ABNORMAL ANATOMY OF THE LARYNX. 



125 



mental researches of Magendie and Le Gallois, 

 lie supposes that, if the recurrent nerves are 

 compressed to such an extent as to have their 

 functions impaired, the glottis, under the in- 

 fluence of the superior laryngeal branches, 

 would become and continue fast closed. The 

 cause of the disease then, according to him, 

 will be found in some tumour, scrofulous or 

 otherwise, so situated as to create an injurious 

 degree of compression on the recurrent nerves. 

 That an enlargement of the thymus gland may, 

 from its situation, produce great and serious in- 

 convenience, it would be absurd to question, 

 and perhaps there is sufficient evidence to shew 

 that it may occasion the symptoms and results 

 of this very disease : but it is far from being 

 proved that spasm of the glottis may not occur, 

 and even prove fatal in cases where no such 

 enlargement existed. Alterations of size, shape, 

 and structure, even if rapid, take place gradu- 

 ally, and their results should be gradual also, 

 whereas this disease has been known to destroy 

 its victim in its first and only paroxysm ; and 

 moreover, if structural change in the gland was 

 its sole exciting cause, it would be difficult to 

 account for its sudden disappearance on the 

 removal of the child to the country and its diet 

 being changed. Whilst therefore it may not 

 be denied that hypertrophy of the thymus can 

 occasion the phenomena by others attributed 

 to spasm of the glottis, there is not sufficient 

 proof of its being the general or even frequent 

 cause of this peculiar disease. I shall have 

 occasion to notice the supposed consequences 

 of pressure on the recurrent nerves hereafter. 



It is questionable how far spasm occasioned 

 by the contact of noxious or irritating sub- 

 stances can justly be termed sympathetic, for 

 they are the results of an application of a di- 

 rect stimulus : it is immediate in its effects, 

 and more or less complete according to the 

 nature or quality of the exciting cause. Death 

 from total submersion in carbonic acid gas 

 occurs so quickly as almost to seem instan- 

 taneous, and the spasm entirely occludes the 

 glottis. The mildest form of spasm seems to 

 be that occasioned by the accidental admission 

 of some particle of food which is usually 

 expelled again very quickly by a cough suf- 

 ficiently distressing but seldom dangerous: yet 

 instances have been known of the apparently 

 trifling occurrence of the introduction of a par- 

 ticle of salt being attended by a fatal result. 



However, when spasm is, or appears to be 

 produced by the presence of a foreign body in 

 the oesophagus or the trachea, or by the pres- 

 sure of an aneurismal tumour, it is evidently 

 sympathetic, and it may be interesting to in- 

 quire into the evidence by which such relation 

 of cause and effect is established. 



I had formerly entertained the opinion that 

 spasm of the glottis should be the consequence 

 of some irritation applied to the larynx itself, 

 and not external to or at a distance from it, and 

 therefore that the presence of a foreign body 

 in the oesophagus ought not to hold a place 

 amongst its exciting causes. I have since, 

 however, altered my views on the subject, and 

 indeed, when we consider the number of cir- 



cumstances under which this morbid action 

 may occur, we cannot be justified in denying it 

 in this case in opposition to most respectable 

 testimony. Mr. Kirby has published a case in 

 the Dublin Hospital Reports, in which death 

 was apparently produced by spasm of the glot- 

 tis in consequence of the lodgment of pieces 

 of meat and bone in the oesophagus : and Dr. 

 Stokes saw an instance in which a piece of 

 money was lodged in the oesophagus and where 

 croupy breathing and other laryngeal sym- 

 ptoms were manifestly the result. In this lat- 

 ter instance the foreign body was not lodged in 

 the fauces or pharynx. I have myself seen 

 cases to corroborate the above, but it is need- 

 less to swell this article with proofs of a patho- 

 logical fact that will probably not be called in 

 question. 



It is probably a new observation at all 

 events it is one of great pathological interest, 

 that spasm of the glottis may be produced by 

 the presence of a foreign body lodged within 

 the bronchi. In the month of May, 1836, 

 a child was brought from the country and 

 placed under the care of my friend Mr. Cu- 

 sack : his father's account of the case was that 

 he had swallowed a small pebble, was instantly 

 seized with a violent paroxysm of cough, had 

 croupy or sonorous breathing ever since the 

 accident with occasional remissions and exacer- 

 bations, but was sometimes brought to the 

 verge of suffocation. The stethoscopic indi- 

 cations were that the foreign body was loose 

 and mobile within the trachea. I assisted Mr. 

 C. in performing the operation of tracheotomy 

 on this child ; but, although the aperture in the 

 windpipe was made very large, no stone was 

 expelled, and the size of the organ did not 

 admit of the employment of any forceps with 

 which we were furnished. Immediately on 

 the opening into the windpipe being perfected 

 the croupy breathing disappeared, neither was 

 there a severe paroxysm of cough experienced 

 afterwards, and the father, either doubting that 

 the foreign body had ever obtained admittance, 

 or dissatisfied at its not being removed, car- 

 ried him off to the country contrary to the 

 wishes and advice of his medical attendants. 

 We afterwards heard that the little pebble had 

 been coughed up in about three weeks after he 

 left town, but have not been informed as to the 

 ultimate termination of the ca^e. 



On the 13th of September, 1839, a child, 

 aged three years and a half, was brought to the 

 Meath Hospital : he had, half an hour pre- 

 viously, swallowed a small stone, and was in- 

 stantly seized with a violent cough which con- 

 tinued up to the period of admission. His 

 breathing was quite stridulous countenance 

 expressive of great distress face and lips 

 lived efforts at respiration hurried and gasp- 

 ing. The left side of the chest heaved vio- 

 lently, the right was comparatively quiet : re- 

 spiration very weak and interrupted in the 

 right lung, in the left loud and puerile : no 

 dulness over either lung on percussion. I per- 

 formed the operation of tracheotomy, but no 

 foreign body was expelled, and yet the little 

 patient experienced the greatest relief. The 



