141 



Case IV — Was a patient of Dr. Swett in medical ward No. 9, 

 North House, New York Hospital, named James Rourke, aged 27 

 years, born in Ireland. On Tuesday, February 28th, 1848, at 2J 

 o'clock P. M. was suffering with well marked symptoms of oedematous 

 laryngitis, that had supervened in the progress of typhus fever at 

 about the end of the third week. An abundant petechial eruption, 

 great prostration, subsultus tendinum, and extensive bronchitis had 

 characterized the fever. A supporting and stimulating plan of treat- 

 ment had been pursued, and a large blister had been applied over the 

 chest within a day or two for the relief of the bronchitis. Patient 

 was also taking Stokes' Expectorant. When seen, his breathing, 

 especially during inspiration, was difficult and sonorous, and his 

 f voice hoarse. 



There was some soreness of the throat with a copious expectoration 

 of viscid mucus. 



The velum and fauces were of a deep red colour, clean and free 

 from swelling or exudation upon their surface. With the finger, the 

 edge of the epiglottis was felt thickened, swollen and pulpy, by Dr. 

 Swett, as well as myself. The glosso-epiglottic frgenum and pouches 

 on either side were not swollen. 



I scarified the edges of the glottis and the epiglottis, two or three 

 times at a few moments interval, which was followed by slight 

 hemorrhage, and from which patient admitted that he felt some 

 relief, though from the confused state of his intellect incident to the 

 fever, his own testimony was considered doubtful. 



Some difficulty was experienced in the operation from the in- 

 voluntary closing of the jaws as if by a movement of subsultus, by 

 which the left forefinger was compressed between the teeth. The 

 instrument used was the curved knife. On the following day, patient 

 was found to have passed the night comfortably and was no worse, 

 the hoarseness and dyspnoea were about the same; no paroxysms of 

 suffocation had as yet supervened. Stokes' expectorant and stimu- 

 lants were continued. 



Second day, 4 o'clock P. M. — Patient is decidedly worse, dyspnoea 

 very much increased, paroxysms of suffocation and choking have 

 now supervened, and are excited by attempts to swallow and on 

 falling asleep, during which the face and lips become livid. The 

 pulse is 80, full and quick, the skin warm and dry, the tongue brown 

 and dry, and the throat clogged with viscid mucus; the epiglottis is 

 felt to be much more swollen. I repeated the scarification very freely, 

 taking the precaution to insert a piece of wood between the molar 



