326 Prof. T. P. Anderson Stuart. [Jan. 21, 



Around the central point of this triradiate fissure are to be noted 

 three prominences or thicknesses, viz., in front, and in the mesial 

 plane, the cushion of the epiglottis more or less filling up the slight 

 hollow left between the two prominences next to be mentioned, viz., 

 slight thickenings at the point of flexion of the ary-epiglottic folds, 

 where the lateral boundary of the antero-posterior limb of the fissure 

 becomes continuous with the posterior boundary of the transverse 

 portion ; these are the tubercles of Wrisberg. 



Having observed the appearances in the case of Dyason (' Jl. 

 Anat. Physiol.,' ut supra), I thought it advisable to get independent 

 observations made by professed laryngologists, whom I had made 

 acquainted with my observations. At my request, therefore, Dr. 

 Barrett and Mr. Iredell, of Melbourne, kindly undertook to look into 

 the matter, and here is what they say : 



Dr. Barrett. " The appearances of the larynx as seen from above 

 with the laryngoscope when closed during forcible expulsive efforts. 

 A laryngoscopic examination was made in the cases of two young 

 men with normal throats. They were directed to make expulsive 

 efforts, as in defalcation. In both cases the appearances were similar. 

 A view was first obtained during ordinary expiration, and then forcible 

 expulsive efforts were made. The following changes occurred : 

 The cords and arytenoids approximated, and then the arytenoids 

 moved forward until the mucous membrane and cornicula over them 

 were firmly pressed against the epiglottis, at a point much higher 

 than the attachment of the vocal cords. The epiglottis did not 

 during the closure in any way alter its inclination, remaining vertical 

 throughout. In one case, however, it became very much more curved 

 round a vertical axis. It did not participate actively in the closure. 

 The closed larynx may be said to show a triradiate figure like a 

 shortened ~fj tne vertical limb being much shortened, and representing 

 the fissure between the arytenoids, and the crossed limb being some- 

 what curved." 



Mr. Iredell. " Undoubtedly during straining the posterior carti- 

 lages of the rim of the larynx come forward and appear to be about 

 to form the figure you draw, but long before anything of the kind is 

 perfect the muscular parts of the pharynx prevent all view. This is 

 much more so during the act of swallowing. This much is clear : 

 there is no sign of the epiglottis folding backwards and downwards, 

 and as the act of swallowing proceeds this would appear to become 

 more and more impossible. Yet there is an appearance it may be 

 only an appearance of a tendency to move back the whole body of 

 the tongue, carrying with it the epiglottis."* 



* I believe that the difference in the amount seen by the two observers is due to 

 the fact that Dr. Barrett probably used the cocaine spray, while Mr. Iredell did not. 

 I remember that the former did use it in one case in nay presence, while with the 

 latter I did not speak of it. 



