OCR Text |
Show or ULCERATION or THE GLOTT‘IS. M THE (ESOI'IIAGUS‘ Ul‘ EXI'RAC'IIXG BODIES FRO st down, because A bone we should be unwilling to thru n with violence, is being sharp, and sticking: to force it dow avour to pass the to lacerate the oesophagus ; we rather ende avour to pull it hook end of the probang beyond it, and ende up. y, stones of All indigestible bodies, pins, pieces of mone up with the fruit and shells, we should endeavour to pull mbered, that hook end of the probang.--And it may be reme been forcsuch bodies sticking about the top of the larynx, have ang. As prob the ed into it, by the use of the sponge end of r to we have mentioned a substitute for the probang, in orde sary, neces lly equa is , push a piece of meat or cartilage down it to suggest a contrivance for a hook, with which to pull up bodies from the (esophagus, or pharynx. For this purpose nothing is so good, as a piece of wire bent in this manner.- {435on imam ,- . .,.. a: rwfl"? C‘l‘ulfiatfl'f«-T¢-.p_ . The advantage of this is that it can be made of any form or take any curve, enabling us to adapt it so, as to operate upon that side where the pin or stone is supposed to lodge. (In nine of ten cases they stick across the throat within sight.) In the way of a regular instrument nothing is superior to a pair of long slender steel forceps with a slight curve, for CX‘ tracting pins, or feathers, from the gullet. We are particularly anxious to bring up pins from the throat, because if they pass down into the intestinal canal they may stick there and occasion fatal inflammation, though more frequently foreign bodies swallowed and sticking in the intestines, open a way outwardly by abscess and ulceration. Let us not however take the most unfavourable supposition in the event of a pin being swallowed, for it generally happens that it is passed by stool. We should not forget that often the soreness left by the b0- dy which has stuck in the throat, gives to the patient thC sensation of its being still in the place after it has gone down 5 Very often small bodies, as crumbs of bread, peas, and cherry-stones, or nut shells, fall at once into the Chink of the glottis. Then the breathing becomes sonorous or stridulous with heaving of the chest, and long and difficult respiration ---there is not that action, partaking both of coughing and vomiting which is the effect of something sticking in the upper part of the pharynx. Yet even in this case the patient will not die immediately. Dr. Jefi‘ery of Glasgow has a preparation in which a piece of coal fills the trachea almost entirely, yet the patient lived for three days. When the foreign body passes entirely into the trachea and does not stick in the more irritable glottis, I believe it gives less distress, though there is every moment danger that the breath may throw it again into the grasp of the glottis and suitocate the person ; but of this presently. The inflammatory affections of the trachea which I have known to prove fatal are, ulceration of the glottis; pustule. on the rima glottidis ; many instances of croup with the for- mation of the membrane in the trachea. In all these instances the high excitement occasioned spasmodic contraction of the glottis ; that again excited paroxysm, or continued difficulty of breathing ; and the difficult breathing, watery exudation into the cellular texture of the lungs. \Vhich last has always appeared to me, on dissection, to be the immediate cause of death. In two cases of ulceration of the epiglottis where I lately examined the parts I regretted that mercury had not been thought of : for from the history of the case I imagined that there was a considerable probability that the ulceration was venereal. It is I fancy the slight degree of irritability so peculiar to venereal sores, which allows of a continued ulceration of this delicate valve without producing immediate sutiocation. I have found too that with nearly similar symptoms an ulcer had made considerable progress in the sacculus laryngeus, and even lower in the larynx. |