REPORT ON DISEASES OF THE THROAT. 
By F. I. Knight, M.D. 
In General. 
(1.) Aphonia. Andrew II. Smith, M.D. Philadelphia Med. Times, 
Oct. 4, 1873. 
(2.) Notes on a solution of iodoform. Lewis Elsberg, M.D., Pro- 
fessor of Laryngology, Ac. 
(3.) Der Kehlkopf oder die Erkenntniss und Behandlung des 
Menschlichen Stimm-organs im gesunden und erkrankten Zustande. 
Merkel. Illustrirte Gesundheitsbucher. Leipsig. 1873. 
(2.) Dr. Elsberg says that a great objection to the employment of 
iodoform (C3 II I3) in substance is. its bad odor, which is very pene- 
trating and persistent; furthermore, there has not been in use any 
effective solution for topical application in cases where ointments are 
inapplicable. Rhighini used an ethereal solution for direct inhalation, 
and Dr. Sass used an ethereal solution, and also a mixture of iodoform 
and sweet almond oil by means of a spray producer for inhalation. 
Dr. Gubler requested Messrs. Odin and Leymarie to ascertain the 
relative proportions in which iodoform is soluble in ether, and the most 
favorable conditions for its preparation ; their experiments and conclu- 
sions are published in the Pharmaceutical Journal, Aug. 2, 1873. The 
London, Doctor for Sept. 1st tells us that experiments were made with 
pure ether of 65° Baume (specific gravity .724), and also with ether of 
62° Baume, and 56° Baume, the temperature being 13° 0. Eight 
grains of tincture obtained with these ethers contained iodoform in 
solution, respectively, to the following extent:-• 
Ether of 65° Baume 1.61 grammes. 
" 62° " 1.26 • " 
" 56° " 1.13 
Their conclusions are, 
1. To employ iodoform in the crystalline state. 
2. To make the solution in a red glass flask by simple agitation. 
3. To use the following proportions :- 
Crystallized iodoform, 1 gramme ; 
Ether (60° Baume) 4 grammes. 
Dr. Elsberg had a solution prepared with Squibb's ether, and finds 
that it possesses all the advantages of iodoform in powder for local 
application, without its disadvantages. The solution smells only of 
ether, and the smarting produced on the mucous membrane is so mo- 
mentary that the application is really painless. It may be applied to 
the mucous membrane of the throat, nose, mouth, larynx, vagina, 
rectum, Ac. Its beneficial effects surpass Dr. Elsberg's expectations. 
Nares. 
(1.) On Fibrous Polypus of the Nose, with particulars of a case and 
operation. George Lichtenberg, M.D., Surgeon to the German Hos- 
pital, Ac. Lancet, Nov. 30, 1873. [The operation was one of Langcn- 
beck's, viz., by displacing the nasal bone, and the nasal process of the 
maxillary bone.'] 2 
(2.) Cure of a Naso-pharyngeal Polypus, by galvano-cautery. Cini 
belli. Il Raccoglitore Medico, Jan. 10, 1873. Allg. Med. Central- 
Zeitung, Feb. 22, 1873. 
(3.) An improved Method of plugging the Posterior Nares. A. 
Godrich. British Med. Journal, April 12, 1873 
(4.) Magnus. Der Nasenrachenraum; eine Studie am Lebenden 
gemacht. Archiv f. Ohrenheilk. vi. 4, p. 246 (Schmidt's). 
(5.) Schulze. Ein Beitrag zur Technik der Nasendusche. Arch. f. 
Ohrenheilk. vi. 4, p. 263. 
(6.) Morin. Compression der Arteria Facialis bei Nasenbluten. 
(Revue de Therap. Med. et Chirurg. 1873.) Allg. Med. Central- 
Zeitung, June 14, 1873. 
(2.) Ciniselli's case, reported as one of naso-pharyngeal polypus, 
cured by galvano-caustic, seems to have been one in which the treat- 
ment may be considered to have been electrolytic as much as in the 
case of Bruns. The tumor occupied the whole wall of the pharynx, 
completely stopping up the left nostril and partially the right, poste- 
riorly. It extended deep down in the pharynx, and pushed the epi- 
glottis against the base of the tongue. Its point of origin could not 
be determined. As it was not admissible to subject the much ema- 
ciated anaemic patient to a bloody operation, Ciniselli decided to apply 
" galvano-caustic." On November 20, 1869, treatment was com- 
menced with a small Grenet's battery, of eight elements. The steel 
electrodes were twelve centimetres long, and covered with caoutchouc 
to within two and a half centimetres of the end. The needle of the 
negative pole (zinc) was introduced into the polyp through the left 
nostril, the other through the mouth into the right side of the tumor. 
The electric current was passed through the tumor for fourteen minutes. 
On the 29th of November, an eschar came away from the throat, and a 
brownish yellow fluid, mixed with shreds of dead cellular tissue, began 
to flow from the left nostril. On the 8th of December, respiration and 
deglutition were already qasier. The treatment was continued every 
twenty days till October, 1871, when the tumor was so much dimin- 
ished in size that only an insignificant "bony" (knocherne) promi- 
nence was to be seen on the posterior inferior wall of the pharynx. 
Fauces. 
(1.) Cook, A.B. Adhesion of the Soft Palate and Uvula with the 
posterior Wall of the Pharynx. Operation. Cure. Philadelphia Med. 
and Surg. Reporter, xxviii. 10, p. 203. March. 
(2.) Depres. Retropharyngeal abscess ; adenitis retropharyngealis. 
(Gaz. des Hopitaux, No. 32.) Schmidt's Jahrb. 
(3.) On Enlargement of the Tonsils as a cause of Nightmare. IIaward. 
Brit. Med. Journal, June 7, 1873. 
