t any age, and is comparatively
common in children. It most frequently springs from the vocal cords
and adjacent parts, forming a soft, pedunculated, cauliflower-like
mass of a pink or red colour, which may form a fringe hanging from
the edge of the cord (Fig. 288), or may spread until it nearly fills
the larynx. In children, the growths are frequently multiple and show
a marked tendency to recur after removal. They sometimes disappear
spontaneously about puberty.

[Illustration: FIG. 288.--Papilloma of Larynx.

(From drawing lent by Dr. Logan Turner.)]

The most prominent symptoms are hoarseness, aphonia, and dyspnoea,
which in children may be paroxysmal.

The _treatment_ consists in removing the growth by means of laryngeal
forceps or the snare, under cocain and adrenalin anaesthesia. For the
removal of multiple papillomata, the removal of the growths through
Killian's tubes or by suspension laryngoscopy has now taken the place
of the external operation in children. In a certain number of cases it
has been found that the tumour disappears after the larynx has been
put at rest by the operation of tracheotomy.

#Cancer.#--_Epithelioma_ of the larynx is almost always primary, and
usually occurs in males between the ages of forty and seventy. It is
important to distinguish between those cases in which the growth first
appears in the interior of the larynx--on the vocal cords, the
ventricular bands, or in the sub-glottic cavity (_intrinsic
cancer_)--and those in which it attacks the epiglottis, the
ary-epiglottic folds, or the posterior surface of the cricoid
cartilage (_extrinsic cancer_).

_Clinical Features._--In the great majority of cases of _intrinsic_
cancer the first and for many months the only symptom is huskiness of
the voice, which may go on to complete aphonia before any other
symptoms manifest themselves. When the larynx is examined in an early
stage, the presence of a small warty growth on the posterior part of
one vocal cord, or a papillary fringe extended along the free edge of
the cord, should raise the suspicion of malignancy, especially if the
affected cord is congested and moves less freely than its fellow.
Early diagnosis is essential in intrinsic cancer, and the absence of
enlargement of lymph glands, or of foetor and cachexia, must in no way
influence the surgeon against making a diagnosis of malignancy. The
impaired mobility of the affected cord is an important point in
determining the mali