Chapter XXIX.

Chapter XXIX.Of Substances stopt between the Mouth and the Stomach.Sect.406.The Food we take in descends from the Mouth through a very strait Passage or Chanel, called theOesophagus, the Gullet, which, going parallel with the Spine or Backbone, joins to, or terminates at, the Stomach.It happens sometimes that different Bodies are stopt in this Chanel, without being able either to descend or to return up again; whether this Difficulty arises from their being too large; or whether it be owing to their having such Angles or Points, as by penetrating into, and adhering to the Sides of this membranous Canal, absolutely prevent the usual Action and Motion of it.§ 407. Very dangerous Symptoms arise from this Stoppage, which are frequently attended with a most acute Pain in the Part; and at otherTimes, with a very incommodious, rather than painful, Sensation; sometimes a very ineffectual Commotion at, or rising of, the Stomach, attended with great Anguish; and if the Stoppage be so circumstanced, that theGlottisis closed, or the Wind-pipe compressed, a dreadful Suffocation is the Consequence: the Patient cannot breathe, the Lungs are quite distended; and the Blood being unable to return from the Head, the Countenance becomes red, then livid; the Neck swells; the Oppression increases, and the poor Sufferer speedily dies.When the Patient's Breathing is not stopt, nor greatly oppressed; if the Passage is not entirely blocked up, and he can swallow something, he lives very easily for a few Days, and then his Case becomes a particular Disorder of theOesophagus, or Gullet. But if the Passage is absolutely closed, and the Obstruction cannot be removed for many Days, a terrible Death is the Consequence.§ 408. The Danger of such Cases does not depend so much on the Nature of the obstructing Substance, as on its Size, with Regard to that of the Passage of the Part where it stops, and of the Manner in which it forms the Obstruction; and frequently the very Food may occasion Death; while Substances less adapted to be swallowed are not attended with any violent Consequences, though swallowed.A Child of six Days old swallowed a Comfit or Sugar Plumb, which stuck in the Passage, and instantly killed it.A grown Person perceived that a Bit of Mutton had stopt in the Passage; not to alarm any Body he arose from Table; a Moment afterwards, on looking where he might be gone, he was found dead. Another was choaked by a Bit of Cake; a third by a Piece of the Skin of a Ham; and a fourth by an Egg, which he swallowed whole in a Bravo.A Child was killed by a Chesnut swallowed whole. Another died suddenly, choaked (which is always the Circumstance, when they die instantly after such Accidents) by a Pear which he had tossed up, and catched in his Mouth. A Woman was choaked with another Pear. A Piece of a Sinew continued eight Days in the Passage, so that it prevented the Patient from getting down any Thing else; at the Expiration of that Time it fell into the Stomach, being loosened by its Putridity: The Patient notwithstanding died soon after, being killed by the Inflammation, Gangrene and Weakness it had occasioned. Unhappily there occur but too many Instances of this Sort, of which it is unnecessary to cite more.§ 409. Whenever any Substance is thus detained in the Gullet, there are two Ways of removing it; that is either by extracting it, or pushing it down. The safest and most certain Way is always to extract or draw it out, but thisis not always the easiest: and as the Efforts made for this Purpose greatly fatigue the Patient, and are sometimes attended with grievous Consequences; and yet if the Occasion is extremely urging, it may be eligible to thrust it down, if that is easier; and if there is no Danger from the obstructing Bodies Reception into the Stomach.The Substances which may be pushed down without Danger, are all common nourishing ones, as Bread, Meat, Cakes, Fruits, Pulse, Morsels of Tripe, and even Skin of Bacon. It is only very large Morsels of particular Aliments, that prove very difficult to digest; yet even such are rarely attended with any Fatality.§ 410. The Substances we should endeavour to extract or draw out, though it be more painful and less easy than to push them down, are all those, whose Consequences might be highly dangerous, or even mortal, if swallowed. Such are all totally indigestible Bodies, as Cork, Linen-Rags, large Fruit Stones, Bones, Wood, Glass, Stones, Metals; and more especially if any further Danger may be superadded to that of its Indigestibility, from the Shape, whether rough, sharp, pointed, or angular, of the Substance swallowed. Wherefore we should chiefly endeavour to extract Pins, Needles, Fish-bones, other pointed Fragments of Bones, Bits of Glass, Scissars, Rings, or Buckles.Nevertheless it has happened, that every one of these Substances have at one Time or another been swallowed, and the most usualConsequences of them are violent Pains of the Stomach, and in the Guts; Inflammations, Suppurations, Abscesses, a slow Fever, Gangrene, theMiserereor Iliac Passion; external Abscesses, through which the Bodies swallowed down have been discharged; and frequently, after a long Train of Maladies, a dreadful Death.§ 411. When such Substances have not passed in too deep, we should endeavour to extract them with our Fingers, which often succeeds. If they are lower, we should make use of Nippers or a smallForceps; of which Surgeons are provided with different Sorts. Those which some Smoakers carry about them might be very convenient for such Purposes; and in Case of Necessity they might be made very readily out of two Bits of Wood. But this Attempt to extract rarely succeeds, if the Substance has descended far into theOesophagus, and if the Substance be of a flexible Nature, which exactly applies itself to, and fills up the Cavity or Chanel of it.§ 412. If the Fingers and the Nippers fail, or cannot be duly applied, Crotchets, a Kind of Hooks, must be employed.These may be made at once with a pretty strong iron Wire, crooked at the End. It must be introduced in the flat Way, and for the better conducting of it, there should be another Curve or Hook at the End it is held by, to serve as a Kind of Handle to it, which has this further Use, that it may be secured by a String tied to it; a Circumstance not to be omitted in anyInstrument employed on such Occasions, to avoid such ill Accidents as have sometimes ensued, from these Instruments slipping out of the Operators Hold. After the Crotchet has passed beyond and below the Substance, that obstructs the Passage, it is drawn up again, and hooks up with it and extracts that Impediment to swallowing.This Crotchet is also very convenient, whenever a Substance somewhat flexible, as a Pin or a Fishbone stick, as it were, across the Gullet: the Crotchet in such Cases seizing them about their middle Part, crooks and thus disengages them. If they are very brittle Substances, it serves to break them; and if any Fragments still stick within, some other Means must be used to extract them.§ 413. When the obstructing Bodies are small, and only stop up Part of the Passage; and which may either easily elude the Hook, or straiten it by their Resistance, a Kind of Rings may be used, and made either solid or flexible.The solid ones are made of iron Wire, or of a String of very fine brass Wire. For this Purpose the Wire is bent into a Circle about the middle Part of its Length, the Sides of which Circle do not touch each other, but leave a Ring, or hollow Cavity, of about an Inch Diameter. Then the long unbent Sides of the Wire are brought near each other; the circular Part or Ring is introduced into the Gullet, in order to be conducted about the obstructing Body, and so to extract it. Very flexible Rings may be madeof Wool, Thread, Silk, or small Packthread, which may be waxed, for their greater Strength and Consistence. Then they are to be tied fast to a Handle of Iron-Wire, of Whale-bone, or of any flexible Wood; after which the Ring is to be introduced to surround the obstructing Substance, and to draw it out.Several of these Rings passed through one another are often made use of, the more certainly to lay hold of the obstructing Body, which may be involved by one, if another should miss it. This Sort of Rings has one Advantage, which is, that when the Substance to be extracted is once laid hold of, it may then, by turning the Handle, be retained so strongly in the Ring thus twisted, as to be moved every Way; which must be a considerable Advantage in many such Cases.