148 



xii.,) after relating four cases of this accident, observes, in remark- 

 ing on the treatment: — "If the suffocation -were imminent, I should 

 not hesitate to propose laryngotomy or tracheotomy, and the former 

 would appear to reach below the seat of the affection. But I now 

 regret that I did not propose the scarification of the epiglottis and 

 glottis, so as to evacuate the blisters." The suggestion of this dis- 

 tinguished physician does not appear to have been carried into effect 

 or even noticed by those who have treated of this subject since it 

 was made. Dr. Jameson, in his Observations on (Edema of the 

 Glottis from attempts to swallow boiling water, (Dub. Quart. Journ. 

 of Med. Set., No. IX., Feb. 1848,) makes no allusion to it. 



Lisfranc has proposed making punctures (mouchetures) of the 

 swellings in Oedema of the glottis, of which Cruveilhier says, (Diet, 

 de Med. ct de Chir. Pratique, tome ii. p. 41, 1834,) " I doubt 

 whether this little operation lias ever been performed." Mr. Ryland 

 (A Treatise on the Diseases and Injuries of the Larynx and Trachea, 

 Philadelphia, 1838, p. 51,) says of this method, and of that of M. 

 Thuillier, which consists in making pressure from time to time by 

 means of the finger upon the distended lips of the glottis, to promote 

 the absorption of the effused serum, " both plans are fantastic, very 

 difficult if not impossible of accomplishment, and more likely to in- 

 crease than diminish the existing mischief." 



Mr. Busk, at a meeting of the Royal Med. and Chir. Soc, March 

 9, 1847, (London Lancet, March, 1847,) related "two cases treated 

 successfully by making a great number of minute punctures on the 

 back of the tongue, the uvula, and pharynx, with a sharp pointed 

 bistoury, and repeating them every half hour for two or three 

 hours." 



These are the only methods of treatment analogous to the one 

 under consideration that have been hitherto proposed by others so 

 far as my researches have ascertained.* 



The question of diagnosis in this disease is one of vital importance, 

 irrespective of the present operation, but in connection with it its 

 importance becomes very greatly enhanced. Without stopping to 

 notice the distinctive symptoms which have been generally regarded 

 as characteristic of this disease, or those of other diseases that are 

 most likely to be mistaken for it, I beg leave to insist upon one sign 

 which is strictly pathognomonic, and does not appear to have been 

 sufficiently appreciated. 



* See note at the end of this paper. 



