ABNORMAL ANATOMY OF THE LARYNX. 



123 



parts was found apparently perfect in its orga- 

 nization. But not to rely on observations made 

 on the inferior animal, a case soon afterwards 

 occurred in the Richmond Surgical Hospital, of 

 a young female wounded in the trachea rather 

 low down in the neck. From this wound por- 

 tions of the ingesta frequently escaped, and 

 yet after death the larynx was found healthy, 

 its organization complete, and no unnatural 

 communication whatever between the oesophagus 

 and windpipe in any part or situation what- 

 ever. I have since had a precisely similar case 

 under my care in the Meath Hospital. These 

 are instances in which the epiglottis seems inert, 

 and the larynx is left patulous and unprotected ; 

 there are other cases in which it appears to be 

 morbidly active, although it is difficult to ex- 

 plain the agency by which such activity is pro- 

 duced. In prosecuting some experiments on 

 the subject of asphyxia, a stout middle-sized 

 dog was let down into a brewing vat that had 

 been emptied of the fermenting liquor about 

 ten minutes previously; he was to all appear- 

 ance perfectly dead in two minutes. After al- 

 lowing the "body to remain thus for twenty 

 minutes, it was examined : the glottis was 

 found to be of a very pale colour, and the rima 

 completely shut up by the close approximation 

 of the arytenoid cartilages. The epiglottis was 

 shut down like a lid upon a box, so as perfectly 

 to close the superior aperture of the larynx : 

 this latter was a curious appearance, and I 

 know not what muscles could produce the 

 effect, but the fact was witnessed by Dr. Hart, 

 now one of the professors of practical anatomy 

 in the College of Surgeons, by Dr. Young, and 

 others. I am also ignorant as to whether a 

 similar condition of the epiglottis obtains in 

 men who have been suffocated by carbonic 

 acid ; human subjects are seldom examined so 

 soon after falling into a state of asphyxia as to 

 allow of the immediate appearances being ob- 

 served, and yet information on this point 

 would be of great value in determining the 

 suitable means for attempting resuscitation. 



The most difficult part of the pathology of 

 the larynx to contend with is that which has 

 reference to muscular organization, and unfor- 

 tunately it is that which has been least ex- 

 amined, or on which examination has thrown 

 the faintest and most unsatisfactory light. 

 Furnished with an exquisitely delicate and 

 beautiful arrangement of muscle, the normal 

 actions of which are exemplified in the pro- 

 duction of the different sounds of the voice, 

 and in giving force to the exit of the air in 

 coughing, sneezing, &c. it would appear only 

 reasonable to suppose that the functional de- 

 rangements of the larynx should be accom- 

 panied by some appreciable corresponding le- 

 sion of its muscular apparatus ; yet such does 

 not seem to be the case, at least not invariably, 

 and we sometimes find the voice impaired or 

 perhaps lost, the muscles of the organ ex- 

 hibiting their ordinary appearance, and again 

 remarkable and seemingly important lesions 

 without much injury to voice or respiration. 

 Under these circumstances we must speak of 

 the morbid appearances that have been ob- 



served in the first instance, and consider the 

 irregularities of function afterwards. 



The muscles of the larynx are sometimes 

 found in a state of extraordinary develope- 

 ment amounting almost to hypertrophy. I 

 know not how far this may be considered to be 

 an abnormal condition, or whether it may not 

 be the natural result of great and constant em- 

 ployment of the organ : reasoning from ana- 

 logy this latter seems more probable, but dis- 

 section has hitherto thrown no light upon the 

 subject. 



They are likewise subject to atrophy or 

 wasting, the fibres appearing thin, pale, and 

 attenuated. Andral mentions cases of loss of 

 voice in which he sometimes found the fibres 

 of the thyro-arytenoid muscle wonderfully atro- 

 phied, and sometimes separated from each 

 other by some morbid secretion, either of pus 

 or tubercular matter. I have been informed by 

 Sir P. Crampton that he has seen in the Mu- 

 seum of the Veterinary College in London, 

 several preparations illustrative of the disease 

 termed " roaring" in the horse, which seems to 

 be produced by an atrophy of the arytenoid 

 muscles. A relaxation is thus effected which 

 allows to the arytenoid cartilages an unnatural 

 degree of mobility. Whilst the animal is at 

 rest or moving slowly, the current of air passes 

 gently, and there is no " roaring;" but when he 

 is put to greater speed and respiration becomes 

 more hurried or more forced, the little valves 

 are acted on, the rima is proportionably closed, 

 the breathing becomes stridulous, and that pe- 

 culiar noise so well known to persons conver- 

 sant with horses is produced. 



Lesion of function in the muscles of the la- 

 rynx exhibits itself in the opposite conditions 

 of atony and spasm. Examples of the former 

 are to be found in some cases of partial pa- 

 ralysis where the patients become totally in- 

 capable of uttering any sound, however in- 

 distinct and inarticulate ; in the hoarseness and 

 sometimes loss of voice that suddenly attacks 

 young persons, particularly females, from ex- 

 posure to cold and damp ; and perhaps fre- 

 quently in the sympathetic aphonia that precedes 

 or attends on phthisis. On the pathology of 

 these affections morbid anatomy has thrown but 

 little light, nor is it surprising that the subject 

 has attracted a minor degree of attention, when 

 it is recollected that the more severe laryngeal 

 symptom, that of difficult respiration, is seldom 

 or never present. I have had two cases of 

 aphonia attended with pain and soreness in the 

 larynx, which, under an idea that the disease 

 was either gout or rheumatism, I treated with 

 colchicum with apparently favourable results. 

 I know not whether the supposition that the la- 

 rynx may be the seat of either of these painful 

 affections is correct or not, but I see no reason 

 why it should enjoy so fortunate an exemption. 

 However, although atony of the muscles of the 

 larynx may not be attended with much peril, a 

 spasmodic action of them is always eminently 

 perilous, sometimes destroying life with a ra- 

 pidity that almost precludes the possibility of 

 assistance. There can, therefore, be few sub- 

 jects more interesting to the practitioner, and 



