and is thus described in the third volume of the "Medical Gazette," at page 585:

"It consisted of an oblong piece of looking-glass, set in silver wire, a long shank. The reflecting portion is placed against the palate, while the tongue is held down by a spatula, when the epiglottis and the upper part of the larynx became visible in the glass."

The impetus now seems to have been given to further improvements and discoveries. In France, MM. Traupeau and Belloc published in

A. Great cornu of the hyoid bone.

B. Body of the os hyoides.

C. Small cornu of the hyoid.

D. Thyroid cartilage.

E. Upper cornu of the thyroid.

F. Lower cornu of the thyroid.

G. Cricoid cartilage.

H. Arytænoid cartilage.

I. Cartilage of Santorini.

J. Crico-arytenoideus posticus muscle.

K. Cuneiform cartilage.

L. Epiglottis.

M. Thyro-hyoid ligament.
N. Crico-thyroid ligament.
O. True chorda vocalis.

P. False chorda vocalis.

Q. Ventricle of the larynx.

R. Rima glottidis.

S. Sacculus laryngis.
T. Thyro-hyoid membrane.

U. Arytæno-epiglottid fold.

V. Arytænoideus posticus muscle.

W. Interior of the trachea.

X. Muscular part of the trachea.

Y. Rings of the trachea.

Fig. 5.

1837 the result of the investigation they had made by means of an instrument made by an ingenious mechanic of the name of Selligue, and which they call a speculum laryngis; and in 1838 M. Beaumes, of Lyons, exhibited a mirror he had constructed for examining the throat, larynx, and back of the nostrils; while in England the names of the late Mr. Avery and Dr. Warden should also receive honourable mention for their efforts in the same direction.

But I must pass on now to a name that must ever occupy a very high place in the list of those distinguished men who have, within the last

twenty years, not merely metaphorically, but literally, thrown so much light upon the larynx. I mean M. Garcia, the celebrated teacher of singing, and brother of the great prima donna of thirty years ago, Madame Malibran. M. Garcia had for many years made the anatomy and physiology of the larynx, as the organ of voice, a subject of constant study, and had long felt a great desire to witness the mechanism and movements of the organ of the human voice in the act of singing. This he carried out successfully by a very simple plan, making his own throat the subject of his experiment, when he was at Paris in September 1854. Standing with his back to the sun, he held a looking-glass in his left hand before his face; the sun's rays were thus reflected by the glass into his open mouth. Then, having previously warmed a small mirror, similar to that used by dentists, he placed it at the back of his mouth, and then he saw reflected in the mirror his own larynx, with the vocal cords in action as he sung an air. He next performed a series of experiments in relation to the movements of the vocal cords and the general action of the larynx in various persons in the act of singing, with a view to determine the chest registers of the voice, and the means by which the falsetto is produced. The result of M. Garcia's observations were given by him in a very interesting paper entitled "Physiological Observations on the Human Voice," which were read before the Royal Society on May 24th, 1855, and which, if you desire to read (and well will it repay perusal), you will find in the Proceedings of that Society for the year 1855. Many important observations and discussions resulted from the publication of this paper. The eminent physiologist, Dr. Türck, of Vienna, became acquainted with this paper, and was induced by it to use the laryngeal mirror in the wards of the general hospital of that city during the year 1857, for the purpose of making a diagnosis in cases of diseases of the larynx. In the autumn of that year he lent his mirrors to Dr. Czermak, who very soon made a great improvement in the invention. Hitherto sunlight had been the means employed for illuminating the interior of the throat, which, of course, was not always to be attained. He conceived the idea of adapting the ophthalmoscopic mirror, designed by Ruete, for the purpose of concentrating and reflecting artificial light, thus making the laryngoscope, as he now termed his instrument, available at all times as a means of inspecting the larynx and of guiding the hand in the application of local remedies. He also employed mirrors of various sizes and perfected them in every way. The name of Czermak has ever since been prominently associated with what is termed the art of laryngoscopy, though we ought not to omit mentioning, with high honour, the names of Sir G. D. Gibb, Dr. George Johnson, and Dr. Mackenzie in our own country, and those of Battaille and Merkel on the Continent. Czermak travelled over the best part of Europe in order to make known his researches, and the views he held in consequence. But with a most praiseworthy modesty he never failed to give Garcia all the merit his originality deserved; and the very first essay Czermak published, which was in 1858, bore as its title "Physiological Researches with the Laryngeal Mirror of Garcia," showing the importance and value he attached to the experiments and researches of

