140 



increased, I repeated the scarifications with the guarded bistoury, 

 (the curved knife being in the hands of the cutler,) but without ac- 

 complishing the operation satisfactorily. 



Third day. — Patient is decidedly worse, the obstruction to respi- 

 ration has evidently increased, and paroxysms of dyspnoea and 

 choking have supervened. The epiglottis is felt to be more swollen. 

 The voice is more affected. The pulse continues full and strong. 

 Two five grain doses of sulphate of copper had been administered 

 and produced vomiting, but without relief. 



At 3 o'clock P. M., I repeated the scarifications with the curved 

 knife in the usual way, and they were followed, as before, with 

 moderate bleeding. 



At 6 o'clock P. M., though the patient expressed himself as feel- 

 ing some relief, the obstruction still appeared so great, and the 

 danger of suffocation during the night so imminent, that my col- 

 league, Dr. Hoffman, and myself, considered that tracheotomy ought 

 to be resorted to without further delay, and we both of us urged upon 

 the patient to submit to it, but he obstinately refused. 



At this time an erysipelatous blush had shown itself on the right 

 cheek. Another patient in the ward had been seized with ery- 

 sipelas the same morning. 



The calomel and tartarized antimony to be continued as before. 



Fourth day. — To our great surprise patient is still living, and 

 apparently no worse; he says he feels himself better; pulse has not 

 fallen off, and the paroxysms of dypsnoea have not recurred. The 

 erysipelas is spreading upon the temple and forehead attended with 

 moderate swelling. 



Fifth day. — Patient is decidedly better, and at evening the epi- 

 glottis was ascertained by the touch to be of its normal size. 



Sixth day. — A still further improvement in respiration has taken 

 place, and the voice is resuming its clear tone. 



The subsequent progress was favourable. The erysipelas pursued 

 its course in a mild form and gradually subsided. No mercurial 

 ptyalism was at any time perceptible, and in a few days the patient 

 was free from all symptoms of laryngeal disease. 



"When seized with the above attack, this patient was confined to 

 his bed in a very debilitated condition, with fracture of the right 

 os brachii at its neck, that had happened six weeks previously on 

 ship-board where he had been exposed to typhus infection; several 

 of his fellow passengers and his own wife, having died of the fever 

 on the voyage. 



