266 HEALTH AND DISEASE 



Although certain well-marked signs of the accident are usually present 

 there are cases in which a diagnosis is difficult to accomplish. 



Where the impediment is in the throat the symptoms are such as may 

 be mistaken for ordinary sore throat. The nose is poked out and the 

 head is carried somewhat stiffly (fig. 96). Repeated attempts are made 

 to swallow, each effort being attended with marked pain. The jaws are 

 moved restlessly about, and a discharge of saliva issues from the mouth. 

 Food is refused, and should an attempt be made to drink, some of the 

 fluid will pass down the nostrils and some may enter the respiratory 

 passage and provoke an outburst of convulsive coughing. 



Pressure on the throat causes pain and may reveal the presence of the 

 offending body. These symptoms are specially marked in the case of 

 thorns, sticks, and other pointed substances. Should the obstructing mass 

 be large, and cause pressure on the windpipe, the breathing will be inter- 

 fered with, and may be very difficult and noisy, with heaving at the flanks 

 and general indications of distress. 



Choking in the course of the neck and in that part of the gullet which 

 passeo through the chest is attended by violent retching and attempts to 

 vomit. During the paroxysms or fits, the muscles of the neck are first 

 violently contracted, the chin is forcibly drawn towards the breast, and 

 the crest is sharply arched (fig. 97). At this time the eyes stare, the face 

 wears a painful and anxious expression, and ultimately the muscles of the 

 entire trunk become more or less convulsed. Any impediment lodged 

 between the throat and the lower third of the neck will be readily felt, 

 and in cases of high choking are distinctly recognized as a bulging in the 

 channel of the neck. Should relief be long delayed the body becomes 

 swollen up with gas, and with it abdominal pain occurs as the result of 

 impaired digestion. 



Treatment. — Here the object is clearly to remove the obstruction. 

 Haste and excitement are to be avoided in dealing with this as with all 

 other accidents, but no time should be lost in devising means for freeing 

 the passage from the object obstructing it. Any suspicion of trouble in the 

 throat must be promptly acted upon — nay, it is good practice in all cases 

 where doubt exists as to the seat of the stopjDage to introduce the hand 

 into the mouth and thoroughly explore the pharynx or cavity behind. 

 Should the offending body be found there, careful handling usually suffices 

 to effect its removal. Where the impediment is seated in the neck, an 

 attempt should be made to move it upward or downward by gentle pressure, 

 first in one direction then in the other. This will be facilitated by first 

 giving the patient a small quantity of linseed-oil. Imperfectly chewed hay 

 or straw may be broken down, by careful manipulation from without, and 



