now WE SNEEZE, LAUGH, STAMMER, AND SIGH. 493 



ity may be due to a cleft palate, or to some less grave defect which 

 prevents insufficient contact between the soft palate and the back wall 

 of the pharynx. Various other noises emanate from the mouth and 

 nose, accompanying certain unusual and mainly involuntary forms of 

 respiration. These are classified by Von Meyer, from whose " Organs 

 of Speech," in the " International Scientific Series," most of the mate- 

 rial for this article has been obtained, as disturbances of inspiration, 

 to which class belong hiccough, gaping, and stammering, and dis- 

 turbances of expiration, under which he enumerates sneezing, cough- 

 ing, laughing, and sighing. 



Hiccough is the simplest of the former class, and is merely a vio- 

 lent inspiration caused by a convulsive contraction of the diaphragm. 

 The ensuing expiration then takes place quietly. The air inhaled may 

 enter principally either through the mouth or the nose, or through 

 both equally, and in each case the accompanying noise is different. 

 A contraction of the glottis may also take place at the same time, and 

 in this case the entering stream of air creates, in passing between the 

 vocal chords, a sharp, clear tone. During an attack, one inspiration 

 in about four or five is convulsive. Hiccough arises from over-irri- 

 tation of the nerves of the diaphragm, the cause of which we know 

 to be either psychical conditions or overfilling of the stomach. When 

 the stomach is overladen with food or with effervescing or alcoholic 

 drinks, it resists to a greater or less extent the fall of the diaphragm ; 

 the contractions of the diaphragm necessarily become more labored, 

 and occasionally, like other over-irritated muscles, assume a convulsive 

 character. Frequently, however, the hiccough appears as a sign of 

 the general over-irritation of the nervous system in hysteria, and, 

 probably from the same reason, it may not uncommonly be observed 

 in otherwise healthy young persons, particularly children. The above 

 explanation of hiccough as a convulsive contraction of the diaphragm 

 is further confirmed by the manner in which it may be stopped. It 

 is, namely, only necessary to allow an exceedingly protracted and, at 

 the end, forcible expiration to follow a long and quiet inspiration. 

 The slow inspiration, especially when it is chiefly performed by the 

 wall of the chest, prevents the phrenic nerve from being too power- 

 fully irritated, while the long expiration gives this nerve time to re- 

 cover from its over-irritation. A remedy which the writer has tested 

 many times without a failure can always be used upon a person who 

 has " the hiccoughs " by some one else, and generally by the sufferer 

 himself. You say to your friend something like this : " See how close 

 together you can hold the tips of your forefingers without their touch- 

 ing. No, keep your elbows out free from your sides. You can get 

 your fingers closer than that. They are touching now. There, now 

 hold them so. Steady." By this time you can generally ask, " Now, 

 why don't you hiccough ? " The involuntary tendency to breathe 

 slowly and steadily when the attention is fixed on performing a deli- 



