— - 
ledging in the upper part of the funnel of the gullet; for i such h ins 
Reseed it commonly happens, that patients fs ‘al ly « ok 
before any assistance can be procured. ees 
3. Polypous excrescences of the nose, have been known to fall into — 
the funnel, so as to endanger suffocation ; and tumors that originate 
ae the veil or upper part of the funnel, are attended with this 
effect. 
4. Tumors that are firm, particularly those that are of a schirrous 
and fleshy kind, even when seated externally, have been known to 
compress the windpipe so much as almost entirely to obstruct respi- 
ration ; when so situated as to cover all the accessible parts of the 
windpipe, which is often the case, this operation is inadmissible. 
5. Inflammation of the tongue may arrive at such a height as en- 
tirely to obstruct the passage to the fauces ; and this most frequently 
is the effect of mercurial irritation, or salivation, which, when carri- 
ed far, induces such a tumefied state of the glands of the mouth and 
throat, as to produce suffocation. 
6 Swellings of the almonds of the ears and contiguous parts, may 
become so large as to obstruct respiration; thereby rendering an 
an operation, he should always be placed upon a table-; and this is. 
a matter of much importance in this operation. The patient being _ 
laid upon a table, with his head drawn back, and limbs secured by 
an assistant, a longitudinal incision should be made with a scalpel 
through the skin and cellular substance on the middle and lower 
part of the windpipe, beginning at the lower part of the shield car- 
tilage, and proceeding downwards for the space ofan inch. The 
breast and shield muscles are thus brought into view; and being 
separated from one another, a considerable part of the shield gland 
is in this manner Jaid bare. As this gland is plentifwly supplied 
with blood vessels, and as the division of any of these always proves 
troublesome, and in some instances, even dangerous, it should be 
“carefully guarded against. ‘This may commonly be easily done by 
‘avoiding the lower portion of the gland, where the two lobes of 
which it is composed, unite, and finishing the operation at the upper 
part of it where they separate. In order, too, to guard as much as 
possible against the inconvenience arising from the division of the - 
arteries of this gland, the incision should be slowly made ; and, as 
the arteries are so large as to be preceptible to the naked eye, they 
may, with due care, be avoided. ‘i 
The cellular substance lying between these portions of the gland — 
being cautiously removed, the windpipe is thus laid bare; and if ne 
large blood vessel has been divided, the operation may be immedi- __ 
ately finished, by making an opening between any two of the carti- — 
tages; but if any large artery has been cut, it must first be t 
up. ‘The incision between the cartilages may be made w: 
cet, and should be of such size as to admit a tube ore 
