126 
trachea was too small to allow of the intro- 
duction of any instrument for the extraction 
of the offending substance if such was there, 
so J merely satisfied myself with keeping the 
wound open, in the hope of its being coughed 
up. Whenever from any accident the wound 
in the throat became obstructed, the breathing 
became dreadfully oppressed, but he obtained 
instant relief when it was opened again and 
cleaned. Such were the phenomena of the 
case generally up to the 6th of October, when 
it was found that the wound had gradually 
closed and healed so as to leave the artificial 
opening very small, and on that day, in ¢on- 
sequence of the increased difficulty of breath- 
ing, I was obliged to open up the whole wound 
anew. This second operation afforded im- 
mediate relief. On the 6th of December the 
wound being again nearly healed, in a despe- 
rate fit of coughing he expelled a small stone 
about half an inch long by about two lines 
broad, through the rima glottidis. 
There were many other interesting facts con- 
nected with this case, which I omit here, my 
object being only to show that the difficult re- 
Spiration which rendered the operation neces- 
Sary was not caused by the mechanical ecclu- 
sion of the bronchi by the presence of the 
stone, but had ‘its seat in the larynx. The 
child had always repose when not called upon 
to employ the rima in respiration, although the 
stone was present in one or other of the bron- 
chi, and in this case it was remarkable that 
it shifted its position, as proved by stethoscopic 
evidence. 
It is sufficiently well known that the pres- 
sure of an aneurism, and of course of any 
other tumour, on the trachea or bronchi will 
produce difficult respiration to such an extent 
as to simulate laryngitis and to place the pa- 
tient’s life in imminent peril. is has been 
supposed to proceed from the mechanical ob- 
struction given to the passage of the air by the 
compression of the tumour, and I shall not 
deny that this cause may occasion inconveni- 
ence, but still may be allowed to doubt that it 
roduces the stridulous breathing and other 
aryngeal symptoms—at least in the majority 
of cases. In the month of July, 1837, I was 
requested by another practitioner to see a case 
of acute laryngitis and to operate if I deemed 
it necessary. The case appeared to be seriously 
urgent: the man oon to be on the point of 
suffocation; and having made some inquiries 
as to the history, and particularly as to the con- 
dition of the chest as ascertained by auscul- 
tation, I operated immediately. The relief was 
as marked and as decided as I had ever seen 
in any laryngeal affection ; and, after allowing 
the patient two or three hours’ repose, I had 
him removed to the Meath Hospital, in order 
to be under my own immediate care. He died 
on the fourth day afterwards from the bursting 
of an aneurism of the aorta within the chest, 
and on examination the larynx was found in a 
perfectly healthy and normal condition; yet 
was it evident, from the relief experienced on 
the opening being made below it, that the ob- 
struction to respiration that existed during life 
REGIONS OF THE LEG. 
had been caused within this organ. Th 
who, with Le Gallois and Magendie, exp 
spasm of the glottis by a compression e: 
cised on the recurrent nerves, may possi 
consider that the aneurism in this case | 
duced such pressure, and I am not ina‘ 
dition to deny it, because the sac was collap 
and empty, and I could not say what pres 
it might have created directly or indir 
when tense and full of blood. But the sa 
no situation lay in contact with the nervy 
seemed to hold any relation to it that ¥ 
lead to such a conclusion. I may add, 
dentally, that I have seen aneurismal tum 
which must have implicated this nerve 
which the spasmodic difficulty of bre 
did not exist, and therefore whilst I be 
that spasm of the glottis may be prod 
consequence of, or in connexion with, the 
istence of some tumour compressing the trael 
or bronchi, I cannot (in the present stat 
our knowledge) yield to the opinion t 
it so entirely to a compression of the 
nerve, . 
The ligaments of the larynx are, of e 
liable to disease. Thus, during life, we a 
on the possibility of an abnormal state af 
sion or relaxation, from observing certain 
rations of the tone of voice which are” 
supposed to be capable of being explai 
but the most frequent morbid appearance ft 
after death is ulceration, although here i 
evidence of its ever commencing in these s 
tures. In all cases of phthisis laryngea, 1 
ligaments suffer severely and in some are ¢ 
ally destroyed ; for the expulsion of the 
tenoid cartilages by coughing is no infre 
symptom of that disease, and it could not o 
wise occur. I have often imagined that 
ulceration of the ligaments was one caus 
the difficult respiration, particularly im ‘ 
where there is a marked difference between 
Spiration and expiration, by allowing to 
arytenoid cartilages too great a degree of 
bility, and permitting them to be thrown ¢ 
on the rima. When the connexions bet 
the cricoid and arytenoid cartilages are 
across posteriorly, it is easy to lay the ] 
down in such a manner as nearly to oblit 
the rima; and if a similar division be eff 
by disease, why may not these little b 
become loose, be acted on by the curre 
air and shut like a valve in every act of 
spiration ? ' 
( W. H. Porte 
LEG (Recrons or THE).—If the impor 
of a part, and the interest connected wit 
study of its structure and its diseases, be 
sured by the general amount of s 
through it entailed upon mankind, by 
treme liability to accident and injury, ai 
its value in the general movements ant 
being of the body, certainly the 
possess claims to our consideration gre: 
any other portion of the system of 
extent. From the integument to the bone 
from the knee to the ankle, every part of 
the frequent subject of disease, more or 
