136 



ing the diseased parts, and thus establishing the diagnosis beyond 

 doubt. 



Though the oedeniatous swelling of one or both edges of the glottis 

 is the cause of the dyspnoea, from the mechanical obstruction it pre- 

 sents to the entrance of air into the larynx, yet, as will hereafter 

 appear, the epiglottis almost always participates in the swelling, and 

 being within reach of the fore-finger passed into the mouth, it affords 

 an invaluable means of diagnosis. 



The following is the mode of performing the operation of scarify- 

 ing, as employed in the cases about to be related. 



The patient being seated on a chair, with his head thrown back, 

 and supported by an assistant, he is directed to keep his mouth as 

 wide open as possible; and if there be any difficulty in this respect, 

 a piece of wood an inch and a quarter in width, and half an inch in 

 thickness, is to be placed edgewise between the molar teeth of the 

 left side. The fore-finger of the left hand is then to be introduced 

 at the right angle of the mouth, and passed down over the tongue 

 till it encounters the epiglottis. 



But little difficulty is generally experienced in carrying the end 

 of the finger above and behind the epiglottis so as to overlap it and 

 press it forwards towards the base of the tongue. In some indivi- 

 duals the finger may be made to overlap the epiglottis to the extent 

 of three-fourths of an inch. 



Thus placed, the finger serves as a sure guide to the instrument 

 to be used, which is represented accurately in the accompanying 

 plate. (See PI. II. Fig. 1.) The knife is then to be conducted with its 

 concavity directed downwards, along the finger till its point reaches 

 the finger nail. By elevating the handle so as to depress the blade 

 an inch to an inch and a half farther, the cutting extremity is placed 

 in the glottis between its edges (see plate I.) ; at this stage of the 

 operation the knife is to be slightly rotated to one side and the other, 

 giving it a cutting motion in the act of withdrawing it. This may 

 be repeated without removing the finger, two or three times on either 

 side. The margin of the epiglottis, and the swelling between it and 

 the base of the tongue may be scarified still more easily with the same 

 instrument, or scissors curved flatwise may be employed for these 

 parts, guided in the same manner as the knife. 



Though a disagreeable sense of suffocation and choking is caused 

 by the operation, the patient soon recovers from it, and submits to 

 a repetition after a short interval. In every instance the operation 

 has been performed twice, and in some three times. 



