ADDITIONS TO THE REVISED EDITION OF 1880. 57 



vowels and diphthongs in different tones, and by the simple rubbing 

 of the pharyngeal organs and of the chords with a sound (Bruns> 

 Rossbach), or even by the mere pressure from without upon the 

 upper horns of the thyroid cartilage, the patient meanwhile making 

 deep sonorous in spiratory movements (Ollivier), which perhaps may 

 be explained by the hypothesis that, in these long-standing palsies 

 of the glottis-closers, a luxation outward of the cartilages takes 

 place, which becomes reduced under the pressure above mentioned, 

 so that afterward the electric current may have good effect ( Ger- 

 hardt). 



It has also been proposed to provoke reflex contractions of the 

 muscles by insufflation of alum and other powders, and by the 

 breathing of stimulating vapors. In a few exceptional cases good 

 results have followed hypodermic injections of strychnine. 



All this treatment is usually tried when electricity (which usu- 

 ally affords the happiest and sometimes the most astonishing results) 

 has failed. In the latter treatment both the constant and the in- 

 duced current may be employed. In some cases, especially in hys- 

 terical aphonia, rapid and sure success is obtained by the percuta- 

 neous method, wherein the electrodes are applied directly to the 

 sides of the larynx. In more difficult cases direct faradization of 

 the larynx (M. Mackenzie) is in place, the negative electrode being 

 then set upon the neck without, while within a specially constructed 

 intra-laryngeal electrode is applied to the chords or arytenoid carti- 

 lages by help of the laryngoscope ; or, where but one muscle is af- 

 fected, direct faradization is applied to it according to the precise 

 instruction of Ziemssen. At first the effect of electrization is incom- 

 plete and transient, and it is only after its patient and continued 

 use that a lasting effect is obtained.] 



ADDITIONS TO THE REVISED EDITION OF 1880. I 



SECTION I. AFFECTIONS OF THE LARYNX. 



1. P. 3. 



During life, by aid of the laryngoscope, we can see that the ca- 

 tarrh is sometimes diffused, sometimes circumscribed, and is often 

 limited to a very small region. It may be recognized by its redness 

 of variable intensity. In the more severe cases we find the epiglot- 

 tis, the aryepiglottic folds, and the false chords thickened and of a 

 deep-red hue, and perhaps so much swollen by oedematous infiltra- 



