149 



I refer to the swelling of the epiglottis as ascertained by the touch. 

 The discovery of it, according to Bayle, {Diet, des Scien. Med., 

 tome xviii., p. 507,) is due to M. Thuillier, who proposed it in a 

 thesis sustained before the Faculty of Medicine in Paris, in 1815. 

 The value of this sign will be admitted if we consider how frequent 

 the swelling of the epiglottis co-exists with that of the glottis. 

 Bayle, (he. eit.,) who dissected more than seventeen cases of this 

 disease, says, "the epiglottis is rarely intact, often it is very much 

 swollen at its edges." Ryland says, (loc. eit., p. 48,) "The oedema 

 is seldom confined to these localities, but extends to the base and 

 latejal edges of the epiglottis, &c." 



Among seventeen cases collected from different sources, and in 

 which the condition of the epiglottis was ascertained, either by dis- 

 section after death, or by the touch or inspection during life, swell- 

 ing was found in fifteen. Of the eight cases reported in this paper, 

 the epiglottis was found swollen in seven, and in the remaining one 

 there was no evidence that it was not swollen. 



This swelling takes place either at the margin on one or both sides 

 of the median line, or on the lingual surface of the epiglottis at its 

 base, filling up one or both depressions between it and the tongue, 

 and obliterating the central glosso-epiglottic frsenum. 



It conveys to the touch the sensation of a soft pulpy body, easily 

 recognized and distinguished from the stiff rigid swelling of these 

 parts in membranous laryngitis. 



The facility of ascertaining the condition of the epiglottis with 

 the end of the forefinger, not only by placing it in contact with its 

 anterior surface, but by passing over its upper edge and applying it 

 upon its posterior surface, has been already noticed. 



To test this question still further, the experiment has been repeated 

 in at least twelve individuals, and in all with success, though not 

 with equal facility. In some these parts were easier of access than 

 in others, but in none did the experiment fail. 



In the exceptional cases where the epiglottis is not found swollen, 

 the edges of the glottis may be brought more within reach by press- 

 ing up the os hyoides with one hand applied externally over it, and 

 acting from below upward, while the forefinger of the other hand is 

 introduced as directed into the mouth. 



Should this not accomplish the object, the fore and middle finger 

 may be thrust far back into the pharynx, as is required for the re- 

 moval of a foreign body lodged in the throat. 



In all the five cases treated by scarifications, it will be remem- 



