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SUBSTANCES STOPPED, <fcc.

I

of two evils, and rather run the hazard of pushing them down,than suffer the patient to perish in a few minutes ; and we oughtto scruple the resolution the less, as a great many instances havehappened, where the swallowing of such hurtful and indigestiblesubstances has been followed by no disorder.

Whenever it is manifest that all endeavours either to extract orpush down the substance must prove ineffectual, they should bediscontinued : because the inflammation occasioned by persistingin them might be as dangerous as the obstruction itself. Somehave died in consequence of the inflammation, even after the bodywhich caused the obstruction had been entirely removed.

While the means recommended above are making use of, thepatient should often swallow, or, if he cannot, he should frequentlyreceive by injection, through a crooked tube or pipe that may reachdown to the gullet, some emollient liquor, as warm milk andwater, barley-water, or a decoction of mallows. Injections of thiskind not only soften and soothe the irritated parts, but, whenthrown in with force, are often more successful in loosening theobstruction than all attempts with instruments.

When, after all our endeavours, we are obliged to leave the ob-structing body in the part, the patient must be treated as if he hadan inflammatory disease. He should be bled, kept upon a lowdiet, and have his whole neck surrounded with emollient poultices.The like treatmeut must also be used, if there be any reason tosuspect an inflammation of the passages, though the obstructingbody be removed.

A proper degree of agitation has sometimes loosened the inher-ing body more effectually than instruments. Thus a blow on theback has often forced up a substance which stack in the gullet ;but this is still more proper and efficacious when the substancegets into the windpipe, in this case, vomiting and sneezing arelikewise to be excited. Pins, which stuck in the gullet, have beenfrequently discharged by riding on horseback, or in a carriage.

When any indigestible substance has been forced down into thestomach, the patient should use a very mild and smooth diet,consisting chiefly of fruits and farinaceous substances, as puddings,pottage, and soups. He should avoid all heating and irritatingthings, as wine, punch, pepper, and such like ; and his drinkshould be milk and water, barley-water, or whey.

When the gullet is so strongly and fully closed, that the patientcan receive no food by the mouth, he must be nourished by clystersof soup, jelly, and the like.

When the patient is in danger of being immediately suffocated,and all hope of freeing" the passage is vanished, so that deathseems at hand, if respiration be not restored, the operation ofbronchotomy , or opening of the windpipe, must be directly perform-ed. As this operation is neither difficult to an expert surgeon, norvery painful to the patieut, and is often the only method which canbe taken to preserve life in these emergencies, we thought properto mention it, though it should only be attempted by surgeonsskilled in anatomy.