OCR Text |
Show or THE rnomnc. ‘J H enters the trachea: or a husk of grain drawn in by the breath and adhering near the top of the wind-pipe. Even in difficulty of breathing, and of deglutition, proceeding from tumours pressing on the trachea, as well as from these causes, the obstruction of breathing is not continual, but comes in paroxysms, at intervals, and still depends on the same occasional spasmodic affection of the muscles of the glottis. Every kind of obstruction will of course be aggra~ rated upon violent exertion. This in some instances we ought to provide against, as in labour. If a woman have a tumour pressing on the wind-pipe with occasional paroxysms of difficult breathing, we should be prepared to give relief during the exertion and determination of the blood to the head, in consequence of labour: or by free scarifications, pre« vent the tumour from being gorged with blood during labour. If we are called to a patient having a bone in the throat, we ought not in an impressive and rapid manner to seize up on him; for this puts him into terror and anxiety that in- creases the difficulty of breathing. Without much loss of time, it is possible to set down before him in that composcd manner which will give him confidence of relief.-Openv ing his mouth you press down the tongue with a spatula or spoon, and endeavour to see the bone-(we shall often be able to see it, for it may be grasped just upon the entry of the fauces). When we can observe it, we should seize it firmly with a pair of forceps, and extract it. Should we not be able to see it, we may put in the finger by the side of the mouth, and so deep into the throat as to touch the bone, and unfix its sharp points, when the effort to cough and vomit from the presence of the finger in the throat, will throw it out. OF THE USE OF THE PROBANGr .. IN the first place, we may recollect, that if a neighbour l.1: chpking, -' r he n ought - not to run . - search . k in of a probang, for a nest any thing may do, to push the morsel down t r "I" "I" C'Iu'arvv f-«" .r-- . «up, . .. i 4350w mom . 3 01" THE PROBANU. The ringer, if dexterously put in by the side of the mouth, will often unfix a body, when lying across the pharynx. The end of a table-spoon, or a wax candle, and on some occasions, the end of a whip, has done good service. Nothing is better for pushing down a morsel than a leek. In a child and sometimes in the adult, the finger will extricate the substance, either by pushing it down, or hooking it out. The probang is introduced by forcing it against the back part of the pharynx. The yielding of the pharynx, and. the elasticity of the instrument, directs it down into the oesophagus. The rule may be taken, that all soft or digestible substances are to be thrust down into the stomach, whilst we must endeavour to catch, or pull, sharp and indigestible ones up. But when a large piece of meat, or cartilage, or a. Crust of bread, or piece of tripe, sticks firmly in the phaé rynx, we should rather endeavour to bring it up, though it be a digestible substance; for it sometimes is so wedged in, that it will not pass down, and our efforts only fix it the more firmly. If it be within the reach of the finger so that it may be unfixed, the effort of the throat will proba bly throw it out. Or if this be impossible, the polypus forceps is the best instrument to take hold of it, and pull it forthts. In short, this must be accomplished in some way, or at least we must have it unfixed from the grasp of the horns of the thyroid cartilage, else the struggle of the patient will soon be over. People suffocating, may be able to speak at first; but this is soon over, and the surgeon will generally know nothing further, than that the patient is struggling in imminent danger of instantaneous suffocation, and of course the first thing to be attempted, both because bodies in the oesophagus are the most frequent occasion of suffocation, and because it is in that case chiefly where we can instantly relieve the pa tient, is, to examine the pharynx. * Forceps of various sizes should be an indispensable part of surgi» cal apparatus-A pair of curved forceps on these occasions will perhaps prove a more nsesul instrument than the probnng‘ |