Growths. 
(1.) On the Results of Thyrotomy for the Removal of Growths from 
the Larynx. Morell Mackenzie. British Medical Journal, April 26th, 
and May 3d, 1873. 
(2.) Eine neue Methode zur Ausrottung von Kehlkopfpolypen. Von 
Dr. Jelenffy in Pest. Wiener Med. Woch , Nos. 11, 12 and 13. 
Jahrgang 23. 
(3.) Critique on Jelenfly's method, &c. Wien. Med. Presse, No. 3, 
1873. 3 
(4.) Reply from Dr. Jelenffy. Wien. Med. Presse, No. 6,1873. 
(5.) Exhibition of Specimen of Epithelioma of the Tongue and 
Larynx. Bagshawe. Med. Times and Gazette, June 14, 1873. 
(6.) Soft Tumors of the Larynx. Dr. Emile Nicolas Duranty. Lan- 
cet, Jan. 4, 1873. 
(7.) Abstract of Lecture on Disease of the Neck with Dyspnoea, 
necessitating Tracheotomy : probable Cancerous nature of the Disease. 
De Morgan. Brit. Med. Journal, May 17, 1873. 
(8.) Die Sogenuante Kehlkopfsguillotine. Bruns. Wiener Med. 
Presse, May 11, 1873. 
(9.) Emele, Carl, (a) Hochgradige Stenose der untern Larynx- 
hiilfte ; (6) Aphonie durch einen Kehlkopfpolypen bedingt. (Sitzungs- 
Bericht des Vereins der Aerzte in Steiermark, ix. p. 5, 1872.) Schmidt's 
Jahrb., June 23, 1873. 
(10.) Zur electrolytischen Behandlung der Nasen-Rachenpolypen. 
P. Bruns. Berliner Klin. Woch., Aug. 11, 1873. 
(11.) Du Traitement des Polypes Laryngiens. Charles Livon. 
Paris. 1873. 
(12.) On Section of the Laryngeal Cartilages for the Removal of 
Morbid Growths. Durham. Med.-Chir. Trans., 2d series, vol. 37, 1872. 
(1.) Dr. Mackenzie's article is a thorough and exhaustive reply to a 
paper by Mr. Arthur Durham in the current volume of the Medico- 
Chirurgical Transactions, "On Section of the Laryngeal Cartilages 
for the Removal of Morbid Growths." The summary of results, ac- 
cording to Mackenzie, reduced to percentages and placed in a tabular 
form, is as follows :- 
Per ct. on 48 cases. 
Complete success,* 14.58 
Partial " 22.91 
Death, 8.33 
Severe dyspnoea, requiring use of canula, 31.25 
Severe dyspnoea, requiring fresh operation, 8.33 
Per ct, on 45 cases. 
Aphonia, 40.0 
Dysphonia, 20.0 
Modified voice, 11.11 
Not stated, but probably defective voice, 6.66 
Percentage based on 39 benign cases. 
Recurrence, or incomplete removal, 38.46 
These results differ considerably from the percentages derived from 
37 cases, which Mr. Durham introduced into his article, but space will 
not allow us to give Dr. Mackenzie's reasons for classifying many of 
the same cases differently (for Dr. M.'s list includes all those of Mr. 
Durham), but those who are interested are referred to his paper. 
Dr. Mackenzie closes his paper by saying that, as a result of his own 
experience and from the investigations he has made into the subject, 
he ventures to submit the following propositions :- 
First, That the operation ought never to be performed for loss of 
voice alone. 
* Complete success is understood to mean recovery of perfect voice and perfect respira- 
tion, and absence of recurrence of growth; partial success to mean recovery of one func- 
tion, with injury to another or temporary recovery of both functions, with subsequent re- 
currence of growth. 4 
Second, That in cases of cancer the operation is useless, except 
where the growth is very small and distinctly circumscribed. 
Third, That the operation should be confined to those cases in 
which there is danger to life from sulfocation or dysphagia, and then 
only to be performed after an experienced laryngoscopist has pro- 
nounced it impossible to remove the growth per vias naturales. 
(10.) In our report published in this Journal, November, 1812, we 
gave full particulars of a case of naso-pharyngeal polypus cured by Dr. 
Bruns by means of electrolysis, after very long treatment. Dr. Bruns 
now communicates a case in which a very large naso-pharyngeal poly- 
pus was cured by him in eleven applications of the electric current. 
Dr. B. publishes this case now partly to show that the treatment by 
electrolysis need not always be so prolonged as in his first case, 
which may have deterred others from trying it. The patient was a 
man of thirty years of age, who had had symptoms of the growth for 
fourteen years, and had undergone several ineffectual operations for 
removal. 
On examination, a fibrous polypus was found filling the vault of the 
pharynx, attached on the right, reaching as low as the base of the 
uvula, covering the openings of the nares posteriorly, but not project- 
ing into them. Besides this, the right nostril was filled with a num- 
ber of mucous polypi. The treatment was continued from the 12th of 
March to the 7th of April. 
Before treatment by electrolysis was commenced, a part of the mu- 
cous polypi were removed from the right nostril to facilitate the intro- 
duction of one of the electrodes. The battery used for obtaining the 
constant current was Frommhold's, of thirty-two elements. As elec- 
trodes at both poles, strong zinc needles were used, one being intro- 
duced into the tumor through the nostril, and the other through the 
mouth. The needle which was introduced through the nostril was 
covered with an Eustachian catheter of hard rubber. Nine applica- 
tions were made in this way, both needle electrodes being inserted 
into the tumor. The number of elements included was six. On each 
attempt to increase the strength of the current the patient expressed 
pain. The circuit was closed with only one element and the number 
gradually increased, and in the same manner the number of elements 
was gradually diminished, in order to diminish the shock of opening 
and closing as much as possible. The length of the sittings was, 
usually, from fifteen to twenty-five minutes. The two other applica- 
tions were made with the positive electrode covered with sponge held 
in the hand or upon the sternum. In these, the number of elements 
included was from ten to twenty, and the length of the sitting was 
thirty minutes. 
