146 



the ninth day after tracheotomy, he was sufficiently recovered to 

 get up. By holding the edges of the wound together he could 

 breathe through the larynx and speak, but there was still a fooling 

 of difficulty which made it necessary to open the wound again in a 

 short time." 



Mr. Wood (in Med. Ckir. Trans., vol. xvii. p. 159,) says of a 

 patient, "on the fourth day after tracheotomy, she breathes easily 

 except when the artificial opening is obstructed by mucus." Ptyalisni 

 was also produced in this case. 



All of these cases recovered. The obstruction of the larynx, how- 

 ever, was slow and gradual in its disappearance, and, in three of 

 them, the progress of absorption was aided by the mercurial action. 



It may, therefore, I think be fairly inferred that the rapid removal 

 of the obstruction in the case under consideration is to be attri- 

 buted to the free scarifications that had preceded the operation of 

 tracheotomy, and in all probability they alone might have been relied 

 on to accomplish the desired object. The mechanical obstruction to 

 the entrance of air into the larynx, produced by the oedematous 

 swelling of one or both edges of the glottis, with the spasm induced 

 by it, constitutes the essential and dangerous feature of this disease, 

 and one which will admit of no delay in its removal. 



In the almost constant failure of other means to accomplish this 

 object, the operation of tracheotomy has been very properly recom- 

 mended by the best medical authorities to be early resorted to. 



By this means an artificial entrance is provided for air into the 

 lungs, by which life is supported, and time gained for the gradual 

 removal of the obstruction. 



The operation now under consideration aims at the removal of the 

 obstruction itself in the most direct manner, and the results already 

 obtained may well encourage the hope that this formidable disease 

 will not hereafter bear such fatal sway as the annals of medical 

 science show it to have done heretofore. 



In respect to the difficulties of the operation, it may be re- 

 marked that those which exist on the side of the patient are — 

 1st. Irritation and disturbance of the affected parts themselves 

 produced by the presence of the finger and instrument. These, 

 as has already been incidentally remarked in the report of the 

 cases, have not been so great as to prevent the accomplishment 

 of the operation or deter from its repetition. The patient soon re- 

 covers from them, and in every instance two or three repetitions, at 

 intervals of three or four minutes, have been submitted to. In one 