the latter in thus giving his name to the mirror. That Garcia has a rightful claim to originality in what is called auto-laryngoscopy, or the means of inspecting one's own larynx, cannot, therefore, now, I think, be disputed. Still, Czermak must have the just merit given to him of being considered the discoverer of the art of laryngoscopy in its application to the diagnosis and treatment of diseases of the larynx; and he was also the first to practise the application of a somewhat similar contrivance to rhinoscopy, or the inspection of the posterior recesses of the nostrils.

I quite agree with the late Sir George Duncan Gibb, who has written a most valuable and elaborate work on the laryngoscope,* where he says that the experiments of Czermak are many of the most important that have ever been, or are likely to be, made, and reflect the highest credit upon the sagacity and genius of their originator. They are so beautiful, and so physiologically true in relation to the human voice, and help us so much to appreciate the pathology of vocalisation, that we cannot be too grateful for them as they appear under the title of "Observations on the Human Voice," in the Proceedings of the Royal Society. Sir G. D. Gibb himself, in a lecture which he delivered on the 11th of March 1863, before "The Musical Society of London," entitled "On the Influence of Musical and other Sounds upon the Larynx, as seen by the aid of the Laryngoscope, illustrated by a large number of coloured Diagrams," took the opportunity of acknowledging how much we owed to Garcia, and stated that his researches, which had given the first impulse to the study of laryngoscopy, had formed the basis of experiments for all subsequent observers.

Now, then, let me show you in this diagram a general view of the larynx, and of these vocal cords in particular, when they are in a state of repose and silence. (See Fig. 6.)

View of the larynx in a state of repose and silence, as seen in the laryngoscope. a. Upper or lingual surface of the epiglottis. b. Lip of the epiglottis on its laryngeal surface. c. Cushion of the epiglottis. d. Vocal cords, on the outer side of which is a dark line, the entrance of the ventricles. e. Cricoid cartilage. f. Trachea. g. Glosso-epiglottic folds. h. Aryteno-epiglottic folds. i. Regulator of the glottis (false cord). k. Cartilage of Wrisberg. I. Capitulum Santorini, forming the apex of the arytenoid cartilage. m. Arytenoid commissure.

"The Laryngoscope in Diseases of the Throat." By Sir George Duncan Gibb, Bart., M.D. Churchill & Sons, New Burlington Street. See also the two Lec

D

These two long narrow bands marked d d are the vocal cords, extending, you perceive, from the angle of the thyroid cartilage to the base of the arytenoid cartilages. They are always quite unmistakable, for their colour is a brilliant, pearly, glistening white, sometimes partaking of a tinge of grey, and, in the act of vocalisation, capable of the most astonishing rapidity of movement. The average length of each of the vocal cords in man is rather more than half an inch, in woman somewhat less. Müller states that the relative lengths of the vocal cords in the male and female larynx are as three to two, both in the relaxed and in the extended state. As regards their structure, they consist of a bundle of fine elastic tissue, covered with a thin mucous membrane. You notice that each vocal cord has two free surfaces, one internal, which looks to its fellow, and one above, where it bounds the ventricle; and the free edge between those two surfaces is the part that is made to vibrate by the out-going current of air, as I shall explain to you shortly. This diagram, then, shows you the position of the vocal cords when we are silent, and you perceive that their vibrating edges are at a distance from each other and divergent behind, and the air that we expire passes by them, when we are in a state of health, without producing any sound whatever. But now, in order that voice should be produced either for speaking or singing, these edges of the vocal cords require to be approximated and put parallel to each other by certain specific muscles, which perform that office, and thus be placed in what is called the vocalising position. This is instantly done at the command of that marvellous and mysterious power-the human will. The expired air