The three first sittings occurred from the 12th to the 14th of March. 
During the succeeding four days, there was a profuse discharge of 
pus and mucus, and small particles of the tumor, llhinoscopic exami- 
nation showed the inferior surface of the tumor ulcerated and gangre- 
nous, besides a considerable shrinking of it. The next three sittings 
occurred from the 19th to the 21st of March. Then there was a sus- 
pension of the treatment for ten days, on account of an attack of angina. 
After this, rhinoscopic examination showed that the tumor had dimin- 
ished in size by one half. The seventh to the eleventh sitting occurred 
from the 1st to the 7th of April. During this time, there was a rapid 5 
diminution of the tumor in size. At the end of this time, treatment 
was suspended on account of the temporary absence of Dr. B., and the 
patient went home. On his return, foui- weeks after, none of the 
tumor remained, only a cicatrix at the place of insertion. 
(1.) C. J. Eberth. Die Diphtheritischen Processe. Centralbl. fur 
die Med. Wissensch, No. 8, 1873. Allg. Med. Central-Zeitung, Feb. 
19, 1873. 
(2.) Letzerich. Kritische Bemerkungen uber die verschiedenen 
Methoden zur Heilung der Diphtheric. 
(3.) Letzerich. Statistische Uebersicht der vom Jahre, 1868, an 
bis Ende 1872 in seinen verschiedenen Wohuozten behaudelten Diphth- 
eriekranken mit Angahe der Gestorbenen. 
(4.) Kuhn. Ueber innere Behandlung der Diphtheritis. Berl. Klin. 
Woch., Feb. 10, 1873. 
(5.) Henry Reynolds. Successful local treatment of Diphtheria. 
(E. Wilton, Me.) [Carbolic acid and glycerin p. m.] Medical News, 
Dec., 1872. 
(6.) Welsch, jun. Tod als Mittel gegen Croup. [Aerzt. Int. Blat., 
No. 12, 1873.] Allg. Med. Central Zeitung, April 16, 1873. 
(7.) Rapp, jun. Brom inhalationen und Bepinselungen gegen 
Croup. (Bayer, Arztl. Intell Bl. xx. 4) Schmidt's Jahrb., June 23. 
(8.) Bohm. lod als Mittel gegen Croup, Allg. Med, Central-Zeitung, 
May 28, 1873. 
(9.) Ueber gewisse atiologische Beziehungen der Diphtheritis zu 
anderen Krankenheiten, Zum Sande. Berl. Klin. Woch , July 7, 1873. 
(10.) Binder. Die Diphtheritis in Siebenbiirgen, speziell in 
Agnetheln. Wiener Med. Woch., Aug. 16, 1873. 
(11.) Dr. John Bartlett. Lime Baths in membranous Croup. Chi- 
cago Med. Examiner, Aug. 15. (Phil. Med. Times, Sept. 20, 1873.) 
13. Des Complications Cardiaques du Croup et de la Diphtherie, et 
en particulier de Fendocardite secondaire diphtheritique. Par Le Dr. 
Labadie Lagrave. Paris. 1873. 
Diphtheria and Croup. 
Tracheotomy and Laryngotomy. 
(1.) Maunder. Cases of Laryngotomy. British Medical Journal, 
Feb. 1, 1873. 
(2.) Tracheotomy performed by Gal vano-caustic Apparatus. La 
France Medicale, Jan. 22, 1873. Practitioner, March, 1873. 
(3.) Mackenzie, Semple and Thornton. Eight cases of Tracheotomy. 
Med. Times and Gazette, June 7,1873. 
(4.) Schech. Ueber die Functionen der Nerven und Muskcln des 
Kohlkopfs. Berl. Klin. Woch., May 19, 1873. 
(5.) Durham. On the Operation of Opening the Larynx by Section of 
the Cartilages, &c., for the removal of morbid growths. Med. Chir. 
Trans., 2d series, Vol. 37, 1872. 
(6.) Bourdon. Tracheotomy by Galvano-caustic. Archiv. Gen. 
G Ser. xxi. p. 53. Jan. (Schmidt's). 
(7.) B. W. Richardson. On Artificial Respiration after the Opera- 
tion of Tracheotomy. Med. Times and Gazette, Aug. 2, 1873. 
(8.) De Ranse. Nouveau procede de Laryngotomie. Gazette Med. 
de Paris, July 5, 1873. 
(1.) Mr. Maunder reports three cases under this heading, which 6 
occurred at the London Hospital. The first was one of naso-pharyn- 
geal polypus, in which the breathing became so bad after an attempt 
at removal by the ecraseur, that tracheotomy (the word used in the 
detailed report) was performed, and afterwards the growth was re- 
moved by slitting the soft palate, and perforating and cutting away 
sufficient of the hard to allow plenty of space. He then removed the 
growth by freely scraping bare all the bony surfaces from which it 
took its origin. The tumor was fibrous, and took its main origin from 
the basilar process of the occipital bone. Mr. Maunder remarked that 
these growths sprang from the periosteum, and, to remove them effect- 
ually, it was necessary to scrape off this completely. After the ope- 
ration, the wound in the hard and soft palate was to be left open for 
some time, to examine the part readily, and to destroy, if necessary, 
with the galvanic cautery, any fresh growth. 
