122 



ABNORMAL ANATOMY OF THE LARYNX. 



the product of cicatrization, and the place which 

 should have been occupied by the broad por- 

 tion of the cricoid cartilage exhibits an empty 

 cavity, as if that structure had been removed 

 by absorption or some other process, and 

 nothing deposited in its room. One of the pa- 

 tients on whom I operated in the year 1829 

 died about a year since in the Fever Hospital, 

 and the larynx was examined by the surgeon of 

 that institution, Mr. Trant ; it presented ap- 

 pearances so nearly similar to the above as not 

 to require particular detail, and quite sufficient 

 to shew that the original destruction had been 

 such as totally to preclude the possibility 

 of the organ ever being capable subsequently 

 of performing the ordinary function of respi- 

 ration. 



The cartilages of the larynx are also liable to 

 mortification following on inflammation, and 

 apparently produced by the causes that induce 

 gangrene in other structures. I suppose this 

 affection to be extremely rare, as I have met with 

 but two cases, and have not heard of its being 

 observed by others. In one of these cases a 

 large abscess existed in front of the larynx and 

 upper part of the trachea, in which the thyroid 

 cartilage lay like a foreign substance entirely 

 denuded, mortified, and abominably offensive, 

 its appearance resembling that of wetted rotten 

 leather. The front of the cricoid cartilage and 

 of the two upper rings of the trachea had been 

 removed by mortification also. The lining 

 membrane of the larynx was thickened, corru- 

 gated, and had a granular appearance ; part of 

 it was ulcerated, through which the abscess had 

 communicated with the pharynx. The remnant 

 of this larynx is preserved in the pathological 

 collection of the School in Park-street, and 

 shews that at least five-eighths of the organ had 

 been totally and entirely destroyed. It proves 

 that such a disease must be utterly hopeless and 

 irremediable, and that, quite independent of the 

 constitutional derangement that must lead to 

 its formation and accompany its progress, no 

 chance could exist of cicatrization and subse- 

 quent recovery. 



Occasionally, although I should suppose very 

 rarely, the cartilages of the larynx are the sub- 

 jects of an alteration of structure strongly re- 

 sembling the ordinary product of scrofula. Of 

 this I have seen but one specimen, for which I 

 am indebted to the kindness of my friend Dr. 

 Benson. December, 1838. A man, set. 39, 

 was received into the City of Dublin Hospital, 

 under the care of Dr. B. for the treatment of 

 what was considered to be chronic rheumatism. 

 It was soon discovered that the pains were not 

 rheumatic, but most probably depended on 

 cerebral disease. The larynx presented a firm 

 tumour externally, and there was an almost 

 total loss of voice. He died, and after death 

 scrofulous tubercles were discovered in the 

 brain. The larynx was of a healthy structure 

 in every part except in the thyroid cartilage, the 

 alse of which were converted into a firm scrofu- 

 lous mass, about the size of a large chesnut on 

 each side. The scrofulous or tubercular matter 

 appeared to have been deposited originally in 

 the centre of each ala. The margins and cor- 



nua of the cartilage were unaltered, and lh 

 cartilaginous structure seemed to lose itself in- 

 sensibly on the surface of the tumour. 



This very interesting preparation is preserved 

 in the Museum of the Royal College of Sur- 

 geons in Ireland. 



Besides these deviations from the ordinary 

 healthy conditions of the cartilages of the la- 

 rynx, it is certain that one at least of them pre- 

 sents appearances of abnormal changes both of 

 size and shape. Morbid thickening or hyper- 

 trophy of the epiglottis, as well as its opposite 

 state of contraction or shrivelling, have been 

 spoken of by authors, but I have never been 

 fully satisfied that the former of these was not 

 rather the result of a thickened condition of the 

 mucous membrane than of the cartilage itself, 

 and I believe the latter never is seen unless as 

 the consequence of previous ulceration. A de- 

 viation from its usual shape is by no means 

 very uncommon in this cartilage, most instances 

 of which are trivial and unimportant, and are 

 probably congenital ; but in some few instances 

 the change is more remarkable. One of these 

 has been noticed by Dr. Stokes in the chapter 

 of his work which treats of diseases of the la- 

 rynx and trachea, and by him it is termed the 

 leaf-like expansion of the epiglottis. He de- 

 scribes it thus : " This has not been described by 

 any author, but a most remarkable preparation 

 of the disease exists in the Museum of the 

 School of Anatomy and Medicine in Park- 

 street. The epiglottis is thinned and singularly 

 elongated, and its form so altered as to repre- 

 sent the shape of a battledore, the narrow ex- 

 tremity being next the glottis. In the prepara- 

 tion alluded to it is fully two inches in length, 

 and coincides with double perforating ulcers of 

 the ventricles. Nothing is known as to the 

 history of the case, but I have seen more or 

 less of a similar alteration in other cases of la- 

 ryngeal disease." 



In a paper professedly devoted to abnormal 

 anatomy, I know not whether I am warranted 

 in noticing derangements of function, unat- 

 tended by any lesion of structure discoverable 

 by dissection, yet there are some of these ex- 

 hibited by the epiglottis which seem deserving 

 of the attention of the physiologist. The use 

 ascribed to this cartilage of protecting the la- 

 rynx during the process of deglutition is well 

 known, yet observation has furnished us with 

 examples of exceptions to this use, both posi- 

 tively and negatively ; for, as when this valvular 

 structure is altogether removed (by experiment 

 in animals and by disease in man), the larynx 

 is nevertheless often found able to protect itself, 

 and the subject to swallow both liquidsand solids 

 without much, and occasionally without any in- 

 convenience, so, on the other hand, it is a fact 

 which cannot be controverted, that the epiglottis 

 sometimes seems to be deprived of its protec- 

 tive sensibility, and permits the free introduction 

 into the windpipe of substances attempted to 

 be swallowed. This latter fact I first noticed in 

 the case of a Wapiti deer which was bronchoto- 

 mized by Sir Philip Crampton : it frequently 

 discharged portions of its food through the 

 wound, and yet after death the larynx in all its 



