The Recognition of Early Changes in the Larynx in Tuberculosis.

Not differing from tuberculosis elsewhere, the first definite change provoked by the bacillus in the larynx is an infiltration of the mucosa and submucosa by a diffusion of small, round, mononuclear cells, interspersed among which are collections of epithelioid and lymphoid cells in the form of tubercles, which are deposited, in large part, in the connective tissue beneath the epithelial and structureless layers, and hence near enough to the surface to change its aspect in form and feature. Accordingly, the recognition of early changes in tuberculosis of the larynx will be promoted by keeping in mind: First, the disposition of tubercles and tuberculous nodules to assume a globular form, which gives the surface of the infiltration, also termed hyperplasia, a mammillated aspect. Secondly, their disposition to excite verrucous and granulomatous formations which, though ordinarily delayed till the stage of ulceration, may make an earlier appearance and give the surface a