The second case was one of syphilitic disease of the pharynx, in 
a syphilitic man, aged 30, who had had for several days severe attacks 
of dyspnoea. The soft palate and uvula were found to be united to 
the base of the tongue, completely closing up the fauces, with the ex- 
ception of one small hole on the right side of the uvula, which admit- 
ted a No. 4 catheter. He said that he could eat meat after masticating 
it well, and seemed to make light of any great difficulty in swallowing. 
Laryngotomy was performed, and attempts were then regularly made 
to dilate the aperture above described by passing catheters and bou- 
gies, but the largest that could be passed was a No. 11 catheter. He 
could eat chop and vegetables without apparent difficulty. Mr. 
Maunder then enlarged the aperture by making an incision through it 
parallel with the uvula, and then forcibly dilating with his finger. 
The whole of the pharynx appeared to be filled up with diseased tissue. 
Five days afterwards, he had an attack of erysipelas of the face, which 
disappeared in twelve days. Mr. Maunder proposed still further to 
dilate the aperture in the pharynx by passing bougies at intervals, 
and, if necessary, by making incisions at right angles to the present 
opening. 
The third case was one of inflammation of the floor of the mouth, 
tongue, pharynx, and left side of the neck, in a man of 21, who, 
on admission, attributed the swelling, redness, &c. of the above- 
named parts to a fight which he had had four days before. Two days 
after admission, the floor of the mouth was so much swollen that it 
reached about the level of the teeth, and was indented by them. The 
tongue so filled the mouth that the back of the mouth or fauces could 
not be seen. He could swallow nothing. He breathed moderately 
well. An incision into the side of the neck gave vent to a little pus. 
Dressing forceps were introduced into the wound, and through the 
deep fascia and withdrawn open. On the following evening, his 
breathing became rather worse ; and,'at 2, A.M., his condition was so 
urgent that the house surgeon performed laryngotomy. The neck was 
so much swollen and so brawny that the thyroid cartilage could not 
be felt; and after cutting through thickened and infiltrated tissue for 
more than an inch, the larynx was found to be pushed very much to 
the right of the median line. The operation afforded instantaneous 
relief. The swelling of the mouth, tongue and neck had so subsided 
two days after this operation that the fauces could readily be seen. In 
six days the tube was removed, and the patient was rapidly recovering. 7 
(2.) This proceeding was originally introduced into practice by M. 
Amussat fils, in 1870, and was first performed on a boy, aged 13. Dr. 
Amussat passed a curved needle, carrying a double thread of platinum, 
through the integuments, so as to embrace at the same time about two 
centimetres of the trachea in the loop. After the removal of the needle, 
he seized one of the threads with two forceps in communication with 
an electric battery, and made the section of the tissues comprised in 
the loop without haemorrhage. The trachea being opened, the child 
coughed violently, and expelled the foreign body which was in the 
trachea, and for which the operation had been performed. A week 
subsequently, the wound was healed and the patient well. 
The first number of the Archives Generales de Medecine for 1873 
contains a series of eight operations by different operators, the particu- 
lars being furnished by M. Bourdon. 
The operation as performed by M. Verneuil is as follows : There 
are three steps ; the incision of the skin and of the soft parts ; the in- 
cision into the trachea, and the introduction of the canula. 1st. After 
having marked with the nail the point which corresponds to the inferior 
border of the cricoid cartilage, the extremity of the blade of the instru- 
ment is pressed in and made to cut downwards to an extent corre- 
sponding to the diameter of the canula that is desired to be introduced, 
and the thickness of the soft parts covering the trachea. In the infant, 
the first incision, which is made with great rapidity, ought not to be 
made deeper than the skin, lest the trachea should be opened at the 
outset, and there be a risk of cauterizing it, if not of perforating the 
posterior wall. 2d. The trachea being exposed, it should be seen that 
the wound corresponds to the middle line, and the point of the knife 
should be made to penetrate into the first interspace between the 
cartilages and the necessary number of rings divided. 3d. The 
introduction of the canula is the last and easiest of all. This proceed- 
ing, it is obvious, differs considerably from that of M. Amussat, but 
in view of the difficulties that are presented by the adult -when trache- 
otomy is required, M. Bourdon prefers the latter. 
Foreign Bodies. 
(1.) Laboulbene. Foreign Bodies in the Larynx. Bulletin de The- 
rapeutique. Lancet, Nov. 16, 1872. 
(2.) Trendeblenburg. Zur Extraction von Fremdkorpern aus dem 
(Esophagus. Langenbeck's Archiv, Band. xiv. Heft iii. Berliner 
Klinische Wochenschrift, Feb. 24, 1873. 
(3.) Chevalier. Corps etranger dans le pharynx; abces retropha- 
ryngean ; congestion pulmonaire (?); mort. Archiv. Med. Beiges. 
Gazette Medicale de Paris, Mar. 8, 1873. 
(4.) Landi. Corps etrangers dans la trachee ; tracheotomie. Lo 
Sperimentale, 1872. Gazette Medicale de Paris, Jan. 25, 1873. 
(5.) Cohen. Bone removed from the Larynx (post mortem). Phil. 
Med. Times, June 7, 1873. 
(6.) Annandale. Foreign Bodies in the Larynx; appearance of 
Croup. Edinburgh Med. Journ., xviii. p. 849, March. 
(7.) Donlos. Leech in the Pharynx ten days. Bull.de Therapie, 
Ixxxiv. p. 236, March. Schmidt's Jahrb., June 23. 
Trachea. 
(1.) Plugging the Trachea in Operations on the Mouth and Throat. 
British Medical Journal, May 24, 1873. 8 
(2.) D. S. Lamb, M.D., Act. Assist. Surgeon U. S. A. A Fatal 
Case of Congenital Tracheo-oesophageal Fistula. Philadelphia Medi- 
cal Times, Aug. 9, 1873. 
