Clinical tuberculosis . te consideration elsewhere in these pages (see Volume II,Chapter XXX. Hoarseness.—Hoarseness may be due to several causes in ad-vanced tuberculosis. Probably the most frequent cause operat-ing to produce it is reflex stimulation. This we are justified inassuming from the fact that it begins often as one of the earliestsymptoms before other causes which operate later, are present,and also from the fact that it is so often exaggerated with theacute inflammatory changes which accompany the advanced dis-ease. The stimulation may come through either the superior or in-ferior
Clinical tuberculosis . te consideration elsewhere in these pages (see Volume II,Chapter XXX. Hoarseness.—Hoarseness may be due to several causes in ad-vanced tuberculosis. Probably the most frequent cause operat-ing to produce it is reflex stimulation. This we are justified inassuming from the fact that it begins often as one of the earliestsymptoms before other causes which operate later, are present,and also from the fact that it is so often exaggerated with theacute inflammatory changes which accompany the advanced dis-ease. The stimulation may come through either the superior or in-ferior laryngeal nerves. When through the former, there is arelaxed condition of the cords; they are not stretched tightly, buthave a sagging appearance; the ends approximate, but thecenters do not, leaving an oval slit between, as shown in Fig. through the inferior laryngeal, the cord, usually on oneside, lags, failing to approximate its fellow, as shown in Fig. 82. 448 SIGNS AND SYMPTOJIS OF PULMONARY TUBERCULOSIS. <I FEVER CHART 449
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