tructures of the larynx.
Syphilitic ulcers are usually single, deep, and crateriform; the base
is covered with a dirty white secretion, and the surrounding mucosa
presents an angry red appearance. When the perichondrium becomes
invaded, necrosis of cartilage is liable to occur.

Hoarseness, dyspnoea, and, when the epiglottis is involved, dysphagia,
are the most prominent symptoms.

Cicatricial contraction leading to stenosis may ensue, and cause
persistent dyspnoea.

The usual _treatment_ for tertiary syphilis is employed, but on
account of the tendency of potassium iodide to increase the oedema of
the larynx, this drug must at first be used with caution. Intubation
or tracheotomy may be called for on account of sudden urgent dyspnoea
or of increasing stenosis. The stenosis is afterwards treated by
gradual dilatation with bougies, which, if a tracheotomy has been
performed, may conveniently be passed from below upwards. An annular
stricture causing occlusion may be excised, and the ends of the
trachea sutured.

#Tuberculosis.#--The larynx is seldom the primary seat of tubercle. In
the majority of cases the patient suffers from pulmonary phthisis, and
the laryngeal mucous membrane is infected from the sputum. The disease
may take the form of isolated nodules in the vicinity of the arytenoid
cartilages, of superficial ulceration of the vocal cords and adjacent
parts, or of a diffuse tuberculous infiltration of all the structures
bounding the upper aperture of the larynx. The mucous membrane becomes
oedematous and semi-translucent. The nodules coalesce and break down,
leading to the formation of multiple superficial ulcers. The parts
adjacent to the ulcers are pale in colour. Perichondritis may occur
and be followed by necrosis of cartilage and the formation of
abscesses in the submucous tissue of the larynx or in the cellular
tissue of the neck.

The voice becomes hoarse or may be lost, there is persistent and
intractable cough, and in some cases dyspnoea supervenes. When the
epiglottis is involved there is pain and difficulty in swallowing.

In the presence of advanced pulmonary phthisis the treatment is
chiefly palliative, but if the disease in the lungs is amenable to
treatment, and the laryngeal lesion limited, the electric cautery may
be used. Tracheotomy may be called for on account of urgent dyspnoea.

#Tumours.#--The commonest form of simple tumour met with in the larynx
is the _papilloma_. It may occur a