by nomeans invariable, which strikes us with most force in the laryngealmirror is the pallor of the mucou
Diseases of the nose and throat . oms even at the beginning isrough. The cough of laryngeal tuberculosis is most marked in the TUBERCULOSIS OF THE LARYNX. 367 morning and when the patient first assumes the recumbent positionat night. The diagnosis of laryngeal tuberculosis in typical cases is free fromdifficulty. There is hardly any laryngeal disease, however, whichpresents so many variations from what we are accustomed to call thetypical form. In the early stages of the disease, a feature by nomeans invariable, which strikes us with most force in the laryngealmirror is the pallor of the mucous membrane. This is especiallymarked in the chronic form and is not proportionate to the degreeof general anemia. Infiltration and tumefaction are observed particu-larly in the interarytenoid space and of the ary-epiglottic folds. Thenormal prominences of the arytenoids are effaced by a pyriform swell-ing involving both sides of the larynx and usually quite assume the so-called club-shaped contour (Fig. 125). The. Fig. 125. Tuberculosis of Larynx. Clubbing of Arytenoids and PapillaryExcrescences at Posterior Commissure. (Schnitsler.) epiglottis may be infiltrated and swollen, or turban-shaped. Inexceptional cases the infiltration of the larynx is unilateral, and theuncertainty of diagnosis is much increased (Fig. 126). The mucousmembrane has an edematous, soggy look. The movements of thearytenoids are interfered with by infiltration of the muscles or pos-sibly by an inflamed cricoarytenoid joint. The importance of thelatter has been especially insisted upon by W. Fowler, who in upwardsof fifty autopsies found implication and more or less disorganizationof the joint in every instance. Aphonia may be due to this cause, orsimply to a general weakness of the intrinsic muscles of the larynx, 368 DISEASES OF THE NOSE AND THROAT. or to an intercurrent laryngitis. When there is apparent unilateralparesis it is generally observed upon the right side and is due toinvolve
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