360

SUBSTANCES STOPPED BETWEEN

duct is exceedingly injudicious, as a fit of coughing, or twenty oth-er accidents, may force over the substance before the person isaware.*

When any substance is detained in the gullet there are two ways,of removing it ; viz. either by extracting it or pushing it down.The safest and most certain way is to extract it; but this is notalways the easiest : it may, therefore, be more eligible sometimesto thrust it down, especially when the obstructing body is of sucha nature that there is no danger from its reception into the stom-ach. The substances, which may be pushed down without danger,are, all common nourishing ones, as bread, flesh, fruits, and thelike. All indigestible bodies, as cork, wood, bones, pieces of metal,and such like, ought, if possible, to be extracted, especially if thesebodies be sharp-pointed, as pins, needles, fish-bones, bits ofçlass, &c.When such substances have not passed in too deep, we shouldendeavour to extract them with our fingers ; which method oftensucceeds. When they are lower we must make use of nippers, ora small pair of forceps, such as surgeons use. But this attempt toextract rarely succeeds, if the substance be of a flexible nature,and has descended far into the gullet.

If the fingers and pincers fail, or cannot be duly applied,crotchets, a kind of hooks, must be employed. These may bemade at once, by bending a piece of pretty strong iron wire at oneend. It must be introduced in the flat way ; and, for the betterconducting it, there should likewise be a curve or bending at theend it is held by, to serve as a kind of handle to it; which has thisfarther use, that it may be secured by a string tied to it ; a circum-stance not to be omitted in any instrument employed on such occa-sions, to avoid such ill-accidents as have sometimes ensued fromthese instruments slipping out of the operator's hand. After thecrotchet has passed below the substance that obstructs the passage,it is drawn up again, and hooks up the body along with it. Thecrotchet is also very convenient when a substance somewhat flex-ible, as a pin or fish-bone, sticks across the gullet, the hook, insuch cases, seizing them about their middle part, crooks and thusdisengages them ; or, if they are very brittle substances, serves tobreak them.

When the obstructing bodies are small, and only stop up a partof the passage, and which may either easily e'ude the hook, orstraighten it by their resistance, a kind of rings, made either ofwire, wool, or silk, may be used. A piece of fine wire of a properlength may be bent into a circle, about the middle, of about aninch diameter, and the long unbent sides brought parallel, and neareach other: these are to be held in the hand, and the circular partor ring introduced into the gullet, in order to be conducted aboutthe obstructing body, and so to extract it. More flexible rings maybe müde of wool, thread, silk, or small pack-thread, which may hewaxed for their greater strength and consistence. One of these isto be tied fast to a handle of iron wire, whalebone, or any kind offlexible wood, and by this means introduced, in order to surround

* A woman in one of the hospitals of this city lately discharged a great number of¡(ins. which she had swallowed in the course of her business, through an ulcer in herside.