Vocal Cords in Quiet Respiration in Man, fyc. 425 



been able for a long time to follow a case in "which qnite analogous 

 conditions had been produced by perichondritis of the larynx ending 

 in anchylosis of the crico-arytenoid articulations, the cords being 

 fixed in the cadaveric position. The width of the glottic base, 

 measured with the graduated mirror, completely corresponded with 

 about the maximum of that seen after death in that it was between 

 5 and 6 mm. (the patient was a woman). There were no other 

 laryngeal lesions interfering with the calibre of that organ, nor any 

 other affections causing diminution in the calibre of the air passages. 

 The patient when at complete rest breathed quietly and without any 

 effort ; the number of her respirations per minute was on the average 

 20. As -soon, however, as she was told to twice pace up and do'wn 

 the length of the room in which she was examined, and then to sit 

 down again, the number of her respirations at first very considerably 

 increased, viz., to 36 or 40, then gradually the frequency diminished, 

 but the inspirations became much more intense, the contraction of 

 the scaleni being distinctly visible, and the levatores alee nasi per- 

 ceptibly acting. It always took some time until the previous quiet 

 type of respiration was re-established. The patient complained of 

 considerable dyspnoea on however slight exertion. 



Thinking that a more positive reply to the question might be 

 obtained by a study of the effects in man of sudden diminution of the 

 calibre of the glottis to the cadaveric width, such as are unintentionally 

 produced sometimes by section of the recurrent laryngeal nerves during 

 operations for the removal of goitres, I addressed in 1884 a collec- 

 tive question to several colleagues* as to the respiratory phenomena 

 after sudden bilateral section, of paralysis of the recurrent laryngeal 

 nerves, and of even unilateral paralysis in children. The latter 

 question was inspired by the wish to learn whether, analogous to the 

 conditions observed in young animals, even a minor degree of diminu- 

 tion in the young human subject might lead to considerable respi- 

 ratory disturbance, a very interesting case reported by Sommerbrodtf 

 having shown that unilateral paralysis of an abductor muscle of the 

 vocal cord (which in the adult so far as respiration is concerned is 

 perfectly harmless) suffices in a child of 1 year to produce most 

 grave dyspnoea necessitating tracheotomy. 



I regret to say that this question has not been productive of any 

 satisfactory reply. 



In a paper published since by Jankowski,J some statements occur 

 which are of interest in connexion with the subject of the present 

 investigation, inasmuch as they refer to cases in which both recurrent 



* ' Internationales Centralblatt fur Laryngologie,' &c., 1884, p. 40. 

 t ' iBreslauer Aerztliche Zeitschrift,' No. 10, 1881. 



J " Lahmungen der Kehlkopfmuskeln nach Kropfexstirpation " (' Deutsche 

 Zeitschrift f. Chirurgie,' vol 12). 



VCL. XLVIII. 2 G 



