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Show use or THE FLEXIBLE rm. use or me FLEXIBLE run. into the tube touches the throat, the point of the tube maypass to do ted direc be d glottis. 0n the contrary the patient shoul the matters swallowed cannot fail to lodge about the ulcer- ated surface. that, which indeed he will naturally do, when he feels the tube in the fauces; let him imitate the action of swallowmg, necessary part of the cure. The (esophagus is subject to a cancerous ulceration. '14: draw back the tongue, and consequently push down the epiglota tis : and the tube should not be passed quickly into the throat, but slowly, moving the point of it ofl‘ the soft palate to the back part of the pharynx, when (being flexible) it will be (11rected into the bag of the pharynx and into the oesophagus. Yet after this precaution, and when the tube is in the oesophagus, we pass the upper part of it through a sheet of paper, and then hold the flame ofa candle to it. It has happened that in this experiment the air rushing from the tube, has shown it to be in the trachea, and not in the oesophagus! The liquid food which is to be thrown into the stomach in this way, must be cooler than what a person could take by the spoon, for it flows continually hot upon one part of the stomach. And I have dissected a body where I suspected a ' mum patch of inflammation, in the inner surface of the stomach, proceeded from this cause. If it should be thought necessary to keep the tube in the oesophagus for any considerable time, it must then be intro‘ r. "wane-f a} -‘a..._-,,....- 2-3:-" ... a ' duced through the nostril ; and here it is necessary to be still more particular that the throat, be exerted, as in swallowing, in order that the tube may pass into the pharynx. There are many occasions on which the tube is to be used to convey nourishment into the stomach: for example, in young women affected with hysteria, paralytic affection of the oesophagus is not nnfrequent, and they would die of this trifling complaint but for this invention. I have attended a girl who was nourished for two months in this way, the affection of the throat was entirely cured, but some months after she died of a complication of disease-The oesopha- gus on dissection was quite natural. Ulcerations in the tract of the oesophagus I imagine are perpetuated and increased to a fatal degree by the perpetual irritation of the oesopha‘ gas in swallowing. The action itself is an excitement, and 15 In this case the use of the tube will form a It becomes hard, and irregular, and ulcerated, and the mus- cular structure of the tube being destroyed, the continuous action, by which the food is carried into the stomach, also fails, and the flexible tube is necessarily employed. Sacs are sometimes formed of the pharynx. At first, by some accidental lodging of the stones of fruit, perhaps, and afterwards by the accumulation of the food. Each meal forcing a little more into this hole or sac, it is at last enlarged into a bag, which having formed by the side of the oesophagus, and being crammed with the food in the attempt to swallow, presses upon the oesophagus, and obstructs the passage into the stomach. If the flexible tube be used, the food will no longer accumulate in the lateral sac, and this sac may shrink and be obliterated. Abscesses, forming by the side of the pharynx, and open- ing into it, afterwards receive the food in the act of swallowing, with even a worse effect than in the last instance; this too the flexible tube may palliate or cure. When a person has attempted self-destruction by firing a pistol into his mouth, and the brain and spinal marrow and carotids have escaped, there is danger of suffocation from the inflammation and swelling of the throat, and the action of swallowing is for a long time impeded. Here the tube has been of essential service. When the attempt at suicide is made by cutting the throat, the action of swallowing impedes the cure, because the larynx is pulled up in swallowing, and by this means the union of the trachea is prevented, and even the outward wound tom open ; and here the flexible tube is also of great service, "W" are l v I l rr v' |
