PATHOLOGY AND MORBID ANATOMY.--In catarrhal chronic laryngitis there is congestion of the mucous membrane, dilatation of the blood-vessels, and altered secretion. The mucous membrane becomes, as a rule, hypertrophied, tougher, and more firmly connected with the subjacent tissues. Laryngeal venous congestion (so-called phlebectasis laryngea) is occasionally, though rather rarely, met with; and still more rare is a hemorrhage from the surcharged vessels in chronic cases. In granular or glandular chronic laryngitis--_i.e._ when the muciparous glands are prominently involved in the inflammatory process--they form elevations, making the surface uneven, and the tissues become tenser and more compact. When the submucous connective tissue takes much part in the process the hypertrophy is still greater, and not only may the lumen of the laryngeal cavity become greatly diminished, but projections of various lengths (the so-called cellular polypi and papillary excrescences) are apt to occur. The objective term tuberosa is sometimes added to laryngitis or to the designation for inflammation of a portion of the larynx; as, for example, that of the vocal bands--viz. chorditis tuberosa, when small whitish, tumor-like elevations occur. These, especially on the vocal bands, where they have been described by Tuerck, Elsberg, Cohen, and others, are also called trachomata. In cases to which the name muscular chronic laryngitis is given the muscular tissue has been found prominently hypertrophied. Moura Bourillou has recorded a case in which the striated fibres of the posterior crico-arytenoid muscle were converted into fibrous tissue. In many of {123} the common cases of catarrhal chronic laryngitis the alteration of the voice depends upon paralysis of the muscles--especially the thyroid arytenoid and the arytenoid--directly caused by the transmitted inflammation and by thickening of the overlying mucous membrane. In fetid chronic laryngitis there is usually found excoriation of the mucous membrane, and atrophy. That erosions--_i.e._ superficial ulcerations extending no deeper than the epithelial layer--frequently occur in the course of catarrh is admitted by everybody, but much unnecessary discussion has been indulged in concerning the question whether deeper ulcerations of the mucous membrane can ever take place under these circumstances. It has been insisted upon that catarrhal ulcerations never occur. This is a mistake, but it is true that catarrhal ulceration is rare unless the patient is greatly debilitated or cachectic. Ulcerative chronic laryngitis in the majority of cases depends upon some cachexia--_i.e._ tuberculosis, syphilis, lupus, lepra, etc.