DEGLUTITION. 201 



posture, and food and drink were habitually taken in that 

 position. At the time that this patient, a female, was in the 

 Bellevue Hospital, under the observation of Dr. Flint, the 

 deglutition was improving. Dr. Flint noted that after she 

 had been in the hospital a few days, on causing her to swal- 

 low in his presence, the act of deglutition was performed 

 with a certain deliberation but without difficulty. An exam- 

 ination of the parts with the laryngoscope was made by Dr. 

 Church, in the presence of Dr. Flint and Dr. Dalton : " The 

 absence of the epiglottis was determined by sight. The 

 vocal cords were distinctly seen. The little excrescences 

 described as apparent to the touch were visible." a 



In the case just described, there was not a constant and 

 considerable difficulty in deglutition ; but it is stated that 

 difficulty had existed, undoubtedly from the passage of arti- 

 cles into the larynx ; and when no such accident took place 

 the act was performed with a " certain deliberation." It is a 

 curious fact, also, that when the difficulty in swallowing was 

 considerable, deglutition was accomplished most easily in the 

 recumbent posture, in which the tendency of particles of 

 food to pass into the larynx must have been much lessened. 



While, with attention on the part of the subject, the lar- 

 ynx may frequently, and perhaps generally, be protected 

 from the entrance of foreign substances during deglutition 

 after loss of the epiglottis when other parts are not affected, 

 a study of the numerous cases of this lesion as the result of 

 disease or injury shows that the epiglottis is by no means so 

 inefficient in the protection of the larynx as was supposed by 

 Magendie. Still it is but one of the means which have been 

 provided for this end. 



Since the air-passages have been so fully explored by 

 means of the laryngoscope, this instrument has been used to 

 a certain extent in the study of the phenomena of deglutition. 



1 The points in the history of this case bearing on the functions of the epi- 

 glottis in deglutition were taken from the hospital records of Dr. Flint, by whom 

 they were personally noted. 