View of the larynx during the act of phonation, as seen in the laryngoscope. The same parts above the glottis are seen as in Fig. 6, only that the glottis is closed whilst sounds are being uttered, and the larynx above the glottis forms a sort of hollow, with the walls somewhat approximated.

a. Vestibule of the larynx. b. Capitulum Santorini, below which is the arytenoid cartilage. c. Arytenoid commissure. d. Vocal process. e. Cornu of hyoid bone. f. Pharyngeal surface of cricoid cartilage.

now puts the free edges of the vocal cords into a state of vibration, and then sound or voice is immediately produced. The diagram I now tures on the Laryngoscope, delivered at the Royal College of Physicians, by Dr. George Johnson, Professor of Medicine in King's College. Hardwicke & Co., 192 Piccadilly.

show you exhibits the position of the vocal cords in the act of producing voice. (See Fig. 7.)

Now, is it not a wonderful thing to reflect upon that all the exquisite music, and the variety of notes we hear in the voice of a great singer, and the expressive and delicate inflections and modulations of the voice, which we hear in a great orator or actor, are mainly produced by the condition and action of these two little cords, each but little more than half an inch in length? *

The more the vocal cords are relaxed, the lower is the note in the musical scale, whether in song or in the inflections of the voice in Elocution; and, on the contrary, the more they are tightened, the higher is the note that is produced. Alterations in the degrees of tension in the vocal cords are produced and caused by the action of specific and most delicate controlling muscles. But the larynx also plays its part in the production of all the varieties of notes in the musical scale. To produce the deepest note of the voice, the larynx is depressed about half an inch below its mean position, by which the aperture between the vocal cords called the rima glottidis (or chink of the glottis) is opened in its whole extent, and the tension of the cords is very slight. When the larynx is in the lowest position, the voice not only takes its lowest note, but from a diminished action of the air in its egress becomes scarcely audible. On the other hand, when the voice ascends from the lowest to the highest notes of the register of the chest voice, the larynx gradually rises until it reaches half an inch above its mean position, and the aperture of the rima, or chink, diminishes in breadth in proportion as the larynx ascends. †

I find it is stated in "Once a Week" that "Dr. Marcet, of the Brompton Consumption Hospital, has been examining the throat of one of the Tyrolese singers who have lately been warbling at St. James's Hall, the object of the inspection being to ascertain the physiological conditions which produce the beautiful falsetto notes for which the Swiss artists are celebrated. The observations were made by means of the laryngoscope. It is pretty generally known that the human vocal apparatus consists of a pair of membranes situated horizontally in the throat, and just touching at their edges. A drum head, with a slit across it, may convey a popular idea of them. In the act of singing, the lips of these cords, as they are called, are brought into contact, and they approach each other throughout their whole length and remain parallel. When they are set in vibration, by the passage of air through them, under these the ordinary

A full report of Sir. G. Duncan Gibb's Lecture on "The Influence of Musical and other Sounds upon the Larynx, as seen by the aid of the Laryngoscope," delivered before the Musical Society of London, will be found in the Appendix.

+ In November 1873, a wonderful operation was performed for the first time in the annals of surgery in the chief hospital at Berlin, by Professor Billroth. The patient, owing to malignant disease of the larynx, was utterly voiceless. After excising the diseased portion, Professor Billroth supplied its place with an artificial larynx and vocal cords, composed of indiarubber and metal. Voice and speech were restored to the patient, though, of course, the voice had a very abnormal sound. A full account of the operation, with a description and engraving of the artificial larynx, was published by Dr. Gussenbauer, at Berlin, in 1874.