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