TUMOUR ON THE OS HYOIDES. 
77 
the required information, so as to form a correct diagnosis. 
I therefore think that the recording of all cases of an un¬ 
common kind cannot fail, in some measure, in directing the 
mind to circumstances which otherwise might be overlooked; 
and should suggest certain inquiries, and also the interpre¬ 
tation of such symptoms as might present themselves. For 
instance, in the above case, no one would have supposed that 
the difficulty in breathing arose primarily from an injury 
done to the os hyoides ; but such I believe was the fact. 
There is no evidence of its being caused by external violence, 
as there would most likely have been some abrasions or 
marks of some kind on the skin, opposite the seat of injury. 
We do not learn from Mr. Shipley that such existed. I there¬ 
fore incline to the opinion that the injury to the bone was 
the result of force applied from within the mouth. It might 
have been produced when rasping the teeth; the rasp being 
used by some one who, regardless of the structures at the 
posterior part of this cavity, or the mischief he might inflict 
upon them, ignorantly forced it backwards. Or it might 
have been caused by the giving of a ball. Instances have 
been known of individuals placing a ball on the end of a 
large stick, and thrusting it to the back of the mouth, in 
their opinion down the throat. 
Now, supposing the injury to have been inflicted by a 
cause similar to either of the above, most likely inflamma¬ 
tion was induced, followed by suppuration; but, instead of 
the pus escaping, it became confined in the areolar inter¬ 
spaces, thus forming a number of abscesses, the walls of 
which became condensed, and by further effusion considerably 
thickened, and in this way the tumour was formed. 
With regard to the thickening of the base of the epi¬ 
glottis and root of the tongue, we have before conjectured 
how this might have occurred. 
The peculiarity and difficulty of breathing, which led Mr. 
Shipley to think that a tumour was the impediment to the 
normal performance of that function, was caused by the 
pressure of the enlargement upon the lateral part of the aryte¬ 
noid cartilage, and by the fixed condition of the epiglottis. 
