ABNORMAL ANATOMY OF THE LARYNX. 
_ parts wa found apparently perfect in its orga- 
nization. But not to rely on observations made 
on the inferior animal, a case soon afterwards 
becurred in the Richmond Surgical Hospital, of 
a young female wounded in the trachea rather 
w down in the neck. From this wound por- 
tions of the ingesta frequently escaped, and 
yet after death the larynx was found healthy, 
is Organization complete, and no. unnatural 
mmunication whatever between the cesophagus 
d windpipe in any part or situation what- 
ever. I have since had a precisely similar case 
“under my care in the Meath Hospital. These 
we instances in which the epiglottis seems inert, 
and the larynx is left patulous and unprotected ; 
there are other cases in which it appears to be 
orbidly active, although it is difficult to ex- 
_ Plain the agency by which such activity is pro- 
_ duced. In prosecuting some experiments on 
_ the subject of asphyxia, a stout middle-sized 
‘dog was let down into a brewing ‘vat that had 
_ been emptied of the fermenting liquor about 
ten minutes previously ; he was to all appear- 
ince perfectly dead in two minutes. After al- 
wing the body to remain thus for twenty 
Minutes, it was examined: the glottis was 
found to be of a very pale colour, and the rima 
‘eompletely shut up by the close approximation 
| Of the arytenoid cartilages. The epiglottis was 
shut down like a lid upon a box, so us perfectly 
__ to close the superior aperture of the larynz: 
| this latter was a curious appearance, and I 
Know not what muscles could produce the 
effect, but the fact was witnessed by Dr. Hart, 
now one of the professors of practical anatomy 
in the College of Surgeons, by Dr. Young, and 
others. I am also ignorant as to whether a 
similar condition of the epiglottis obtains in 
men who have been suffocated by carbonic 
| acid ; human subjects are seldom examined so 
_ soon after falling into a state of asphyxia as to 
allow of the immediate appearances being ob- 
served, and yet information on this point 
would be of great value in determining the 
| suitable means for attempting resuscitation. 
The most difficult part of the pathology of 
the larynx to contend with is that which has 
_teference to muscular organization, and unfor- 
tunately it is that which has been least ex- 
“amined, or on which examination has thrown 
the faintest and most unsatisfactory light. 
Furnished with an exquisitely delicate and 
beautiful arrangement of muscle, the normal 
etions of which are exemplified in the pro- 
uction of the different sounds of the voice, 
nd in giving force to the exit of the air in 
oughing, sneezing, &c. it would appear only 
. nable to suppose that the functional de- 
_angements of the larynx should be accom- 
anied by some appreciable corresponding le- 
10n of its muscular apparatus ; yet such does 
“hot seem to be the case, at least not invariably, 
and we sometimes find the voice impaired or 
, ote lost, the muscles of the organ ex- 
hibiting their ordinary appearance, and again 
remarkable and seemingly important lesions 
without much injury to voice or respiration. 
Under these circumstances we must speak of 
the morbid appearances that have been ob- 
. 
} 
| 
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123 
served in the first instance, and consider the 
irregularities of function afterwards. 
The muscles of the larynx are sometimes 
found in a state of extraordinary develope- 
Ment amounting almost to hypertrophy. I 
know not how far this may be considered to be 
an abnormal condition, or whether it may not 
be the natural result of great and constant em- 
ployment of the organ: reasoning from ana- 
logy this latter seems more probable, but dis- 
section has hitherto thrown no light upon the 
subject. 
They are likewise subject to atrophy or 
wasting, the fibres appearing thin, pale, and 
attenuated. Andral mentions cases of loss of 
voice in which he sometimes found the fibres 
of the thyro-arytenoid muscle wonderfully atro- 
phied, and sometimes separated from each 
other by some morbid secretion, either of pus 
or tubercular matter. I have been informed by 
Sir P. Crampton that he has seen in the Mu- 
seum of the Veterinary College in London, 
several preparations illustrative of the disease 
termed “ roaring” in the horse, which seems to 
be produced by an atrophy of the arytenoid 
muscles. A relaxation is thus effected which 
allows to the arytenoid cartilages an unnatural 
degree of mobility. Whilst the animal is at 
rest or moving slowly, the current of air passes 
gently, and there is no “ roaring ;” but when he 
is put to greater speed and respiration becomes 
more hurried or more forced, the little valves 
are acted on, the rima is proportionably closed, 
the breathing becomes stridulous, and that pe- 
culiar noise so well known to persons conver- 
sant with horses is produced. 
Lesion of function in the muscles of the la- 
rynx exhibits itself in the opposite conditions 
of atony and spasm. Examples of the former 
are to be found in some cases of partial pa- 
ralysis where the patients become totally in- 
capable of uttering any sound, however in- 
distinct and inarticulate; in the hoarseness and 
sometimes loss of voice that suddenly attacks 
young persons, particularly females, from ex- 
posure to cold and damp; and perhaps fre- 
quently inthe sympathetic aphonia that precedes 
or attends on phthisis. On the pathology of 
these affections morbid anatomy has thrown but 
little light, nor is it surprising that the subject 
has attracted a minor degree of attention, when 
it is recollected that the more severe laryngeal 
symptom, that of difficult respiration, is seldom 
or never present. I have had two cases of 
aphonia attended with pain and soreness in the 
larynx, which, under an idea that the disease 
was either gout or rheumatism, I treated with 
colchicum with apparently favourable results. 
I know not whether the supposition that the la- 
rynx may be the seat of either of these painful 
affections is correct or not, but I see no reason 
why it should enjoy so fortunate an exemption. 
However, although atony of the muscles of the 
larynx may not be attended with much peril, a 
spasmodic action of them is always eminently 
perilous, sometimes destroying life with a ra- 
pidity that almost precludes the possibility of 
assistance. There can, therefore,” be few sub- 
jects more interesting to the practitioner, and 
