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crease the tension of the vocal bands by drawing the cartilages backward. If the vocal bands are made tense by the contrac- tion of all the muscles which bring them together — the lateral crico-arytenoids, the crico-tbyroids, new york new york casino poker tournaments and the arytenoids — then the posterior crico-arytenoids will help in maintaining the ten- sion of the vocal bands. Dr. F. I. Knight. — I would like to ask Dr. Cohen whether the means of diagnosis which he mentioned is based on experi- 114 SVLlS-aOHEN: I'ASALYSIS OF THE POSTERIOR GRICO-ARYTENOID MUSCLES. [N. Y. Med. Jook., ence or not. Has he ever seen a case of isolated paralysis of the crico-tliyroid muscle? Dr. OoHEN. — I have seen a case wliich I thou(,'lit was one of paralysis of that mn.scle. Dr. Knight. — Dr. Leidy's demonstration of the e.xteut of tlio attachment of the crico-thyroid membrane, and its iden- tity with the vocal bands, explains the serions impairment of the voice following the old operation of laryngotomy for jouer machine poker gratuitement the removal of growths, in which a long incision was made from the hyoid bone down to the trachea. It is well known clinic- ally that, when the cricoid cartilage is spared, the chances of a good voice after the operation are very much improved. Dr. F. H. HooPEU. — I have been much interested in the game poker texas hold re- marks relating to the cartilages of Wrisberg, which recall to ray mind a case recently seen at the Boston City Hospital. The patient was an Irishman, about fifty years of age ; he had an enormous development of these bodies. His larynx resembled the larynx of a dog. In the dog there is a muscle attached to these cartilages which corresponds, I suppose, to the dilatator vestibuli laryngis in mau. If this muscle in the dog is stimu- lated, the cartilage is rotated outward, in the same manner as the arytenoid cartilage is by the contraction of the posterior crico-arytenoid muscle. Dr. Leidy. — I am pleased to hear the explanation, and I re- gard it as a very satisfactory one. The President. — The most interesting point to me is that so small a portion of the surface of the cartilages serves as the •origin for tlie laryngeal muscles ; however, this, after all, is only like what is found in other parts of the body. The most delicate muscles everywhere are those which have the least amount of origin and insertion, while large muscles have large gameloft texas hold'em poker 3 apk surfaces of attachment. In the eye, for instance, the muscles have very well-defined points of origin and insertion. FURTHER HISTORY OF THE CASE OF PARALYSIS OF THE POSTERIOR CRICO-ARYTENOID MUSCLES PRESENTED AT THE FIRST MEETING OF THE ASSOCIATION, 1879. With Report of Autopsy and Exhibition of Specimen and Microscopic Preparations* By J. SOLIS-COHEN, M. D., PHILADELPHIA. download game texas holdem poker offline pc As the history of the case was given when the patient was exhibited before the association seven years ago, it i.s unnecessary to repeat it in detail. To quote from the sec- ond edition of my book on " poker online - play bwin poker & internet texas holdem games bwin Diseases of texas holdem poker game for sale the Throat," 1 879. p. 654. " In October, 1870, a gentleman, forty-six years of age, of good physique and in apparent health, had suffered for two years or more witli cough, dyspnoea, and occasional obstruction, and alarming spasm of the larynx, which had eventuated in loss of consciousness in the street on two occasions. His respiration labored, inefficient, and attended with such inspiratory stridor in sleep that it could be heard all over his residence. Early in life he had a suppurative inflammation of his left ear, which offline poker game for android free download had eventually subsided. He had been addicted to excessive smoking (fifteen or sixteen cigars a day, and an occasional pipe or two in addition) for many years. Hearing was somewhat impaired. Read before the American Larvngological Association. Laryngoscopic inspection revealed paralysis of the posterior crico-arytenoid muscle of the left side, with a tendency to spasm of the glottis, as provoked by the examination. Interrogation re- vealed the fact that irritation of the left external auditory mea- tus always induced cough, followed by spasm of the larynx, so that the patient dared not cleanse the ear for fear of exciting a paroxysm. A tentative treatment was instituted, with the addi- tion of a constant supply of nitrite of amyl at hand for inhala- tion on the occurrence of a spasm. All went well for a few days, when an inadvertent manipulation of the ear brought on a terrific spasm that was reported as well nigh fatal. Recount- ing this to me next day, while awaiting his attending physi- cian. Dr. Hinkle, in my reception-room, he placed his finger in his free texas holdem poker flash game ear to illustrate the occurrence, when a severe paroxysm of spasm was provoked just as Dr. Hinkle entered the room, in time to assist rae in controlling it by the prompt administration of, vapor of chloroform. On the poker free no download following day I performed tracheotomy, and the patient has been wearing a tube for more than two years (1878). poker casino new york city After the operation the patient's hear- ing improved and remained improved. Color-blindness, how- ever (chiefly interchange of red flash games texas holdem poker multiplayer and green), soon supervened, and ophthalmoscopic inspection revealed progressive atrophy of the optic nerves, which has since increased to very casino arizona poker tournaments 2012 indistinct vision. The tendency to cough and to spasm on titillation of the ear continues, but no lesion is apparent on inspection. Within a few weeks after the download free full version pc game texas holdem poker operation the right vocal cord became paralyzed likewise, and at the end of free texas holdem poker games against computer about three months the paralysis became so complete, and the tension of the vocal cords and ary-epiglottic folds so marked, that it is diftieult to believe that there is not in addition permanent spasm of the arytenoid and lateral crico-arytenoid muscles ; for from that time to the present (1878), now more than two years, I have never seen the glottis in any other condition, although there is sometimes just enough separation of the arytenoid cartilages on forcible inspiration to see that texas holdem poker gratis flash game they are not welded together ; otherwise the condition simulates adhesion of the arytenoid cartilages, as I have .=een it in stenosis after syphilis." During the next four years I saw this patient at various irregular intervals. His larynx always presented the same picture of apparent tonic spasm of the constrictor download game governor of poker 2 gratis muscles. Irritation of his ear always produced spasmodic cough. The only special complaint he made was of intense cold in his testicles, as though machine de poker en ligne gratuit ice were continuously at the poste- rior part of his scrotum. He became completely blind. His hearing continued good. His voice remained power- ful ; he could speak loudly without occluding the orifice of his tube. I did not see him during the last four years of his life. In the early portion of the present year the physi- cian in attendance at his home in another State sent to me for a special tube that I had used shortly after the trache- otomy, as the tubes worn for so man}- years were giving trouble, by irritating the trachea, probably on account of progressive emaciation in the tissues of the neck. I learned that the patient was gradually sinking by asthenia. He died, and I was offered a long-promised autopsy. Pro- fessor Forbes, of the anatomical chair of Jefferson Medical College, was kind enough to accompany rae and to make the dissection. With great skill he world series of poker game free download for mobile removed in one con- tinuous mass all the structures involved in the question as to the origin of the laryngeal lesion — external auditory me- atus, middle ear. Eustachian tube, palate, pharynx, tesopha- gus, trachea, and adjacent portion of lungs, aortic arch, July 31, 1886.1 SOLIS-GOHEN : PARALYSIS OF THE POSTERIOR ORIGO-ARYTENOID MUSCLES. 115

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