145 



The results obtained under the new treatment in the foregoing 

 cases far exceeded my most sanguine expectations. In every instance 

 a favourable result followed the use of scarifications. In cases 



II. and IV. no other efficient auxiliary treatment was employed ; 

 scarifications alone were relied upon; and, though in cases I. and 



III. venesection, leeches, emetics, mercury, &c, were also employed, 

 it was very obvious that no benefit was derived from them, and that 

 no relief was experienced till the operation was resorted to. 



It is true that in case V. tracheotomy, which has proved effi- 

 cacious in this disease when early performed, was resorted to on 

 account of the imminent danger of suffocation that threatened the 

 patient ; yet, if the particulars of this case are carefully considered, 

 evidence may be derived from it tending to strengthen our confidence 

 in the efficacy of scarifications, if not to show, that even in this par- 

 ticular instance, they might have been exclusively relied upon. It 

 will be borne in mind, that twenty-four hours after the operation of 

 tracheotomy, on closing the opening of the trachea, by compressing 

 the edges of the wound together, the patient could already breathe 

 through the larynx with a good degree of facility, and the epiglottis 

 itself was felt to have diminished in size. At the expiration of forty- 

 eight hours, on closing the outer orifice of the tube, which accurately 

 filled up the opening in the trachea, the patient was able to breathe 

 without effort, showing conclusively that the obstruction of the larynx 

 had disappeared. The epiglottis had also resumed its natural size. 



That the removal of the obstruction of the larynx in this case 

 was very rapid will appear by comparing it with what has been 

 observed in other analogous cases after tracheotomv. 



Mr. Porter (Obs. on the Surg. Path, of the Larynx and Trachea, 

 London, 1837, p. 103,) states, that in a very urgent case of oedema 

 of the glottis, where tracheotomy was performed, " the subsequent 

 progress was, in every respect, as favourable as the operator could 

 wish. The patient had calomel and opium to the extent of affecting 

 his mouth. In a feio days he was able to respire partially through 

 the glottis," &c. Mr. Porter also says (in Med. Ohir. Trans., vol. 

 xi. p. 422,) of a patient, " on the third, day after tracheotomy had 

 been performed, under the most urgent circumstances in this disease, 

 that he had one or two attacks of convulsive breathing from the wound 

 being obstructed. He was sometimes obliged to resort to the natu- 

 ral opening, and to use strong muscular exertions in inspiration," &c. 

 &c. This patient was also taking mercury freely. Mr. Lawrence 

 (in the Med. Ghir. Trans., vol. vi. p. 253,) says of his patient, " on 



