125
ABNORMAL ANATOMY OF THE LARYNX.
mental researches of Magendie and Le Gallois,
he supposes that, if the recurrent nerves are
compressed to such an extent as to have their
functions impaired, the glottis, under the in¬
fluence of the superior laryngeal branches,
would become and continue fast closed. The
cause of the disease then, according to him,
will be found in some tumour, scrofulous or
otherwise, so situated as to create an injurious
degree of compression on the recurrent nerves.
That an enlargement of the thymus gland may,
from its situation, produce great and serious in¬
convenience, it would be absurd to question,
and perhaps there is sufficient evidence to shew
that it may occasion the symptoms and results
of this very disease : but it is far from being
proved that spasm of the glottis may not occur,
and even prove fatal in cases where no such
enlargement existed. Alterations of size, shape,
and structure, even if rapid, take place gradu¬
ally, and their results should be gradual also,
whereas this disease has been known to destroy
its victim in its first and only paroxysm ; and
moreover, if structural change in the gland was
its sole exciting cause, it would be difficult to
account for its sudden disappearance on the
removal of the child to the country and its diet
being changed. Whilst therefore it may not
be denied that hypertrophy of the thymus can
occasion the phenomena by others attributed
to spasm of the glottis, there is not sufficient
proof of its being the general or even frequent
cause of this peculiar disease. I shall have
occasion to notice the supposed consequences
of pressure on the recurrent nerves hereafter.
It is questionable how far spasm occasioned
by the contact of noxious or irritating sub¬
stances can justly be termed sympathetic, for
they are the results of an application of a di¬
rect stimulus : it is immediate in its effects,
and more or less complete according to the
nature or quality of the exciting cause. Death
from total submersion in carbonic acid gas
occurs so quickly as almost to seem instan¬
taneous, and the spasm entirely occludes the
glottis. The mildest form of spasm seems to
be that occasioned by the accidental admission
of some particle of food which is usually
expelled again very quickly by a cough suf¬
ficiently distressing but seldom dangerous : yet
instances have been known of the apparently
trifling occurrence of the introduction of a par¬
ticle of salt being attended by a fatal result.
However, when spasm is, or appears to be
produced by the presence of a foreign body in
the cesophagus or the trachea, or by the pres¬
sure of an aneurismal tumour, it is evidently
sympathetic, and it may he interesting to in¬
quire into the evidence by which such relation
of cause and effect is established.
I had formerly entertained the opinion that
spasm of the glottis should be the consequence
of some irritation applied to the larynx itself,
and not external to or at a distance from it, and
therefore that the presence of a foreign body
in the cesophagus ought not to hold a place
amongst its exciting causes. I have since,
however, altered my views on the subject, and
indeed, when we consider the number of cir¬
cumstances under which this morbid action
may occur, we cannot be justified in denying it
in this case in opposition to most respectable
testimony. Mr. Kirby has published a case in
the Dublin Hospital Reports, in which death
was apparently produced by spasm of the glot¬
tis in consequence of the lodgment of pieces
of meat and bone in the oesophagus: and Dr.
Stokes saw an instance in which a piece of
money was lodged in the cesophagus and where
croupy breathing and other laryngeal sym -
ptoms were manifestly the result. In this lat¬
ter instance the foreign body was not lodged in
the fauces or pharynx. I have myself seen
cases to corroborate the above, but it is need¬
less to swell this article with proofs of a patho¬
logical fact that will probably not be called in
question.
It is probably a new observation—at all
events it is one of great pathological interest,
that spasm of the glottis may be produced by
the presence of a foreign body lodged within
the bronchi. In the month of May, 1836,
a child was brought from the country and
placed under the care of my friend Mr. Cu¬
sack : his father’s account of the case was that
he had swallowed a small pebble, was instantly
seized with a violent paroxysm of cough, had
croupy or sonorous breathing ever since the
accident with occasional remissions and exacer¬
bations, but was sometimes brought to the
verge of suffocation. The stethoscopic indi¬
cations were that the foreign body was loose
and mobile within the trachea. I assisted Mr.
C. in performing the operation of tracheotomy
on this child ; but, although the aperture in the
windpipe was made very large, no stone was
expelled, and the size of the organ did not
admit of the employment of any forceps with
which we were furnished. Immediately on
the opening into the windpipe being perfected
the croupy breathing disappeared, neither was
there a severe paroxysm of cough experienced
afterwards, and the father, either doubting that
the foreign body had ever obtained admittance,
or dissatisfied at its not being removed, car¬
ried him off to the country contrary to the
wishes and advice of his medical attendants.
We afterwards heard that the little pebble had
been coughed up in about three weeks after he
left town, but have not been informed as to the
ultimate termination of the case.
On the 13th of September, 1839, a child,
aged three years and a half, was brought to the
Meath Hospital : he had, half an hour pre¬
viously, swallowed a small stone, and was in¬
stantly seized with a violent cough which con¬
tinued up to the period of admission. His
breathing was quite stridulous—countenance
expressive of great distress—face and lips
lived—efforts at respiration hurried and gasp¬
ing. The left side of the chest heaved vio¬
lently, the right was comparatively quiet : re¬
spiration very weak and interrupted in the
right lung, in the left loud and puerile : no
dulness over either lung on percussion. I per¬
formed the operation of tracheotomy, but no
foreign body was expelled, and yet the little
patient experienced the greatest relief. The