§ 414. A fourth Material employed on these unhappy Occasions is the Sponge. Its Property of swelling considerably, on being wet, is the Foundation of its Usefulness here.If any Substance is stopt in the Gullet, but without filling up the whole Passage, a Bit of Sponge is introduced, into that Part that is unstopt, and beyond the Substance. The Sponge soon dilates, and grows larger in this moist Situation, and indeed the Enlargement of it may be forwarded, by making the Patient swallow a few Drops of Water; and then drawing back the Sponge by the Handle it is fastened to, as it is now too large to return through the small Cavity, by which it was conveyed in, it draws out theobstructing Body with it, and thus unplugs, as it were, and opens the Gullet.As dry Sponge may shrink or be contracted, this Circumstance has proved the Means of squeezing a pretty large Piece of it into a very small Space. It becomes greatly compressed by winding a String or Tape very closely about it, which Tape may be easily unwound and withdrawn, after the Sponge has been introduced. It may also be inclosed in a Piece of Whalebone, split into four Sticks at one End, and which, being endued with a considerable Spring, contracts upon the Sponge. The Whalebone is so smoothed and accommodated, as not to wound; and the Sponge is also to be safely tied to a strong Thread; that after having disengaged the Whalebone from it, the Surgeon may also draw out the Sponge at Pleasure.Sponge is also applied on these Occasions in another Manner. When there is no Room to convey it into the Gullet, because the obstructing Substance ingrosses its whole Cavity; and supposing it not hooked into the Part, but solely detained by the Straitness of the Passage, a pretty large Bit of Sponge is to be introduced towards the Gullet, and close to the obstructing Subtance: Thus applied, the Sponge swells, and thence dilates that Part of the Passage that is above this Substance. The Sponge is then withdrawn a little, and but a very little, and this Substance being less pressed upon above than below, it sometimes happens, that the greaterStaitness and Contraction of the lower Part of the Passage, than of its upper Part, causes that Substance to ascend; and as soon as this first Loosening or Disengagement of it has happened, the total Disengagement of it easily follows.§ 415. Finally, when all these Methods prove unavailable, there remains one more, which is to make the Patient vomit; but this can scarcely be of any Service, but when such obstructing Bodies are simply engaged in, and not hooked or stuck into the Sides of theOesophagus; since under this latter Circumstance vomiting might occasion further Mischief.If the Patient can swallow, a Vomiting may be excited with the PrescriptionNº. 8, or withNº. 34, or35. By this Operation a Bone was thrown out, which had stopt in the Passage four and twenty Hours.When the Patient cannot swallow, an Attempt should be made to excite him to vomit by introducing into, and twirling about the feathery End of a Quill in, the Bottom of the Throat, which the Feather however will not effect, if the obstructing Body strongly compresses the whole Circumference of the Gullet; and then no other Resource is left, but giving a Glyster of Tobacco. A certain Person swallowed a large Morsel of Calf's Lights, which stopt in the Middle of the Gullet, and exactly filled up the Passage. A Surgeon unsuccessfully attempted various Methods to extract it; but another seeing how unavailable all of them were; and the Patient'sVisage becoming black and swelled; his Eyes ready to start, as it were, out of his Head; and falling into frequent Swoonings, attended with Convulsions too, he caused a Glyster of an Ounce of Tobacco boiled to be thrown up; the Consequence of which was a violent Vomiting, which threw up the Substance that was so very near killing him.§ 416. A sixth Method, which I believe has never hitherto been attempted, but which may prove very useful in many Cases, when the Substances in the Passage are not too hard, and are very large, would be to fix a Worm (used for withdrawing the Charge of Guns that have been loaded) fast to a flexible Handle, with a waxed Thread fastened to the Handle, in Order to withdraw it, if the Handle slipt from the Worm; and by this Contrivance it might be very practicable, if the obstructing Substance was not too deep in the Passage of the Gullet, to extract it—It has been known that a Thorn fastened in the Throat, has been thrown out by laughing.§ 417. In the Circumstances mentioned§ 409, when it is more easy and convenient to push the obstructing Body downwards, it has been usual to make Use of Leeks, which may generally be had any where (but which indeed are very subject to break) or of a Wax-candle oiled, and but a very little heated, so as to make it flexible; or of a Piece of Whale-bone; or of Iron-Wire; one Extremity of which may be thickened andblunted in a Minute with a little melted Lead. Small Sticks of some flexible Wood may be as convenient for the same Use, such as the Birch-tree, the Hazel, the Ash, the Willow, a flexible Plummet, or a leaden Ring. All these Substances should be very smooth, that they may not give the least Irritation; for which Reason they are sometimes covered over with a thin Bit of Sheep's Gut. Sometimes a Sponge is fastened to one End of them, which, completely filling up the whole Passage, pushes down whatever Obstacle it meets with.In such Cases too, the Patient may be prompted to attempt swallowing down large Morsels of some unhurtful Substance, such as a Crust of Bread, a small Turnep, a Lettuce Stalk, or a Bullet, in Hopes of their carrying down the obstructing Cause with them. It must be acknowledged, however, that these afford but a feeble Assistance; and if they are swallowed without being well secured to a Thread, it may be apprehended they may even increase the Obstruction, by their own Stoppage.It has sometimes very happily, though rarely, occurred, that those Substances attempted to be detruded or thrust downwards, have stuck in the Wax-Candle, or the Leek, and sprung up and out with them: but this can never happen except in the Case of pointed Substances.§ 418. Should it be impossible to extract the Bodies mentioned§ 410, and all such as it must be dangerous to admit into the Stomach, we mustthen prefer the least of two Evils, and rather run the Hazard of pushing them down, than suffer the Patient to perish dreadfully in a few Moments. And we ought to scruple this Resolution the less, as a great many Instances have demonstrated, that notwithstanding severalbadConsequences, and even a tormenting Death, have often followed the swallowing of such hurtful or indigestible Substances; yet at other times they have been attended with little or no Disorder.§ 419. One of these four Events is always the Case, after swallowing such Things. They either, 1, go off by Stool; or, 2, they are not discharged and kill the Patient. Or else, 3, they are discharged by Urine; or, 4, are visibly extruded to the Skin. I shall give some Instances of each of these Events.§ 420. When they are voided by Stool, they are either voided soon after they have been swallowed, and that without having occasional scarce any troublesome Symptom; or the voiding of them has not happened till a long Time after swallowing, and is preceded with very considerable Pain. It has been seen that a Bone of the Leg of a Fowl, a Peach-stone, the Cover of a small Box of Venice Treacle, Pins, Needles, and Coins of different Sorts, have been voided within a few Days after they had slipt down into the Stomach; and that with little or no Complaint. A small Flute, or Pipe also, four Inches long, which occasioned acute Pains for three Days, has been voided happily afterwards,besides, Knives, Razors, and one Shoe-buckle. I have seen but a few Days since a Child between two and three Years old, who swallowed a Nail above an Inch long, the Head of which was more than three Tenths of an Inch broad: it stopt a few Moments about the Neck, but descended while its Friends were looking for me; and was voided with a Stool that Night, without any bad Consequence. And still more lately I have known the entire Bone of a Chicken's Wing thus swallowed, which only occasioned a slight Pain in the Stomach for three or four Days.Sometimes such Substances are retained within for a long Time, not being voided till after several Months, and even Years, without the least ill Effect: and some of them have never either appeared, nor been complained of.