137 



Before proceeding to the operation, it lias always been explained 

 to the patient, that the seat of his difficulty was a swelling at the 

 top of the windpipe, preventing the air from entering, and the object 

 of the operation was to cut it and let out fluid, and thus give 

 him relief. This explanation corresponds so exactly with his own 

 sensations, which refer to the top of the thyroid cartilage as the seat 

 of obstruction, that he readily submits to the proposed operation, and 

 renders all the co-operation in his power for its performance. 



A slight hemorrhage follows the scarifications, and should be en- 

 couraged by gargling with warm water. In one instance the quan- 

 tity of blood mixed with sputa amounted to half a wineglassful. 



The first case for employing the operation was the following: 



Case I. — Arthur W. Taylor, seaman, born in New York, aged 

 thirty-one years, was acting as nurse in Ward No. 4, south building, 

 New York Hospital. For two days previous to the 13th of April, 

 1847, when his case was first noticed, he had suffered from painful 

 deglutition, with elongation of the uvula, that kept up a constant 

 tickling sensation — the fauces also presented an inflamed appearance. 

 The epiglottis was seen as well as felt to be swollen. Breathing was 

 difficult, and attended with paroxysms of suffocation. 



A stimulating gargle had been used, and, on the morning of the 

 above date, the uvula had been excised with some relief. Six leeches 

 had been applied over the larynx, and the bites were still bleeding 

 at the time of the regular visit at noon. After exploring the parts 

 with the finger, and ascertaining the existence of swelling of the 

 epiglottis, and also allowing my two assistants to do the same, I 

 scarified the aryteno-epiglottic folds and the epiglottis, partly with 

 scissors curved flatwise, and partly with a sharp pointed curved bis- 

 toury, guarded to within one-third of an inch of its point by a narrow 

 strip of adhesive plaster wound around it, and conducted to the parts 

 upon the fore-finger of the left hand, previously introduced at the 

 right angle of the mouth. Two or three repetitions were requisite, 

 at short intervals, to complete the operation. The patient hawked up 

 three or four teaspoonfuls of blood, mixed with mucus, and expressed 

 himself as feeling relieved. Twenty ounces of blood were drawn 

 from the arm soon after, and grain doses of tartar emetic admin- 

 istered. 



On the following day (the 14th), an improvement in the respira- 

 tion had evidently taken place. 



On the 15th, respiration was still further improved, the pulse was 

 10 



