122 
the product of cicatrization, and the place which 
should have been occupied by the broad por- 
tion of the cricoid cartilage exhibits an empty 
cavity, as if that structure had been removed 
by absorption or some other process, and 
nothing deposited in its room. One of the pa- 
tients on whom I operated in the year 1829 
died about a year sincein the Fever Hospital, 
and the larynx was examined by the surgeon of 
that institution, Mr. Trant; it presented ap- 
pearances so nearly similar to the above as not 
to require particular detail, and quite sufficient 
to shew that the original destruction had been 
such as totally to preclude the possibility 
of the organ ever being capable subsequently 
of performing the ordinary function of respi- 
ration. 
The cartilages of the larynx are also liable to 
mortification following on inflammation, and 
apparently produced by the causes that induce 
gangrene in other structures. I suppose this 
affection to be extremely rare, as I have met with 
but two cases, and have not heard of its being 
observed by others. In one of these cases a 
large abscess existed in front of the larynx and 
upper part of the trachea, in which the thyroid 
cartilage lay like a foreign substance entirely 
denuded, mortified, and abominably offensive, 
its appearance resembling that of wetted rotten 
leather. The front of the cricoid cartilage and 
of the two upper rings of the trachea had been 
removed by mortification also. The lining 
membrane of the larynx was thickened, corru- 
gated, and had a granular appearance ;_ part of 
it was ulcerated, through which the abscess had 
communicated with the pharynx.. The remnant 
of this larynx is preserved in the pathological 
collection of the School in Park-street, and 
shews that at least five-eighths of the organ had 
been totally and entirely destroyed. It proves 
that such a disease must be utterly hopeless and 
irremediable, and that, quite independent of the 
constitutional derangement that must lead to 
its formation and accompany its progress, no 
chance could exist of cicatrization and subse- 
quent recovery. 
Occasionally, although I should suppose very 
rarely, the cartilages of the larynx are the sub- 
jects of an alteration of structure strongly re- 
sembling the ordinary product of scrofula. Of 
this I have seen but one specimen, for which I 
am indebted to the kindness of my friend Dr. 
Benson. December, 1838. A man, et. 39, 
was received into the City of Dublin Hospital, 
under the care of Dr. B. for the treatment of 
what was considered to be chronic rheumatism. 
It was soon discovered that the pains were not 
rheumatic, but most probably depended on 
cerebral disease. The larynx presented a firm 
tumour externally, and there was an almost 
total loss of voice. He died, and after death 
scrofulous tubercles were discovered in the 
brain. The larynx was of a healthy structure 
in every part except in the thyroid cartilage, the 
ale of which were converted into a firm scrofu- 
lous mass, about the size of a large chesnut on 
each side. The nag OM or tubercular matter 
appeared to have been deposited originally in 
the centre of each ala. The margins and Ae 
ABNORMAL ANATOMY OF THE LARYNX. 
nua of the cartilage were unaltered, 
cartilaginous structure seemed to lose | 
sensibly on the surface of the tumour. — 
This very interesting preparation is p 
in the Museum of the Royal College of 
geons in Ireland. - 
Besides these deviations from the ord 
healthy conditions of the cartilages of | 
rynx, it is certain that one at least of the 
sents ap ces of abnormal changes b 
size and shape. Morbid thickening or 
trophy of the epiglottis, as well as its op 
state of contraction or shrivelling, hav 
spoken of by authors, but I have never 
fully satisfied that the former of these w 
rather the result of a thickened cond 
mucous membrane than of the cartilage 
and I believe the latter never is seen unle 
the consequence of previous ulceration. 
viation from its usual shape is by no i 
very uncommon in this cartilage, most inst 
of which are ‘trivial and unimportant, ai 
probably congenital ; but in some few inst 
the change is more remarkable. One of 
has been noticed by Dr. Stokes in the ¢ 
of his work which treats of diseases of | 
rynx and trachea, and by him it is terme 
leaf-like expansion of the epiglottis. 
scribes it thus : “ This has not been deserib 
any author, but a most remarkable prepa 
of the disease exists in the Museum 
School of Anatomy and Medicine nS 
street. The epiglottis is thinned and si 
elongated, and its form so altered as 
sent the shape of a battledore, the narro 
tremity being next the glottis. In the pr 
tion alluded to it is fully two inches in } 
and coincides with double perforating ule 
the ventricles. Nothing is known as | 
history of the case, but I have seen me 
less of a similar alteration in other cases | 
ryngeal disease.” a 
In a paper professedly devoted to abn 
anatomy, I know not whether I am warr 
in noticing derangements of function, — 
tended by any lesion of structure dise 
by dissection, yet there are some of thes 
hibited by the epiglottis which seem des 
of the attention of the physiologist. Th 
ascribed-to this cartilage of protecting | 
rynx during the process of deglutition is 
known, yet observation has furnished u 
examples of exceptions to this use, both 
tively and negatively ; for, as when this va 
structure is altogether removed (by expe 
in animals and by disease in man), the 1 
is nevertheless often found able to protect 
and the subject to swallow both liquidsand 
without much, and occasionally without @ 
convenience, so, on the other hand,it is 
which cannot be controverted, that the ep 
sometimes seems to be deprived of its 
tive sensibility, and permits the free introd 
into the windpipe of substances attemp 
be swallowed. This latter fact I first noti 
the case of a Wapiti deer which was brone 
mized by Sir Philip Crampton: it freq) 
discharged portions of its food 
wound, and yet after death the larynx in 
NADLEe 
BE ei’ 
nrou 