§ 421. But the Event is not always so happy; and sometimes though they are discharged through the natural Passages, the Discharges have been preceded by very acute Pains in the Stomach, and in the Bowels. A Girl swallowed down some Pins, which afflicted her with violent Pains for the Space of six Years; at the Expiration of which Term she voided them and recovered. Three Needles being swallowed brought on Cholics, Swoonings and Convulsions for a Year after: and then being voided by Stool, the Patient recovered. Another Person who swallowed two, was much happier in suffering but six Hoursfrom them; when they were voided by Stool, and he did well.It sometimes happens that such indigestible Substances, after having past all the Meanders, the whole Course of the Intestines, have been stopt in the Fundament, and brought on very troublesome Symptoms; but such however, as an expert Surgeon may very generally remove. If it is practicable to cut them, as it is when they happen to be thin Bones, the Jaw-bones of Fish, or Pins, they are then very easily extracted.§ 422. The second Event is, when these fatal Substances are never voided, but cause very embarrassing Symptoms which finally kill the Patient; and of these Cases there have been but too many Examples.A young Girl having swallowed some Pins, which she held in her Mouth, some of them were voided by Stool; but others of them pricked and pierced into her Guts, and even into the Muscles of her Belly, with the severest Pain; and killed her at the End of three Weeks.A Man swallowed a Needle, which pierced through his Stomach, and into his Liver,94and ended in a mortal Consumption.A Plummet which slipt down, while the Throat of a Patient was searching, killed him at the End of two Years.It is very common for different Coins, and of different Metals, to be swallowed without any fatal or troublesome Effects. Even a hundred Luidores95have been swallowed, and all voided. Nevertheless these fortunate Escapes ought not to make People too secure and incautious on such Occasions, since such melancholy Consequences have happened, as may very justly alarm them. One single Piece of Money that was swallowed, entirely obstructed the Communication between the Stomach and the Intestines, and killed the Patient. Whole Nuts have often been inadvertently swallowed; but there have been some Instances of Persons in whom a Heap96of them has been formed, which proved the Cause of Death, after producing much Pain and Inquietude.§ 423. The third Issue or Event is, when these Substances, thus swallowed down, have been discharged by Urine: but these Cases are very rare.A Pin of a middling Size has been discharged by Urine, three Days after it slipt down; and a little Bone has been expelled the same Way, besides Cherry-stones, Plumb-stones, and even one Peach-stone.§ 424. Finally, the fourth Consequence or Event is, when the indigestible Substances thus swallowed, have pierced through the Stomach or Intestines, and even to the Skin itself; and occasioning an Abscess, have made an Outlet for themselves, or have been taken out of the Abscess. A long Time is often required to effect this extraordinary Trajection and Appearance of them; sometimes the Pains they occasion are continual; in other Cases the Patient complains for a Time, after which the Pain ceases, and then returns again. The Imposthume, or Gathering, is formed in the Stomach, or in some other Part of the Belly: and sometimes these very Substances, after having pierced through the Guts, make very singular Routs, and are discharged very remotely from the Belly. One Needle that had been swallowed found its Way out, at the End of four Years, through the Leg; another at the Shoulder.§ 425. All these Examples, and many others of cruel Deaths, from swallowing noxious Substances, demonstrate the great Necessity of anhabitual Caution in this Respect; and give in their Testimony against the horrid, I had almost said, the criminal Imprudence, of People's amusing themselves with such Tricks as may lead to such terrible Accidents; or even holding any such Substance in their Mouths, as by slipping down through Imprudence or Accident, may prove the Occasion of their Death. Is it possible that any one, without shuddering, can hold Pins or Needles in their Mouths, after reflecting on the dreadful Accidents, and cruel Deaths, that have thus been caused by them.§ 426. It has been shewn already, that Substances obstructing the Passage of the Gullet sometimes suffocate the Patient; that at other Times they can neither be extracted nor thrust down; but that they stop in the Passage, without killing the Patient, at least not immediately and at once. This is the Case when they are so circumstanced, as not to compress theTrachæa, the Wind-pipe, and not totally to prevent the swallowing of Food; which last Circumstance can scarcely happen, except the Obstruction has been formed by angular or pointed Bodies. The Stoppage of such Bodies is sometimes attended, and that without much Violence, with a small Suppuration, which loosens them; and then they are either returned upwards through the Mouth, or descend into the Stomach. But at other Times an extraordinary Inflammation is produced, which kills the Patient. Or if the Contents of the Abscess attending the Inflammationtend outwardly, a Tumour is formed on the external Part of the Neck, which is to be opened, and through whose Orifice the obstructing Body is discharged. In other Instances again they take a different Course, attended with little or no Pain, and are at length discharged by a Gathering behind the Neck, on the Breast, the Shoulder, or various other Parts.§ 427. Some Persons, astonished at the extraordinary Course and Progression of such Substances, which, from their Size, and especially from their Shape, seem to them incapable of being introduced into, and in some Sort, circulating through the human Body, without destroying it, are very desirous of having the Rout and Progression of such intruding Substances explained to them. To gratify such Inquirers, I may be indulged in a short Digression, which perhaps is the less foreign to my Plan; as in dissipating what seems marvelous, and has been thought supernatural in such Cases, I may demolish that superstitious Prejudice, which has often ascribed Effects of this Sort to Witchcraft; but which admit of an easy Explanation. This very Reason is the Motive that has determined me to give a further Extent to this Chapter.Wherever an Incision is made through the Skin, a certain Membrane appears, which consists of two Coats orLaminæ, separated from each other by small Cells or Cavities, which all communicate together; and which are furnished, more or less, with Fat. There is not any Fatthroughout the human Body, which is not inclosed in, or enveloped with, this Coat, which is called the adipose, fatty, or cellular Membrane.This Membrane is not only found under the Skin, but further plying and insinuating itself in various Manners, it is extended throughout the whole Body. It distinguishes and separates all the Muscles; it constitutes a Part of the Stomach, of the Guts, of the Bladder, and of all theVisceraor Bowels. It is this which forms what is called the Cawl, and which also furnishes a Sheath or Envelopement to the Veins, Arteries, and Nerves. In some Parts it is very thick, and is abundantly replenished with Fat; in others it is very thin and unprovided with any; but wherever it extends, it is wholly insensible, or void of all Sensation, all Feeling.It may be compared to a quilted Coverlet, the Cotton, or other Stuffing of which, is unequally distributed; greatly abounding in some