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 occlu 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. This 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 produces the stridulous breathing and other laryngeal 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 seemed 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 had been caused within this organ. Those who, with Le Gallois and Magendie, explain spasm of the glottis by a compression exer cised on the recurrent nerves, may possibly consider that the aneurism in this case pro duced such pressure, and I am not in a con dition to deny it, because the sac was collapsed and empty, and I could not say what pressure it might have created directly or indirectly when tense and full of blood. Hut the sac in no situation lay in contact with the nerve, or seemed to hold any relation to it that would lead to such a conclusion. I may add, inci
dentally, that I have seen aneurismal tumours which must have implicated this nerve, in which the spasmodic difficulty of breathing did not exist, and therefore whilst I believe that spasm of the glottis may be produced in consequence of, or in connexion with, the ex istence of some tumour compressing the trachea or bronchi, I cannot (in the present state of our knowledge) yield to the opinion that refers it so entirely to a compression of the recurrent nerve,.
The ligaments of the larynx are, of course, liable to disease. Thus, during life, we argue on the possibility of an abnormal state of ten sion or relaxation, from observing certain alte rations of the 'tone of voice which are thus supposed to be capable of being explained : but the most frequent morbid appearance found after death is ulceration, although where is no evidence of its ever commencing in these struc tures. In all cases of plithisis larynges, the ligaments suffer severely and in some are actu ally destroyed ; for the expulsion of the ary tenoid cartilages by coughing is no infrequent symptom of that disease, and it could not other wise occur. I have often imagined that this ulceration of the ligaments was one cause of the difficult respiration, particularly in cases where there is a marked difference between in spiration and expiration, by allowing to the arytenoid cartilages too great a degree of mo bility, and permitting them to be thrown down on the rima. When the connexions between the cricoid and arytenoid cartilages are cut across posteriorly, it is easy to lay the latter down in such a manner as nearly to obliterate the rima; and if a similar division be effected by disease, why may not these little bodies, become loose, be acted on by the current of air and shut like a valve in every act of in spiration? (IV. H. Porter.) LEG (REotoxs Or THE).—If the importance of a part, and the interest connected with the study of its structure and its diseases, be mea sured by the general amount of suffering through it entailed upon mankind, by its ex treme liability to accident and injury, and by its value in the general movements and well being of the body, certainly the leg would possess claims to our consideration greater than any other portion of the system of the same extent. From the integument to the bone, and from the knee to the ankle, every part of It is the frequent subject of disease, more or less interfering with the comfort, if not with the health, of the entire system.