(2.) Dr. Lamb reports a very interesting case of tracheo-oesopha- 
geal fistula ; he has not been able to find any case recorded which was 
exactly like it, those cases which have been recorded being conjoined 
with other malformation of the oesophagus, as, for instance, cul de 
sac termination. The patient in his case was seven weeks old at death, 
March 31, 1873. From its birth, almost every attempt at nursing was 
attended with strangling, and sometimes with lividity of skin. The 
mother stated that, during a portion of the previous summer, she had 
been roughly treated by her husband while he was intoxicated ; on 
several occasions he had violently choked her. Dr. Lamb saw the 
child for the first time about sixty hours before death. The most pro- 
minent symptom was flatulence, which was abundant and very pain- 
ful ; no vomiting; several thin greenish stools daily; it nursed but 
little. At the autopsy, a small granular deposit was found upon the 
mucous membrane of the trachea, just below the fistulous opening ; it 
was suspected to be from a milk-clot, but was washed off and lost be- 
fore its composition could be made out with certainty. The right 
lung was very dark and hepatized throughout; there was also slight 
pleuritic adhesion between the upper and middle lobes ; no fluid or 
lymph in the cavity. The left lung was somewhat emphysematous in 
its upper lobe; the anterior lower margin, to the extent of about a 
square inch, was in the same condition as the right lung ; there was 
neither fluid, lymph nor adhesion in the left pleura. Heart normal. 
Stomach and intestines distended with flatus. Liver, spleen and kid- 
neys normal. Mesentery somewhat congested. 
The head was not examined, except so far as to notice the condition 
of the palate, which was found normal. The hyoid bone, larynx and 
portions of the trachea and oesophagus were removed. In the median 
line, nearly half an inch below the lower border of the cricoid cartilage, 
was a fistulous communication between the tubes, having a longitudinal 
diameter of three lines and a transverse diameter of one line ; the di- 
rection of the fistula was downwards and backwards, the opening in 
the oesophagus being at a lower level than that in the trachea; the 
edges were smooth and rounded, and the mucous membrane normal. 
This specimen is now in the Army Medical Museum, No. 1161 of 
the medical section. Dr. Lamb concludes his paper with abstracts of 
the descriptions of the cul de sac pharynx or oesophagus, with or 
without fistulous Communications with the air-passages, found in vari- 
ous museum catalogues. He calls attention to the similarity in the 
cause of death in several of the cases. The two cases from which 
were obtained specimens 456 and 457 of the Boston Society for Medi- 
cal Improvement appear to have terminated fatally from pneumonia, as 
did the case reported by him. 
Dr. L. also remarks that it seems to be quite possible for fluids to find 
their way into the trachea of an infant, even without any obstruction 
of the oesophagus. lie quotes from the Lancet of May 10th, 1873, 
the case of a child aged " one year, which was fed by the bottle, put 
to bed at six o'clock, and died at midnight with all the signs of in- 
tense dyspnoea. At the post-mortem examination (ten hours after 
death), the two lower lobes of the lungs were found quite softened, 9 
grayish, having a smell of butter, and, in a word, having undergone 
the action of gastric juice. Altered milk was found in the trach.ea 
and bronchi. In this case, the milk contained in the stomach, which 
doubtless had been taken in excess, was vomited, and, on account of 
the horizontal posture, had penetrated into the air-passages. Dr. 
Panot drew the attention of his colleagues to the importance of the 
fact from a medico-legal point of view. He thinks that this occur- 
rence must be rather frequent, as he has already witnessed two cases 
in his own sphere of observation." 
(1.) Emminghaus. Einiges uber Diagnostik und Therapie mit der 
Schlundsonde. Deutsches Archiv fair Klinische Medicin, xi. Band, iii. 
Heft. 
(2.) Francis Mason. Carcinoma (Esophagi', Gastrotomy; Death. 
Lancet, Jan. 25th, 1873. 
(3.) Totherick and Jackson. Impassable Stricture of the (Esopha- 
gus; Gastrotomy ; Death. Brit. Med. Journal, May 24, 1873. 
(4.) Heyfelder, 0. Krebsige Striktur des (Esophagus, Ernarung 
durch die Schlundsonde und Fleisch-Pankreas-lvlystir. Deutsche 
Ztschr. f. Chir. ii. 3, p. 324. Schmidt's Jahrb. 
(5.) Weichselbaum. Strictura (Esophagi; (Esophagotomie ; Death. 
(Von Podrazki's Klinik.) Wien. Med., Aug. 16, 1873. 
(Esophagus. 
(Esophagotomy. 
(1.) Tillaux. (Esophagotomy. Bull de Ther., Ixxxiv. p. 14, Jan 
15. Schmidt's. 
Instruments. 
(1.) Dobell's Tongue Spatula. Brit. Med. Journal, March 1, p. 
228. Schmidt's. 
(2.) Welsch. Ueber Anwendung von Hohlspiegeln als Kehlkopf- 
spiegel. Deutsche Klinik, 14. 
(3.) An improved Tonsillotome. (Said to have been suggested by 
Dr. J. S. Billings, U. S. A.) Phil. Medical Times, June 28, 1873. 
[Seems to be identical with the tonsillotome made by Mayer and Met- 
zer, of London.] 
(4.) Boeker. Ein Handgriff zur Anwendung des Galvanokaustik 
innerhalb des Kehlkopfs. Berliner Klin. Woch., July 28, 1873. 
Laryngitis. 
(1.) Gerhardt. Chorditis vocalis inferior hypertrophica. Deutsches 
Archiv, Bd. ii. Heft. 7, p. 583. 
(2.) James Sawyer, M.B., Birmingham. On the Treatment of 
Chronic Inflammatory Diseases of the Larynx. Brit. Med. Journal, 
July 12, 1873. 