Places, with none at all in others, so that in these the Stuff above and below touch each other. Within this Membrane, or Coverlet, as it were, such extraneous or foreign Substances are moved about; and as there is a general Communication throughout the whole Extent of the Membrane, it is no ways surprizing, that they are moved from one Part to another very distant, in a long Course and Duration of Movement. Officers and Soldiers very often experience, that Bullets which do not pass through the Parts where they have entered, are transferred to very different and remote ones.The general Communication throughout this Membrane is daily demonstrated by Facts, which the Law prohibits; this is the Butchers inflating, or blowing up, the cellular Membrane throughout the whole Carcase of a Calf, by a small Incision in the Skin, into which they introduce a Pipe or the Nozzle of a small Bellows; and then, blowing forcibly, the Air evidently puffs up the whole Body of the Calf into this artificial Tumour or Swelling.Some very criminal Impostors have availed themselves of this wicked Contrivance, thus to bloat up Children into a Kind of Monsters, which they afterwards expose to View for Money.In this cellular Membrane the extravasated Waters of hydropic Patients are commonly diffused; and here they give Way to that Motion, to which their own Weight disposes them. But here I may be asked—As this Membrane is crossed and intersected in different Parts of it, by Nerves, Veins, Arteries,&c.the wounding of which unavoidably occasions grievous Symptoms, how comes it, that such do not ensue upon the Intrusion of such noxious Substances? To this I answer, 1, that such Symptoms do sometimes really ensue; and 2, that nevertheless they must happen but seldom, by Reason that all the aforesaid Parts, which traverse and intersect this Membrane, being harder than the Fat it contains; such foreign Substances must almost necessarily, whenever they rencounter those Parts, be turned aside towards the Fat which surrounds them,whose Resistance is very considerably less; and this the more certainly so, as these Nerves,&c.are always of a cylindrical Form.——But to return from this necessary Digression.§ 428. To all these Methods and Expedients I have already recommended on the important Subject of this Chapter, I shall further add some general Directions.1. It is often useful, and even necessary, to take a considerable Quantity of Blood from the Arm; but especially if the Patient's Respiration, or Breathing, is extremely oppressed; or when we cannot speedily succeed in our Efforts to remove the obstructing Substance; as the Bleeding is adapted to prevent the Inflammation, which the frequent Irritations from such Substances occasion; and as by its disposing the whole Body into a State of Relaxation, it might possibly procure an immediate Discharge of the offending Substance.2. Whenever it is manifest that all Endeavours, either to extract, or to push down the Substance stopt in the Passage, are ineffectual, they should be discontinued; because the Inflammation occasioned by persisting in them, would be as dangerous as the Obstruction itself; as there have been Instances of People's dying in Consequence of the Inflammation; notwithstanding the Body, which caused the Obstruction, had been entirely removed.3. While the Means already advised are making Use of, the Patient should often swallow, orif he cannot, he should frequently receive by Injection through a crooked Tube or Pipe, that may reach lower down than theGlottis, some very emollient Liquor, as warm Water, either alone or mixed with Milk, or a Decoction of Barley, of Mallows, or of Bran. A two-fold Advantage may arise from this; the first is, that these softening Liquors smooth and sooth the irritated Parts; and secondly, an Injection, strongly thrown in, has often been more successful in loosening the obstructing Body, than all Attempts with Instruments.4. When after all we are obliged to leave this in the Part, the Patient must be treated as if he had an inflammatory Disease; he must be bled, ordered to a Regimen, and have his whole Neck surrounded with emollient Pultices. The like Treatment must also be used, though the obstructing Substance be removed; if there is Room to suppose any Inflammation left in the Passage.5. A proper Degree of Agitation has sometimes loosened the inhering Body, more effectually than Instruments. It has been experienced that a Blow with the Fist on the Spine, the Middle of the Back, has often disengaged such obstructed and obstructing Bodies; and I have known two Instances of Patients who had Pins stopt in the Passage; and who getting on Horseback to ride out in Search of Relief at a neighbouring Village, found each of them the Pin disengaged after an Hour's riding: One spat it out, and the other swallowed it, without any ill Consequence.6. When there is an immediate Apprehension of the Patient's being suffocated; when bleeding him has been of no Service; when all Hope of freeing the Passage in time is vanished, and Death seems at Hand, if Respiration be not restored; the Operation ofBronchotomy, or opening of the Wind-pipe, must be directly performed; an Operation neither difficult to a tolerably knowing and expert Surgeon, nor very painful to the Patient.7. When the Substance that was stopt passes into the Stomach, the Patient must immediately be put into a very mild and smooth Regimen. He should avoid all sharp, irritating, inflaming Food; Wine, spirituous Liquors, all strong Drink, and Coffee; taking but little Nourishment at once, and no Solids, without their having been thoroughly well chewed. The best Diet would be that of farinaceous mealy Soups, made of various leguminous Grains, and of Milk and Water, which is much better than the usual Custom of swallowing different Oils.§ 429. The Author of Nature has provided, that in eating, nothing should pass by theGlottisinto the Wind-pipe. This Misfortune nevertheless does sometimes happen; at which very Instant there ensues an incessant and violent Cough, an acute Pain, with Suffocation; all the Blood being forced up into the Head, the Patient is in extreme Anguish, being agitated with violent and involuntary Motions, and sometimes dying on the Spot. AHungarianGrenadier, by Tradea Shoemaker, was eating and working at the same time. He tumbled at once from his Seat, without uttering a single Word. His Comrades called out for Assistance; some Surgeons speedily arrived, but after all their Endeavours he discovered no Token of Life. On opening the Body, they found a Lump, or large Morsel, of Beef, weighing two Ounces, forced into the Windpipe, which it plugged up so exactly, that not the least Air could pass through it into the Lungs.§ 430. In a Case so circumstanced, the Patient should be struck often on the Middle of the Back; some Efforts to vomit should be excited; he should be prompted to sneeze with Powder of Lilly of the Valley, Sage, or any cephalic Snuffs, which should be blown strongly up his Nose.A Pea, pitched into the Mouth in playing, entered into the Wind-pipe, and sprung out again by vomiting the Patient with Oil. A little Bone was brought up by making another sneeze, with powdered Lilly of the Valley.In short, if all these Means of assisting, or saving the Patient are evidently ineffectual,Bronchotomymust be speedily performed (SeeNº. 6, of the preceding Section.) By this Operation, some Bones, a Bean, and a Fish-bone have been extracted, and the Patient has been delivered from approaching Death.§ 431. Nothing should be left untried, when the Preservation of human Life is the Object. In those Cases, when an obstructing Body can neither be disengaged from the Throat, the Passageto the Stomach, nor be suffered to remain there without speedily killing the Patient, it has been proposed to make an Incision into this Passage, theOesophagus, through which such a Body is to be extracted; and to employ the like Means, when a Substance which had slipt even into the Stomach itself, was of a Nature to excite such Symptoms, as must speedily destroy the Patient.When theOesophagusis so fully and strongly closed, that the Patient can receive no Food by the Mouth, he is to be nourished by Glysters of Soup, Gelly, and the like.

