614 
W. L. WILLIAMS AND P. A. FISH. 
The patient struggled less violently than L, and was less fatigued 
after the operation. 
Tampon and tampon canula applied as in I. and removed on 
following day. 
Deglutition very imperfect, almost all fluids taken into the 
pharnyx being expelled through the nostrils and tracheal open- 
ings. . , . 
From June 6th to 12th the loss of power of deglutition con¬ 
tinued unabated, and there were no notable changes except that 
gradually increasing foetid discharges took place from the nos¬ 
trils and tracheal and laryngeal openings. By the 13th of June 
the patient had become exceedingly weak, having been practi¬ 
cally without food, either solid or liquid, for nine days. At this 
stage the tracheotomy tube which had been removed on June 
6th was replaced as a precautionary measure, and the patient 
allowed to eat succulent grass and soft bran and linseed mashes, 
of which he partook sparingly, much of it dropping out through 
the laryngeal opening. By June 17th the breath had become 
very foetid, which on the i8th had become excessively stinking. 
An examination of the tracheal wound revealed a necrotic 
piece of cartilage which was excised. We then introduced into 
the trachea 5 litres of tepid water, with 30 grammes sod. chlor. 
and 60 c. c. solution of hydrogen peroxide, which flowmg in 
rapidly was largely expelled, flushing thoroughly the air^ pas¬ 
sages, pharynx and surgical wounds, cleansing and deodorizing 
the parts. ' . , 
On the 19th the foetor seemed so much less that the irriga- 
. tion was omitted, but on the 20th the foetor had increased and 
the lungs were again flushed out like on the 18th without induc¬ 
ing any marked discomfort. The intra-tracheal treatment was 
now discontinued. 
After this the patient seemed to improve slowly if at all, m 
strength, appetite and power of deglutition, and was greatly har¬ 
assed by a persistent cough. The tracheotomy tube was re¬ 
moved on June 25th, as the power of deglutition now seemed 
restored, and by July 14th the tracheal and laryngeal wounds 
