This very interesting preparation is preserved in the Museum of the Royal College of Sur geons in Ireland.
Besides these deviations from the ordinary healthy conditions of the cartilages of the la rynx, it is certain that one at least of them pre sents appearances of abnormal changes both of size and shape. Morbid thickening or hyper trophy of the epiglottis, as well as its opposite state of contraction or shrivelling, have been spoken of by authors, but I have never been fully satisfied that the former of these was not rather the result of a thickened condition of the mucous membrane than of the cartilage itself, and I believe the latter never is seen unless as the consequence of previous ulceration. A de viation from its usual shape is by no means very uncommon in this cartilage, most instances of which are trivial and unimportant, and are probably congenital ; but in some few instances the change is more remarkable. One of the has been noticed by Dr. Stokes in the chapter of his work which treats of diseases of the la rynx and trachea, and by him it is termed the leaf-like expansion of the epiglottis. He de scribes it thus "This has not been described by any author, but a most remarkable preparation of the disease exists in the Museum of the School of Anatomy and Medicine in Park street. The epiglottis is thinned and singularly elongated, and its form so altered as to repre sent the shape of a battledore, the narrow ex tremity being next the glottis. In the prepara tion alluded to it is fully two inches in length, arid coincides with double perforating ulcers of the ventricles. Nothing is known as to the history of the case, but I have seen more or less of a similar alteration in other cases of la ryngeal disease." In a paper professedly devoted to abnormal anatomy, I know not whether I am warranted. in noticing derangements of function, unat tended by any lesion of structure discoverable) by dissection, yet there are some of these ex hibited by the epiglottis which seem desermig of the attention of the physiologist. The use ascribed to this cartilage of protecting the la rynx during the process of deglutition is well known, yet observation has furnished us with examples of exceptions to this use, both posi tively and negatively ; for, as when this valvular structure is altogether removed (by experiment in animals and by disease in man), the larynx is nevertheless often found able to protect itself, and the subject to swallow both liquids and solids without much, and occasionally without any in convenience, so, on the other hand,it is a fact which cannot be controverted, that the epiglottis sometimes seems to be deprived of its protec tive sensibility, and permits the free introduction into the windpipe of substances attempted to be swallowed. This latter fact I first noticed in
the case of a Wapiti deer which was bronchoto mized by Sir Philip Crampton it frequently discharged portions of its food through the wound, and yet after death the larynx in all its parts found apparently perfect in its orga nization. But not to rely on observations made on the inferior animal, a case soon afterwards occurred in the Richmond Surgical Hospital, of a young female wounded in the trachea rather low down in the neck. From this wound por tions of the ingests frequently escaped, and yet after death the larynx was found healthy, its organization complete, and no. unnatural communication whateverbetween the oesophagus and windpipe in any part or situation what ever. I have since had a precisely similar case under my care in the Meath Hospital. These are instances in which the epiglottis seems inert, and the larynx is left patulous and unprotected; there are other cases in which it appears to be morbidly active, although it is difficult to ex plain the agency by which such activity is pro duced. In prosecuting some experiments on the subject of asphyxia, a stout middle-sized dog was let down into a brewing 'vat that had been emptied of the fermenting liquor about ten minutes previously ; he was to all appear ance perfectly dead in two minutes. After al lowing the body to remain thus for twenty minutes, it was examined : the glottis was found to be of a very pale colour, and the rima completely shut up by the close approximation of the arytenoid cartilages. The epiglottis was shut down like a lid upon a box, so as perfectly to close the superior aperture of the larynx : this latter was a curious appearance, and I know not what muscles could produce the effect, but the fact was witnessed by Dr. Hart, now one of the professors of practical anatomy in the College of Surgeons, by Dr. Young, and others. I am also ignorant as to whether a similar condition of the epiglottis obtains in men who have been suffocated by carbonic acid ; human subjects are seldom examined so soon after falling into a state of asphyxia as to allow of the immediate appearances being ob served, and yet information on this point would be of great value in determining the suitable means for attempting resuscitation.