Of Substances stopt between the Mouth and the Stomach.

Sect.406.

The Food we take in descends from the Mouth through a very strait Passage or Chanel, called theOesophagus, the Gullet, which, going parallel with the Spine or Backbone, joins to, or terminates at, the Stomach.

It happens sometimes that different Bodies are stopt in this Chanel, without being able either to descend or to return up again; whether this Difficulty arises from their being too large; or whether it be owing to their having such Angles or Points, as by penetrating into, and adhering to the Sides of this membranous Canal, absolutely prevent the usual Action and Motion of it.

§ 407. Very dangerous Symptoms arise from this Stoppage, which are frequently attended with a most acute Pain in the Part; and at otherTimes, with a very incommodious, rather than painful, Sensation; sometimes a very ineffectual Commotion at, or rising of, the Stomach, attended with great Anguish; and if the Stoppage be so circumstanced, that theGlottisis closed, or the Wind-pipe compressed, a dreadful Suffocation is the Consequence: the Patient cannot breathe, the Lungs are quite distended; and the Blood being unable to return from the Head, the Countenance becomes red, then livid; the Neck swells; the Oppression increases, and the poor Sufferer speedily dies.

When the Patient's Breathing is not stopt, nor greatly oppressed; if the Passage is not entirely blocked up, and he can swallow something, he lives very easily for a few Days, and then his Case becomes a particular Disorder of theOesophagus, or Gullet. But if the Passage is absolutely closed, and the Obstruction cannot be removed for many Days, a terrible Death is the Consequence.

§ 408. The Danger of such Cases does not depend so much on the Nature of the obstructing Substance, as on its Size, with Regard to that of the Passage of the Part where it stops, and of the Manner in which it forms the Obstruction; and frequently the very Food may occasion Death; while Substances less adapted to be swallowed are not attended with any violent Consequences, though swallowed.

A Child of six Days old swallowed a Comfit or Sugar Plumb, which stuck in the Passage, and instantly killed it.

A grown Person perceived that a Bit of Mutton had stopt in the Passage; not to alarm any Body he arose from Table; a Moment afterwards, on looking where he might be gone, he was found dead. Another was choaked by a Bit of Cake; a third by a Piece of the Skin of a Ham; and a fourth by an Egg, which he swallowed whole in a Bravo.

A Child was killed by a Chesnut swallowed whole. Another died suddenly, choaked (which is always the Circumstance, when they die instantly after such Accidents) by a Pear which he had tossed up, and catched in his Mouth. A Woman was choaked with another Pear. A Piece of a Sinew continued eight Days in the Passage, so that it prevented the Patient from getting down any Thing else; at the Expiration of that Time it fell into the Stomach, being loosened by its Putridity: The Patient notwithstanding died soon after, being killed by the Inflammation, Gangrene and Weakness it had occasioned. Unhappily there occur but too many Instances of this Sort, of which it is unnecessary to cite more.

