DEGLUTITION. 333 



tioned above. The difficulty in swallowing was noted as not great, but the patient swal- 

 lowed liquids more easily than solids. The difficulty consisted of cough and loss of breath, 

 as the patient described it. It was less when articles were swallowed while the patient 

 was in the recumbent posture, and food and drink were habitually taken in that position. 

 At the time that this patient, a female, was in the Belle vue Hospital under the observa- 

 tion 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 swallow in his presence, the act of degluti- 

 tion was performed with a certain deliberation but without difficulty. An examination 

 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 

 chords were distinctly seen. The little excrescences described as apparent to the touch 

 were visible." 



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 

 articles 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 swal- 

 lowing 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 larynx may frequently, and per- 

 haps 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 degluti- 

 tion. In July, 1865, a note was presented to the French Academy of Sciences, giving 

 the results of experiments by Dr. Krishaber on the mechanism of deglutition as studied 

 by autolaryngoscopy, followed by a note on the same subject by M. H. Guinier. Dr. 

 Krishaber, as the result of his observations, gave the following conclusions : 



" 1st. In the act of deglutition the alimentary bolus passes in one of the pharyngeal 

 grooves, over one of the sides of the epiglottis tilted by the elevation of the larynx ; the 

 bolus thus arrives at the oesophagus at the moment when, by the contraction of the con- 

 strictor muscles, the pharynx is shortened and brought in front of the mass. 



" 2d. The deglutition of liquids is effected in the same manner ; these passing, how- 

 ever, quite frequently upon the epiglottis itself, which happens very rarely with solid ali- 

 ments. 



u 3d. A quantity extremely small, it is true of liquid engages itself during normal 

 deglutition around the border of the epiglottis and moistens the mucous membrane of 

 the larynx and even of the vocal chords. 



" 4th. In gargling, the larynx being widely opened, a larger quantity finds its way 

 into the vocal organ. 



" 5th. An alimentary bolus may be easily tolerated in the respiratory passages ; that 

 is to say, in the larynx, as far as the vocal chords and even in the interior of the trachea. 



" 6th. The sensibility of the trachea to the impression of foreign bodies is infinitely 

 less than that of the larynx. 



" Yth. Hard and cold bodies, as, for example, a sound, are not tolerated in the respir- 

 atory passages ; while any soft body, which can adhere to the mucous membrane and 

 has a temperature like that of the parts touched, is easily tolerated in the respiratory 

 passages and kept in the trachea many minutes without producing the slightest cough." 



These observations confirm the views of Longet and others concerning the passage of 

 alimentary substances down the pharynx by the sides of the epiglottis ; and, in that case, 



