143 



to a sitting posture, which caused hini to expectorate a considerable 

 quantity of yellow viscid matter, that afforded some alleviation of 

 his symptoms. He had expectorated freely the same sort of secre- 

 tion during the night. On inspection, the surface of the velum and 

 fauces was found of a deep red colour, clean and free from swelling 

 of the tonsils or other parts. 



The uvula was ulcerated off about its middle, leaving an even 

 square surface as if it had been excised. Externally about the 

 larynx, the neck was full and swollen, and the surface still suppu- 

 rating from the blister. With the finger, the epiglottis was distinctly 

 felt to be thickened, swollen and pulpy, more especially the left half 

 of its margin. The glosso-epiglottic fraenum and pouches remained 

 natural. No time was lost in scarifying the edges of the glottis and 

 epiglottis with the curved knife, which was accomplished readily 

 from the parts being in this case unusually easy of access. 



The operation was repeated two or three times at short intervals, 

 and followed by a small quantity of blood in the sputa. No remark- 

 able degree of disturbance was occasioned by the operation, and 

 patient expressed some relief. After waiting half an hour it was 

 judged by Dr. Swett, as well as myself, most prudent, in view of the 

 urgency of the dyspnoea and imminent danger attending it, not to 

 rely exclusively upon the scarifications, but to give the patient the 

 additional chance of tracheotomy, which was accordingly performed 

 without delay. 



Great difficulty was encountered from the depth of the trachea, 

 augmented by the swelling of the superjacent parts, and from the 

 resistance of the patient, as well as the copious venous hemorrhage. 



On incising perpendicularly the three superior rings of the trachea, 

 the air rushed in with great force. After introducing a large sized 

 curved silver tube, breathing was soon established through the arti- 

 ficial passage, and with less spasmodic coughing and irritation than 

 usual. 



The happiest effects promptly followed. The patient, from being 

 exceedingly turbulent and excited, became tranquil and submissive. 

 The respiration grew calm, and required no effort, and the counte- 

 nance resumed its natural expression. Patient slept quietly the re- 

 mainder of the day. On the following day at noon patient was doing 

 well; and notwithstanding the tube was very much clogged with 

 viscid mucus, he breathed easily. The swelling of the epiglottis had 

 decidedly diminished. After removing the tube to cleanse it, the sides 

 of the wound were pressed together to close the opening in the tra- 