§ 409. Whenever any Substance is thus detained in the Gullet, there are two Ways of removing it; that is either by extracting it, or pushing it down. The safest and most certain Way is always to extract or draw it out, but thisis not always the easiest: and as the Efforts made for this Purpose greatly fatigue the Patient, and are sometimes attended with grievous Consequences; and yet if the Occasion is extremely urging, it may be eligible to thrust it down, if that is easier; and if there is no Danger from the obstructing Bodies Reception into the Stomach.

The Substances which may be pushed down without Danger, are all common nourishing ones, as Bread, Meat, Cakes, Fruits, Pulse, Morsels of Tripe, and even Skin of Bacon. It is only very large Morsels of particular Aliments, that prove very difficult to digest; yet even such are rarely attended with any Fatality.

§ 410. The Substances we should endeavour to extract or draw out, though it be more painful and less easy than to push them down, are all those, whose Consequences might be highly dangerous, or even mortal, if swallowed. Such are all totally indigestible Bodies, as Cork, Linen-Rags, large Fruit Stones, Bones, Wood, Glass, Stones, Metals; and more especially if any further Danger may be superadded to that of its Indigestibility, from the Shape, whether rough, sharp, pointed, or angular, of the Substance swallowed. Wherefore we should chiefly endeavour to extract Pins, Needles, Fish-bones, other pointed Fragments of Bones, Bits of Glass, Scissars, Rings, or Buckles.

Nevertheless it has happened, that every one of these Substances have at one Time or another been swallowed, and the most usualConsequences of them are violent Pains of the Stomach, and in the Guts; Inflammations, Suppurations, Abscesses, a slow Fever, Gangrene, theMiserereor Iliac Passion; external Abscesses, through which the Bodies swallowed down have been discharged; and frequently, after a long Train of Maladies, a dreadful Death.

§ 411. When such Substances have not passed in too deep, we should endeavour to extract them with our Fingers, which often succeeds. If they are lower, we should make use of Nippers or a smallForceps; of which Surgeons are provided with different Sorts. Those which some Smoakers carry about them might be very convenient for such Purposes; and in Case of Necessity they might be made very readily out of two Bits of Wood. But this Attempt to extract rarely succeeds, if the Substance has descended far into theOesophagus, and if the Substance be of a flexible Nature, which exactly applies itself to, and fills up the Cavity or Chanel of it.

§ 412. If the Fingers and the Nippers fail, or cannot be duly applied, Crotchets, a Kind of Hooks, must be employed.

These may be made at once with a pretty strong iron Wire, crooked at the End. It must be introduced in the flat Way, and for the better conducting of it, there should be another Curve or Hook at the End it is held by, to serve as a Kind of Handle to it, which has this further Use, that it may be secured by a String tied to it; a Circumstance not to be omitted in anyInstrument employed on such Occasions, to avoid such ill Accidents as have sometimes ensued, from these Instruments slipping out of the Operators Hold. After the Crotchet has passed beyond and below the Substance, that obstructs the Passage, it is drawn up again, and hooks up with it and extracts that Impediment to swallowing.

This Crotchet is also very convenient, whenever a Substance somewhat flexible, as a Pin or a Fishbone stick, as it were, across the Gullet: the Crotchet in such Cases seizing them about their middle Part, crooks and thus disengages them. If they are very brittle Substances, it serves to break them; and if any Fragments still stick within, some other Means must be used to extract them.

§ 413. When the obstructing Bodies are small, and only stop up Part of the Passage; and which may either easily elude the Hook, or straiten it by their Resistance, a Kind of Rings may be used, and made either solid or flexible.

The solid ones are made of iron Wire, or of a String of very fine brass Wire. For this Purpose the Wire is bent into a Circle about the middle Part of its Length, the Sides of which Circle do not touch each other, but leave a Ring, or hollow Cavity, of about an Inch Diameter. Then the long unbent Sides of the Wire are brought near each other; the circular Part or Ring is introduced into the Gullet, in order to be conducted about the obstructing Body, and so to extract it. Very flexible Rings may be madeof Wool, Thread, Silk, or small Packthread, which may be waxed, for their greater Strength and Consistence. Then they are to be tied fast to a Handle of Iron-Wire, of Whale-bone, or of any flexible Wood; after which the Ring is to be introduced to surround the obstructing Substance, and to draw it out.

Several of these Rings passed through one another are often made use of, the more certainly to lay hold of the obstructing Body, which may be involved by one, if another should miss it. This Sort of Rings has one Advantage, which is, that when the Substance to be extracted is once laid hold of, it may then, by turning the Handle, be retained so strongly in the Ring thus twisted, as to be moved every Way; which must be a considerable Advantage in many such Cases.

§ 414. A fourth Material employed on these unhappy Occasions is the Sponge. Its Property of swelling considerably, on being wet, is the Foundation of its Usefulness here.

If any Substance is stopt in the Gullet, but without filling up the whole Passage, a Bit of Sponge is introduced, into that Part that is unstopt, and beyond the Substance. The Sponge soon dilates, and grows larger in this moist Situation, and indeed the Enlargement of it may be forwarded, by making the Patient swallow a few Drops of Water; and then drawing back the Sponge by the Handle it is fastened to, as it is now too large to return through the small Cavity, by which it was conveyed in, it draws out theobstructing Body with it, and thus unplugs, as it were, and opens the Gullet.

As dry Sponge may shrink or be contracted, this Circumstance has proved the Means of squeezing a pretty large Piece of it into a very small Space. It becomes greatly compressed by winding a String or Tape very closely about it, which Tape may be easily unwound and withdrawn, after the Sponge has been introduced. It may also be inclosed in a Piece of Whalebone, split into four Sticks at one End, and which, being endued with a considerable Spring, contracts upon the Sponge. The Whalebone is so smoothed and accommodated, as not to wound; and the Sponge is also to be safely tied to a strong Thread; that after having disengaged the Whalebone from it, the Surgeon may also draw out the Sponge at Pleasure.

