OF THE CENTRAL MOTOR INNERVATION OF THE LARYNX. 
191 
vocal disturbances or even laryngeal paralyses have been observed, no conclusions 
can be drawn from them for the decision of the present question, because all of them 
are in sonae way or other incomplete. In some of tliem the diagnosis of a cerebral 
lesion is not at all beyond doubt, in others multiple lesions existed, in a third category 
no laryngoscopic examination had been made, and again in others either no autopsy 
had taken place, or the descriptions of the latter, when made, are defective with 
regard to the condition of the medulla oblongata, the peripheral parts of the laryngeal 
nerves, the microscopic examination of the medulla, the nerve hbres, and the muscles 
themselves, &c. 
In 1884 Bryson Delavan'* * * § ^ called attention to the possibility which existed in his 
opinion, viz., of localising from clinical observation the cortical motor centre for the 
larynx. Of the two cases, however, upon which he based his views, in one (Seguin’s) 
no laryngoscopic examination had been made, whilst he himself frankly stated some 
years afterwards,! that in the second one, his own, in which he had attributed the 
laryngeal paralysis to a cortical lesion, the post-mortem examination had established 
the fact that in reality it was of bulbar nature. 
In 1886 Garel;]; recorded an observation, to which he added, in conjunction with 
M. Dor, another in 1890, which proved,§ in the opinion of these authors, that 
unilateral laryngeal paralysis could be caused by a unilateral lesion of the opposite 
hemisphere or internal capsule. We have elsewhere|| taken exception to the interpre¬ 
tation given by these authors to the paralysis observed in their cases, because (a) the 
medulla oblongata was not microscopically examined at the post-mortem examination, 
and (b) the total paralysis (I'espiratory as well as phonatory) of the vocal cord observed 
in their cases is according to our ablation-experiments absolutely incompatible with 
the idea of its being due to a cerebral lesion. 
Recently Rossbach*! has published a very interesting paper on the subject, in which 
from a carefully observed case under his own care he draws tire conclusion that 
unilateral paralysis of a vocal cord may be caused by a lesion of the opposite insula. 
Seeing however, that in his case there was atrophy of the corresponding side of the 
tongue due to an undoubted lesion of the ganglionic cells of the hypoglossal nucleus 
in the medulla oblongata, and that the integrity of the vago-accessory nucleus in the 
medulla was merely surmised from the fact, that the fibres of the nerve itself, and of 
the laryngeal muscles, had undergone no atrophy, while it was not at all shown that the 
* ‘ Compfce-rendii des Travaux de la Section de Laryngologie du VIII. Oongres International 
Periodique des Sciences Medicale.s.’ Copenbague, 1884, p. 17. 
t ‘ Transactions of the American Laryngological Association,’ 1888, p. 195. 
X ‘ Annales des Maladies de TOreille et du Larynx,’ May, 1886. 
§ Ibidevi, April and May, 1890. 
|| ‘ Annales des Maladies de I’Oreille et du Larynx,’ May and June, 1890. 
^ “ Localisation des corticalen Stiinmcentruins beim Menschen.” ‘ Deutsclies Arcliiv fiir klinische 
Medicin,’ vol. 46, March, 1890. 