(1.) Weil. J Entgegnung. 
Tobold. ( Schlussbemerkungen. Deutsches Archiv fur Klinische 
Medicin, xi. Band, iii. Heft. 
(2.) Review ofVoltolini. Schnitzler. Wiener Med. Presse, xiv. 
Nos. 1, 2 and 4. 
(3.) Von der allgenaeinen Poliklinik in Wien. ii. Sektion. Ab- 
2 
Laryngoscopy. 10 
theilung fur Hals und Brustkrankheiten des Docenten Dr. Schnitzler. 
Spezialbericht, erstattet von Dr. R. Coen, Assistenten, &c. Wiener 
Med. Presse, Feb. 23, 1873. 
(4.) Lectures on the Surgery of the Nares, Larynx and Trachea. 
Cohen. Philadelphia Medical Times, Jan. 25. 
(5.) Aus dem K. K. Garrisons-Spital, No 1, zu Wien, Mittheilun- 
gen uber die daselbst im Jahre 1872 behandelten Kehlkopf, Hals, und 
Nasenkranken. Von Dr. Sidlo. Wiener Med. Woch., June 28, 
1873. 
(6.) The Laryngoscope an American Invention. By G. Troup Max- 
well, M.D., of Middletown, Del. New York Medical Record, Jan. 
15, 1873. 
(6.) Dr. Maxwell claims that the idea of examining the larynx by 
means of a mirror occurred to him before he had heard of Gzermak's 
experiments, and before any notice of them was published in this 
country; and that he had an instrument constructed for this purpose. 
He has made no public mention of tliis before, in the first place, on 
account of the war, and afterwards he had wraited until now for Tiemann 
& Co., who had made the instrument, to find a note of it upon their 
books. 
Parasitic Diseases. 
(1.) Scheff. Soor im Kehlkopfe. Wiener Med. Presse, No. 25, 
1873. (Allg. Med. Central-Zeitung, June 25, 1873.) 
(2.) Fraenkel. Vorstellung eines Failes von gutartiger Mycosis des 
Pharynx. Allg. Med. Central-Zeitung, xlii. Jahrgang, 17 Stuck. 
(2. ) At the meeting of the Berlin Medical Society Jan. 29th, 1873, 
Herr B. Frankel presented a case of benign mycosis of the pharynx. 
This was discovered accidentally in the beginning of the previous 
month in one of his pupils in the laryngoscopic course, and had exist- 
ed since that time without any symptom of disease, except a slight 
chronic pharyngeal catarrh. Over the tonsils and follicles at the base 
of the tongue were to be seen separate white elevations, a line in 
height, and as large as the follicles under them. They did not give 
one the impression of hard pellicles, but resembled rather formations 
of mould ; when removed, they rapidly re-formed. When examined 
under the microscope, they were seen to consist of epithelial cells ; 
many little round bodies (micrococci) sticking to them, and also in 
active motion in the surrounding fluid ; and numerous little rods of 
various lengths, also partly in motion. Herr F. remarked that with- 
out thorough examination such a case might be confounded with diph- 
theria. 
Paralysis and Cramp. 
(1.) On Palsy of the vocal cord from intra-cranial Syphilis. J. 
Hugiilings Jackson, M.D., F.R.C.P. &c. British Medical Journal, 
Jan. 25, 1873. 
(2.) Eigenthiimliche Sprachkrampfe. Von cand. Med. Modi in 
Leipzig. Archiv der Ileilkunde, xiv. Jahrgang, i. Heft. 
(3.) Aneurism of the Arch of the Aorta, with laryngeal Symptoms ; 
death; clinical remarks. G. Johnson. Lancet, Dec. 7, 1872. 
(4.) Changes produced in the Recurrent Laryngeal Nerves in Cases 
of Thoracic Aneurism. R. J. Lee, M.D. Lancet, Jan. 25, 1873. 
(5.) A Case of Diphtheritic Paralysis (Headland) Lancet, Feb. 8,1873. 
(6.) Paralysis of left vocal cord ; relief to dyspnoea from tracheoto- 11 
my ; death. Autopsy-aneurism of arch of aorta. Teale. Lancet, 
Feb. 8, 1873. 
(7.) Paralysis of both posterior crico-arytenoids ; aneurism of arch 
of aorta ; relief from tracheotomy. On autopsy, only the left vagus 
and recurrent found implicated in the walls of the aneurism. George 
Johnson. Lancet, Jan. 4, 1873. 
(8.) Paralysis of vocal cords ; tumor in the oesophagus, involving 
both recurrent laryngeal nerves. Le Fort. L'Union Medicale, April 
10, 1873. 
(9.) Pharynxpolypen mit rcflectorischer Stimmbandlahmung. Bd. 
11, Heft 7, p. 575. Gerhardt. Deutsches Archiv f. Klin. Med. 
(10.) Functioneller Larynxkrampf. Gerhardt. Deutsches Archiv f. 
Klin. Med. Bd. 11, Heft 7, p. 580. 
(11.) Frequently recurring spasm of the glottis dependent upon 
chronic hyperaemia of the larynx. A. II. Smith, M.D. N. Y. Med. 
Record, Aug. 15. [Relieved by four applications of perchloride of 
iron and glycerine (3U §'•)]• 
(12.) Die Laryngoscopie an Thieren. Schmidt. Tubingen. 1873. 
Pp. 106. 
(1.) Dr. Jackson calls attention to the occasional nervous origin, so 
to speak, of syphilitic aphonia. He says it would be unsafe, when a 
patient who is manifestly the subject of syphilis, becomes aphonic, 
especially if he has any nervous symptoms, to conclude, without look- 
ing into that organ itself, that ho had syphilitic disease of the larynx. 