Sponge is also applied on these Occasions in another Manner. When there is no Room to convey it into the Gullet, because the obstructing Substance ingrosses its whole Cavity; and supposing it not hooked into the Part, but solely detained by the Straitness of the Passage, a pretty large Bit of Sponge is to be introduced towards the Gullet, and close to the obstructing Subtance: Thus applied, the Sponge swells, and thence dilates that Part of the Passage that is above this Substance. The Sponge is then withdrawn a little, and but a very little, and this Substance being less pressed upon above than below, it sometimes happens, that the greaterStaitness and Contraction of the lower Part of the Passage, than of its upper Part, causes that Substance to ascend; and as soon as this first Loosening or Disengagement of it has happened, the total Disengagement of it easily follows.

§ 415. Finally, when all these Methods prove unavailable, there remains one more, which is to make the Patient vomit; but this can scarcely be of any Service, but when such obstructing Bodies are simply engaged in, and not hooked or stuck into the Sides of theOesophagus; since under this latter Circumstance vomiting might occasion further Mischief.

If the Patient can swallow, a Vomiting may be excited with the PrescriptionNº. 8, or withNº. 34, or35. By this Operation a Bone was thrown out, which had stopt in the Passage four and twenty Hours.

When the Patient cannot swallow, an Attempt should be made to excite him to vomit by introducing into, and twirling about the feathery End of a Quill in, the Bottom of the Throat, which the Feather however will not effect, if the obstructing Body strongly compresses the whole Circumference of the Gullet; and then no other Resource is left, but giving a Glyster of Tobacco. A certain Person swallowed a large Morsel of Calf's Lights, which stopt in the Middle of the Gullet, and exactly filled up the Passage. A Surgeon unsuccessfully attempted various Methods to extract it; but another seeing how unavailable all of them were; and the Patient'sVisage becoming black and swelled; his Eyes ready to start, as it were, out of his Head; and falling into frequent Swoonings, attended with Convulsions too, he caused a Glyster of an Ounce of Tobacco boiled to be thrown up; the Consequence of which was a violent Vomiting, which threw up the Substance that was so very near killing him.

§ 416. A sixth Method, which I believe has never hitherto been attempted, but which may prove very useful in many Cases, when the Substances in the Passage are not too hard, and are very large, would be to fix a Worm (used for withdrawing the Charge of Guns that have been loaded) fast to a flexible Handle, with a waxed Thread fastened to the Handle, in Order to withdraw it, if the Handle slipt from the Worm; and by this Contrivance it might be very practicable, if the obstructing Substance was not too deep in the Passage of the Gullet, to extract it—It has been known that a Thorn fastened in the Throat, has been thrown out by laughing.

§ 417. In the Circumstances mentioned§ 409, when it is more easy and convenient to push the obstructing Body downwards, it has been usual to make Use of Leeks, which may generally be had any where (but which indeed are very subject to break) or of a Wax-candle oiled, and but a very little heated, so as to make it flexible; or of a Piece of Whale-bone; or of Iron-Wire; one Extremity of which may be thickened andblunted in a Minute with a little melted Lead. Small Sticks of some flexible Wood may be as convenient for the same Use, such as the Birch-tree, the Hazel, the Ash, the Willow, a flexible Plummet, or a leaden Ring. All these Substances should be very smooth, that they may not give the least Irritation; for which Reason they are sometimes covered over with a thin Bit of Sheep's Gut. Sometimes a Sponge is fastened to one End of them, which, completely filling up the whole Passage, pushes down whatever Obstacle it meets with.

In such Cases too, the Patient may be prompted to attempt swallowing down large Morsels of some unhurtful Substance, such as a Crust of Bread, a small Turnep, a Lettuce Stalk, or a Bullet, in Hopes of their carrying down the obstructing Cause with them. It must be acknowledged, however, that these afford but a feeble Assistance; and if they are swallowed without being well secured to a Thread, it may be apprehended they may even increase the Obstruction, by their own Stoppage.

It has sometimes very happily, though rarely, occurred, that those Substances attempted to be detruded or thrust downwards, have stuck in the Wax-Candle, or the Leek, and sprung up and out with them: but this can never happen except in the Case of pointed Substances.

§ 418. Should it be impossible to extract the Bodies mentioned§ 410, and all such as it must be dangerous to admit into the Stomach, we mustthen prefer the least of two Evils, and rather run the Hazard of pushing them down, than suffer the Patient to perish dreadfully in a few Moments. And we ought to scruple this Resolution the less, as a great many Instances have demonstrated, that notwithstanding severalbadConsequences, and even a tormenting Death, have often followed the swallowing of such hurtful or indigestible Substances; yet at other times they have been attended with little or no Disorder.

§ 419. One of these four Events is always the Case, after swallowing such Things. They either, 1, go off by Stool; or, 2, they are not discharged and kill the Patient. Or else, 3, they are discharged by Urine; or, 4, are visibly extruded to the Skin. I shall give some Instances of each of these Events.

§ 420. When they are voided by Stool, they are either voided soon after they have been swallowed, and that without having occasional scarce any troublesome Symptom; or the voiding of them has not happened till a long Time after swallowing, and is preceded with very considerable Pain. It has been seen that a Bone of the Leg of a Fowl, a Peach-stone, the Cover of a small Box of Venice Treacle, Pins, Needles, and Coins of different Sorts, have been voided within a few Days after they had slipt down into the Stomach; and that with little or no Complaint. A small Flute, or Pipe also, four Inches long, which occasioned acute Pains for three Days, has been voided happily afterwards,besides, Knives, Razors, and one Shoe-buckle. I have seen but a few Days since a Child between two and three Years old, who swallowed a Nail above an Inch long, the Head of which was more than three Tenths of an Inch broad: it stopt a few Moments about the Neck, but descended while its Friends were looking for me; and was voided with a Stool that Night, without any bad Consequence. And still more lately I have known the entire Bone of a Chicken's Wing thus swallowed, which only occasioned a slight Pain in the Stomach for three or four Days.

Sometimes such Substances are retained within for a long Time, not being voided till after several Months, and even Years, without the least ill Effect: and some of them have never either appeared, nor been complained of.

§ 421. But the Event is not always so happy; and sometimes though they are discharged through the natural Passages, the Discharges have been preceded by very acute Pains in the Stomach, and in the Bowels. A Girl swallowed down some Pins, which afflicted her with violent Pains for the Space of six Years; at the Expiration of which Term she voided them and recovered. Three Needles being swallowed brought on Cholics, Swoonings and Convulsions for a Year after: and then being voided by Stool, the Patient recovered. Another Person who swallowed two, was much happier in suffering but six Hoursfrom them; when they were voided by Stool, and he did well.

