Buffalo medical and surgical journal . line and is truncated, with jagged upper edge,in comparison with the larger, which is intact and lies to the left;confluent ulceration, of ill-defined, irregular outline, occupies theremainder of this space to the right. 1. From cases reported to the Section on Surgery, Buffalo Academy of Medicine. May30, 1893. 2. Page 276. 276 CLARK : LARYNGEAL TUBERCULOSIS. The case is taken from my clinic records for May, 189 , thirty-one years old and married ; four living, healthychildren ; one child died in infancy of consumption ; clear heredi-tary and perso
Buffalo medical and surgical journal . line and is truncated, with jagged upper edge,in comparison with the larger, which is intact and lies to the left;confluent ulceration, of ill-defined, irregular outline, occupies theremainder of this space to the right. 1. From cases reported to the Section on Surgery, Buffalo Academy of Medicine. May30, 1893. 2. Page 276. 276 CLARK : LARYNGEAL TUBERCULOSIS. The case is taken from my clinic records for May, 189 , thirty-one years old and married ; four living, healthychildren ; one child died in infancy of consumption ; clear heredi-tary and personal phthisical history. Three weeks previous tovisit, throat felt as if it were growing up ; at this time noticedpain in the throat, which was pretty constant, increasing daily,and aggravated upon swallowing. There are phthisical cavities in the upper parts of both lungs. This history,in conjunction with the result of physical examina-tion, belongs with the largest figures in the statistics of the disease,with the exception of sex. *. LARYNGEAL TUBERCULOSIS.—Clark Three facts are herein illustrated : 1. Regional origin. Development and its bearing upon diag-nosis from syphilis. 2. Difficult and painful swallowing as the most prominentsymptom. 3. The best method of treatment. 1. The disease usually (a) begins in the posterior commissure,,in front of the arytenoid cartilages, working its way outwardsthrough the sub-mucosa, thence extending symmetrically to theary-epiglottic folds. This symmetrical arrangement of the ulcera-tion and tumefaction is a very important factor in the (6) differen-tial diagnosis from syphilis. In syphilis the ulcers are most fre-quently unilateral, single, and large; in tuberculosis they arebilateral, numerous, and sm,all; in syphilis the ulcers are sur-rounded by an inflammatory zone; in tuberculosis their margin is CLARK : LARYNGEAL TUBERCULOSIS. 277 pale. If the epiglottis is the seat of ulceration, syphilis seems tohave a predilection for its upper
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