It would be as unjustifiable as concluding, without ophthalmoscopic 
examination, that his blindness, if he were blind too, was owing to 
syphilitic changes in the eye itself. The fact is that in some cases of 
" syphilitic aphonia" there is no other abnormality discernible in the 
larynx than paralysis of one vocal cord. In these cases, the palsy may 
safely, in a person presenting outward signs of syphilis, be put down 
to syphilitic disease affecting the rootlets of the eighth nerve. Dr. 
Jackson is convinced that, in practice, aphonia from intra-cranial 
syphilis is not exceedingly uncommon. lie refers to two cases cor- 
roborative in clinical and post-mortem appearances of the above state- 
ments, which cases were published in the London Hospital Report, 
vol. iv., 1868, pp. 314 and 318. 
(12.) In our last report, we gave an abstract of an article by Schmidt, 
in which he gave an account of the appearances in the larynx of a cat, 
after section of one recurrent laryngeal nerve. In the present mono- 
graph, he gives the results of further experiments, giving the results 
of section of various laryngeal nerve branches and muscles, singly and 
in combination, as seen in the laryngeal mirror. The scries of experi- 
ments is quite complete, the notable exception being that of section 
of the spinal accessory, which it may be very hard or impossible to 
make in the cat before anastomosis. The only reference to the spinal 
accessory seems to be an interrogation mark after one of the conclu- 
sions quoted from the results of Navratil's experiments, i. e. that this 
nerve (the spinal accessory) " has no influence on the muscles of the 
vocal cords." 
The experiments arc preceded by an account of the anatomy and 
the normal laryngoscopie appearance of the cat's larynx. 
After section of both recurrents, the following appearances were 
noted : on inspiration, the vocal cords approached each other so that 12 
they almost touched, and during forcible inspiration approached still 
nearer each other, and separated a little during expiration. Touching 
the vocal cords, ventricular bands and the epiglottis with the sound did 
not excite cough so quickly as in the normal condition. Respiration 
was much less frequent, deeper, and was for some hours after the ope- 
ration accompanied by loud rales. The inspirations lasted much 
longer than the expirations. After a few hours, the respiration be- 
came quiet, and remained so unless the animal was disturbed, as by 
laryngoscopic examination. On the third day, the respiration was 
quiet, even during the examination. The laryngoscopic examination 
showed that the glottis was always open, and was somewhat wider 
than it was on the preceding day, even at the end of expiration. 
In the account of the effects of section of one recurrent laryngeal 
nerve, an additional fact, besides those mentioned in our last report, 
and one of considerable importance, is given, i. e. that the sensibility 
seemed to be somewhat diminished on the affected side. After section 
of one superior laryngeal nerve, at the first glance, it was difficult to 
notice any variation from the normal condition, but careful observation 
showed clearly that the vocal cord of the side on which the section 
had been made, was a little longer than that of the opposite side, and 
that the vocal process of this side stood a little further outward and 
backward. The sensibility of the side on which the section was made 
was much diminished. In a second animal, the sensibility on the side 
of the operation was completely lost. 
The voice in the first case immediately after the operation was 
strong, but hoarse and somewhat lower in pitch. 
In the second case, it was much hoarser and deeper, and the animal, 
which before the operation had frequently mewed, in the two first 
days after the operation was remarkably quiet, but on the third day 
mewed again frequently. The variation in the form of the glottis is 
due to the paralysis of the left crico-thyroid muscle. The left crico- 
arytenoideus posticus obtains a little preponderance, and draws the 
left arytenoid cartilage outward a little more forcibly. 
After section of both superior laryngeal nerves, laryngoscopic exami- 
nation showed that the glottis had a symmetrical form and offered no 
noticeable departure from the normal condition. The changes described 
above, now having occurred on both sides, were so slight as to be un- 
noticeable. In one animal, the sensibility was much less than in the 
normal condition, and in the other it was completely abolished. The 
voice was deeper and much hoarser than after section of one superior 
laryngeal nerve. Dr. Schmidt says that the function of approximating 
the lower edge of the thyroid cartilage to the upper border of the cri- 
Coid, and thereby increasing the tension of the cords, is often very 
erroneously ascribed to the crico-thyroid muscle. 
According to others, the muscle draws the upper border of the cri- 
coid cartilage upwards. If the crico-thyroid muscles, having been 
laid bare, are irritated by the electric current, the latter movement is 
in fact accomplished. 
The function of the crico-thyroid muscles in phonation, therefore, 
according to this result, would be to maintain the anterior insertions 
of the vocal cords in a fixed position. 
Division of the crico-thyroid muscle on one side gave a little different 
result from division of one superior laryngeal nerve, inasmuch as the 13 
vocal cord on that side presented a rectilinear edge, which was not 
the case when the nerve was divided. Farther experience can alone 
determine whether this was an individual peculiarity or whether the 
division of the superior laryngeal nerve in fact causes a little variation 
in the form of the glottis from that seen in division of the muscle 
simply. 
Division of the crico-thyroid muscle and of the lateral crico-arytenoid 
muscle on one side produced the following laryngoscopic appearances. 
During ordinary respiration, the glottis had the same form as after 
division of the crico-thyroid alone. 
On phonation, however, the arytenoid cartilage, with its vocal cord, 
did not move up to the median line on the side which had been ope- 
rated upon, but the other arytenoid cartilage and vocal cord crossed 
the median line, producing a bend in the line of the glottis with its 
convexity towards the side which had been operated upon. More- 
over, the arytenoid cartilage of the affected side stood farther back- 
ward and upward in consequence of the action of the posterior crico- 
arytenoid. The voice was still deeper and hoarser than in paralysis 
of the crico-thyroid alone. 
