[Reprinted from The Medical News, November 4, 1893.] 
AN INSTANCE OF SPONTANEOUS HEALING OF 
AN ULCERATIVE TUB ERCULOUS 
LARYNGITIS. 
By CHARLES P. GRAYSON, M.D., 
OF PHILADELPHIA, 
ASSISTANT PHYSICIAN, DEPARTMENT OF DISEASES OF THE THROAT AND 
NOSE, HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA. 
Although, since the introduction of the surgical 
method of Heryng for the treatment of ulcerative tuber- 
culous laryngitis, instances of its cure are becoming 
more frequent in direct proportion as adoption of the 
method and its skilled application to suitable cases be- 
comes more general, examples of the spontaneous 
healing of this kind of laryngeal ulceration have not 
yet been recorded with sufficient frequency for them to 
have become commonplace. 
The subject of this report presented himself at the 
throat-department of the University Hospital, August 
21, 1893. He had never been examined or received 
any treatment prior to that date. 
The facts of his history pertinent to this report are 
these: The patient, Samuel H., twenty-five years of 
age, single, is a baker by trade. There have been no 
deaths in his immediate family, his parents, two sisters, 
and a brother, being vigorously healthy. He himself 
has never been confined to the house a single day by 
sickness since childhood, having been, up to the begin- 
ning of his present illness, particularly well and strong. 
With several friends he celebrated the 22d of Feb- 
ruary, 1892, by getting moderately tipsy, and during the 
afternoon and evening he did a great deal of shouting 2 
and singing, He does not remember that on the next day 
his voice or throat seemed any the worse for wear, but 
on the afternoon of the 24th his voice began to fail him 
and by nightfall had become extinct. The feeblest 
whisper required much effort and was provocative of 
considerable pain. There was no cough worth men- 
tioning, nor was there any dyspnea or dysphagia. 
With no other treatment than the enforced rest that 
his throat received, the pain attending attempts at pho- 
nation gradually disappeared during the ensuing two 
weeks, but, coincidentally, the voice failed to reappear. 
Shortly after the inception of this throat-trouble the 
patient began to lose flesh and strength; this has con- 
tinued, not rapidly, but without interruption, until now 
he scales fully forty pounds less than at the date of its 
commencement. On one of the intensely hot days of 
July, 1892, he was compelled by an attack of weakness 
to leave his work, and within an hour or two after 
reaching his home had quite a sharp hemorrhage, losing 
probably (allowing a margin - for the customary exag- 
geration) about four ounces of blood. In spite of this 
alarming incident he returned to his work the next 
morning, and since that time has had no recurrence of 
hemorrhage. A slight cough, however, added itself to 
his other symptoms at this time, remained slight for 
several months, but since the beginning of the past 
summer has much increased. With this exception, his 
further history to the date of his application for treat- 
ment is uneventful. 
Although it was the throat that was first examined, it 
may be well to precede the report of the condition of 
this part by a brief statement of the accompanying pul- 
monary disease that was investigated immediately after- 
ward. On the right side consolidation was found ex- 
tending from the apex of the lung to below the second 
rib. Bronchial breathing was present, but no rales. 
Below this, beginning on a level with the nipple, was 
another area of consolidation, over which sub-crepitant 3 
rales and other signs of softening were detected. The 
tubercle-bacillus was abundantly present in the sputum. 
The laryngoscopic examination disclosed an epiglottis 
perfectly normal in everything but color, which was a 
trifle below the tint of health. The ary-epiglottic folds 
were equally well-looking, as was also the greater por- 
tion of the ventricular bands. A large part of the pos- 
terior extremities of these, however, had been destroyed 
and replaced by cicatricial tissue. Upon the anterior 
surface of the meso-arytenoid fold a characteristic 
tuberculous vegetative growth was found. 
On both sides only a narrow ragged fringe of the 
vocal bands remained. Their anterior thirds had been 
least affected, but even here ulceration had deeply in- 
dented their substance, leaving the free margins ex- 
tremely irregular and the upper surfaces disfigured by 
welt-like ridges, somewhat resembling exuberant gran- 
ulations. Posteriorly the bands had been destroyed to 
their outermost limits; the vocal processes had been 
unable to resist the progress of the ulceration, and these, 
too, had melted away. 
The examination that disclosed all this destruction 
failed to reveal the least trace of then-active disease. 
Cicatrization had occurred wherever the ulcerative pro- 
cess had previously existed, and the probe demonstrated 
its firmness and maturity. The sloping surfaces of the 
ventricular bands were uneven at certain points, due, 
presumably, to isolated foci of infiltration, but these, 
during the three months that the patient has been under 
observation, have been perfectly quiescent, no tendency 
to renewed softening and disintegration having displayed 
itself. 
Success in bringing acute laryngeal tuberculosis to a 
standstill, even through the most judicious and skilled 
treatment, is so extremely rare that an instance like this 
of its spontaneous cure is of more than ordinary interest. 
Before dismissing the case it will not be a waste of 
time to indulge in a moment's speculation as to where 4 
the tubercle-bacillus secured its first foothold. Was the 
disease primary in the larynx or did its establishment in 
the lung antedate its laryngeal manifestation ? 
Did the rough usage of the throat eighteen months 
previously occasion a simple but violent catarrhal laryn- 
gitis leading to epithelial erosions; and was it through 
such breaches in its protective covering that the omni- 
present bacillus effected its entrance into the deeper 
tissues ? 
Or, on the other hand, was the lung the original site 
of infection, and was the young man's constitutional 
vigor such as to hold the disease there in abeyance 
until the unfortunate excess of February 22d reduced 
his vitality to such a degree that the hitherto inactive 
bacilli improved the opportunity to become aggressive, 
to widen their dominion in the lung, and to subse- 
quently colonize the larynx ? 
If we recall and group a few of the scattered inci- 
dents of his history, I think there will be little hesita- 
tion in deciding as to which of these two possibilities is 
the more probable. The patient and his mother, each 
of whom has been separately and closely questioned, 
concur in the statement that the young man enjoyed 
unimpeachable health up to the date of that fateful 
little spree. The entire absence of any history of illness 
preceding the present attack, therefore, lends added sig- 
nificance to the succession of events that have marked 
its course. These are : 
The non-recovery of the voice after the other symp- 
toms of a severe simple catarrhal laryngitis had disap- 
peared ; the progressive loss of weight and strength 
following within some weeks the onset of the throat- 
trouble ; the hemorrhage occurring about five months 
after its commencement, and this followed by the estab- 
lishment of cough; and, finally, the complete suspen- 
sion of the tuberculous process in the throat while it 
insidiously extended its lodgment in the lung, until now 
it seems upon the point of duplicating there the destruc- 
tion that attended its earlier occupation of the larynx.