PUNCTURING THE PPIARYNX. 261 



edge of the atlas. A thin layer, partly muscular and partly nbrous, 

 will now present itself. It belongs to the subcutaneous muscle oi 

 the neck, and it lies upon the parotid gland. He should dissect 

 through it carefully, and if his first incision has been a correct one^ 

 he will come upon the posterior edge of the parotid gland. This he 

 must separate cautiously from the atlas, and from the cellular tissue 

 by which it is tied down, and elevate, or turn it aside, as far as the 

 middle of the space which separates the atlas from the mastoid 

 process. 



The forefinger must now be introduced into the opening. There 

 is first felt a layer of soft parts, and then the superior lateral branch 

 of the hyoid bone, from the extremity of which a flat muscle— the 

 stylo-hyoideus (fig. 13, p. 203) — goes to the styloid process of the 

 occipital bone. Immediately under this muscle lies that portion of 

 the pharynx which is connected with the guttural tube of the ear ; 

 and now, the back of the instrument being turned towards, or touch- 

 ing the parotid gland, and the edge of it towards the ear, and the 

 head being somewhat more extended in order to change a little the 

 situation of the carotids and nerves, the bistoury is plunged through 

 the muscle into the pharynx beneath. 



Sometimes the whole of the fluid cannot be evacuated through 

 this first incision, and a new one must be sought in a more downward 

 direction. A curved sounding instrument must be introduced into 

 the first orifice, and the end of it made to press against dififerent parts 

 of the cavity, until it can be plainly felt externally between the bifur- 

 cation of the jugular : every important vessel and nerve will be in 

 this way pushed aside, and the point of the sound may be cut down 

 upon without danger. 



Pharyngitis, laryngitis, inflammation of the windpipe, in short, all 

 inflammation of the air- passages, are termed anfjina, homoeopathically ; 

 and the treatment of one of these diseases will be a formula for all 

 of them, and each of them should be treated as here indicated. 



Homoeopathic treatment. — The first remedy in this oftentimes rather 

 dangerous disease, is aconitum, which generally suffices when we have 

 recourse to it in time; we are to administer from two to four doses 

 within the space of from three to four hours. If the respiratory organs 

 are more especially affected, so that the respiration is difficult, loud, 

 whistling, or if there be a swelling, painful externally, some doses of 

 spongia marina are to be given. Hepar suljjkicns has been found 

 very effectual in the second case, and likewise hryonia. When the 

 angina affects more particulaily the organs of deglutition, so that 

 liquids cannot be swallowed, and return always by the nostrils, the 

 look of the animal being fixed and wild, helladonva acts as a specific. 

 Capsicum is suitable in inflammation of the mucous membranes of 

 the throat, with kinks of coughing, and without any appreciable 

 fever. Antimonium crudum may also be then tried with success 