Division of both crico-thyroid and lateral crico-arytenoid muscles 
produced the following appearances. The glottis was of a perfectly 
symmetrical, regular, triangular form. The two sides of this triangle 
formed perfectly straight lines, so that no projection was noticed in 
the place of the vocal processes. The arytenoid cartilages were strongly 
rotated outward, and executed scarcely any respiratory movement. 
On phonation, the arytenoid cartilages touched quite symmetri- 
cally in the median line ; they executed no movement backwards and 
upwards. Between the vocal cords and the processus vocales there re- 
mained a large, triangular opening. The voice was replaced by a very 
hoarse, deep and rather weak noise, as was to be expected on account of 
the large opening remaining in the glottis, even during attempted pho- 
nation. The sensibility of the vocal cord in the last three cases was 
completely normal. The last experiment shows that the thyreo- 
arytenoidei muscles, which are here uninjured, bring the vocal cords 
considerably nearer the median line on attempted phonation. A com- 
plete approximation, however, is impossible, because the conjoint ac- 
tion of the lateral crico-arytenoid is wanting. 
According to these experiments, then, we find the results (1) of 
paralysis of one crico-thyroid muscle to be rotation of the arytenoid 
cartilage outward, and a rectilinear position of the edge of the vocal 
cord during ordinary inspiration ; (2) of paralysis of both crico-thyroid 
muscles to be a symmetrical triangular glottis with rectilinear edges 
of the vocal cords and strong rotation of the arytenoid cartilages out- 
ward. 
The principal results of paralysis of the lateral crico-arytenoid mus- 
cle are as follows : (1.) On one side, during ordinary respiration, no 
change ; during phonation, a curve of the line of the glottis towards 
the affected side and two chinks, between the vocal cords and between 
the processus vocales. (2.) On both sides, during phonation, a large, 
triangular opening remains between the vocal cords and the processus 
vocales. 
So we see that on section of the crico-thyroid muscle changes were 
found only on ordinary respiration, and, on section of the lateral crico- 
arytenoid, only on phonation. 14 
Section of the arytenoideus transversus muscle.-Immediately after 
the section, the cartilaginous glottis was widened a little posteriorly. 
The interstium inter-arytenoideum became somewhat larger. During 
quiet respiration, the rima glottidis, between the posterior ends of the 
vocal cords, the processus vocales and anterior ends of the cartilagi- 
nous glottis, is somewhat narrower than normal. It strikes the eye so 
much the more, as the ary-glottis is somewhat broader. On intona- 
tion, the vocal cords and vocal processes touched each other, but a 
triangular opening remained between the arytenoid cartilages poste- 
riorly. The voice was hoarse, deeper and weaker. Diplophonia 
(Gibb) at times existed. 
Section of the thyreo-arytenoideus muscles and the recurrent branches 
going to them.-On intonation, the edges of the cords, instead of being 
straight, were concave, thus leaving a small, elliptical opening. The 
voice was weak, hoarse, and lower than usual. 
Section of both crico-arytenoidei postici muscles.-On respiration, 
both vocal cords stood near the median line. The arytenoid cartilages 
were nearer each other than after section of both recurrent nerves. On 
inspiration, the vocal cords approached each other, and on expiration 
separated. After section of the second muscle, the dyspnoea was so 
great that tracheotomy was performed. There was no voice, even 
when the tracheal opening was closed. 
Dr. Schmidt also tried the application of morphia, and morphia and 
chloroform to the larynx of the cat without much effect upon its sen- 
sibility. 
We have given above only a mere outline of a few of the experi- 
ments made by Dr. Schmidt. The monograph contains many others, 
and we recommend its perusal to those interested in the physiology of 
the larynx. 
Bronchocele. 
(1.) Ein Fall von acutem Kropf. Ludwig, in Pontresina. Archiv 
der Heilkunde, xiv. Jahrgang, i. Heft. Berliner Klinische Wochen- 
schrift, March 3, 1873. 
(2.) Goitre. Gross. Phil. Med. Times, May 17th, 1873. 
(3.) Exstirpation eines Kropfes. Fenwick. (Bresse Med. xxv. 13, 
p. 101.) Schmidt's Jahrb. June 23. 
Ulceration and Tuberculosis. 
(1.) Specimen of complete loss of substance of the larynx from 
spphilitic (?) ulceration. Silver. Med. Times and Gazette, June 14, 
1873. 
(2.J Isambert. Presentation des pieces anatomiques (pharynx et 
larynx) [tuberculous granulations] L'Union Medicale, Jan. 28, 1873. 
(3.) Syphilitic ulceration of the larynx ; dyspnoea-tracheotomy; 
death. White. Phil. Med. Times, June 28, 1873. 
Abscess and Perichondritis. 
(1.) Ein Abscess der linken Ary-epiglottischen Falte. B. Wagner. 
Archiv der Heilkunde, xiv. Jahrgang, i. Heft. 
(2.) Retro-pharyngeal abscess, in a child of twenty-five months, 
opened and cured. Roustan. Bulletin Medical du Nord de la France, 
March, 1872, Lancet, Nov. 16, 1872. 15 
(3.) Abscess of the larynx in young children. Parry. Phil. Med. 
Times, June 14, 1813. 
(4.) Perichondritis nach Typhus. Ileilung. Gerhardt. Deutches 
Archiv f. Klin. Med. Bd. ii. Ileft 7, p. 578. 
(5.) Laryngeal abscess simulating croup. Dr. Stephenson. Edin- 
burgh Med. Journal, Aug. 1873, p. 174. 
Stricture. 
(1.) Schroetter. Ueber Larynxstrikturen. Wien. Med. Woch. 
xxiii. 11, p. 251. (Schmidt's.) 
Reprinted from the Boston Medical and Surgical Journal, Nov. 27, 1873.