It sometimes happens that such indigestible Substances, after having past all the Meanders, the whole Course of the Intestines, have been stopt in the Fundament, and brought on very troublesome Symptoms; but such however, as an expert Surgeon may very generally remove. If it is practicable to cut them, as it is when they happen to be thin Bones, the Jaw-bones of Fish, or Pins, they are then very easily extracted.

§ 422. The second Event is, when these fatal Substances are never voided, but cause very embarrassing Symptoms which finally kill the Patient; and of these Cases there have been but too many Examples.

A young Girl having swallowed some Pins, which she held in her Mouth, some of them were voided by Stool; but others of them pricked and pierced into her Guts, and even into the Muscles of her Belly, with the severest Pain; and killed her at the End of three Weeks.

A Man swallowed a Needle, which pierced through his Stomach, and into his Liver,94and ended in a mortal Consumption.

A Plummet which slipt down, while the Throat of a Patient was searching, killed him at the End of two Years.

It is very common for different Coins, and of different Metals, to be swallowed without any fatal or troublesome Effects. Even a hundred Luidores95have been swallowed, and all voided. Nevertheless these fortunate Escapes ought not to make People too secure and incautious on such Occasions, since such melancholy Consequences have happened, as may very justly alarm them. One single Piece of Money that was swallowed, entirely obstructed the Communication between the Stomach and the Intestines, and killed the Patient. Whole Nuts have often been inadvertently swallowed; but there have been some Instances of Persons in whom a Heap96of them has been formed, which proved the Cause of Death, after producing much Pain and Inquietude.

§ 423. The third Issue or Event is, when these Substances, thus swallowed down, have been discharged by Urine: but these Cases are very rare.

A Pin of a middling Size has been discharged by Urine, three Days after it slipt down; and a little Bone has been expelled the same Way, besides Cherry-stones, Plumb-stones, and even one Peach-stone.

§ 424. Finally, the fourth Consequence or Event is, when the indigestible Substances thus swallowed, have pierced through the Stomach or Intestines, and even to the Skin itself; and occasioning an Abscess, have made an Outlet for themselves, or have been taken out of the Abscess. A long Time is often required to effect this extraordinary Trajection and Appearance of them; sometimes the Pains they occasion are continual; in other Cases the Patient complains for a Time, after which the Pain ceases, and then returns again. The Imposthume, or Gathering, is formed in the Stomach, or in some other Part of the Belly: and sometimes these very Substances, after having pierced through the Guts, make very singular Routs, and are discharged very remotely from the Belly. One Needle that had been swallowed found its Way out, at the End of four Years, through the Leg; another at the Shoulder.

§ 425. All these Examples, and many others of cruel Deaths, from swallowing noxious Substances, demonstrate the great Necessity of anhabitual Caution in this Respect; and give in their Testimony against the horrid, I had almost said, the criminal Imprudence, of People's amusing themselves with such Tricks as may lead to such terrible Accidents; or even holding any such Substance in their Mouths, as by slipping down through Imprudence or Accident, may prove the Occasion of their Death. Is it possible that any one, without shuddering, can hold Pins or Needles in their Mouths, after reflecting on the dreadful Accidents, and cruel Deaths, that have thus been caused by them.

§ 426. It has been shewn already, that Substances obstructing the Passage of the Gullet sometimes suffocate the Patient; that at other Times they can neither be extracted nor thrust down; but that they stop in the Passage, without killing the Patient, at least not immediately and at once. This is the Case when they are so circumstanced, as not to compress theTrachæa, the Wind-pipe, and not totally to prevent the swallowing of Food; which last Circumstance can scarcely happen, except the Obstruction has been formed by angular or pointed Bodies. The Stoppage of such Bodies is sometimes attended, and that without much Violence, with a small Suppuration, which loosens them; and then they are either returned upwards through the Mouth, or descend into the Stomach. But at other Times an extraordinary Inflammation is produced, which kills the Patient. Or if the Contents of the Abscess attending the Inflammationtend outwardly, a Tumour is formed on the external Part of the Neck, which is to be opened, and through whose Orifice the obstructing Body is discharged. In other Instances again they take a different Course, attended with little or no Pain, and are at length discharged by a Gathering behind the Neck, on the Breast, the Shoulder, or various other Parts.

§ 427. Some Persons, astonished at the extraordinary Course and Progression of such Substances, which, from their Size, and especially from their Shape, seem to them incapable of being introduced into, and in some Sort, circulating through the human Body, without destroying it, are very desirous of having the Rout and Progression of such intruding Substances explained to them. To gratify such Inquirers, I may be indulged in a short Digression, which perhaps is the less foreign to my Plan; as in dissipating what seems marvelous, and has been thought supernatural in such Cases, I may demolish that superstitious Prejudice, which has often ascribed Effects of this Sort to Witchcraft; but which admit of an easy Explanation. This very Reason is the Motive that has determined me to give a further Extent to this Chapter.

Wherever an Incision is made through the Skin, a certain Membrane appears, which consists of two Coats orLaminæ, separated from each other by small Cells or Cavities, which all communicate together; and which are furnished, more or less, with Fat. There is not any Fatthroughout the human Body, which is not inclosed in, or enveloped with, this Coat, which is called the adipose, fatty, or cellular Membrane.

This Membrane is not only found under the Skin, but further plying and insinuating itself in various Manners, it is extended throughout the whole Body. It distinguishes and separates all the Muscles; it constitutes a Part of the Stomach, of the Guts, of the Bladder, and of all theVisceraor Bowels. It is this which forms what is called the Cawl, and which also furnishes a Sheath or Envelopement to the Veins, Arteries, and Nerves. In some Parts it is very thick, and is abundantly replenished with Fat; in others it is very thin and unprovided with any; but wherever it extends, it is wholly insensible, or void of all Sensation, all Feeling.

It may be compared to a quilted Coverlet, the Cotton, or other Stuffing of which, is unequally distributed; greatly abounding in some Places, with none at all in others, so that in these the Stuff above and below touch each other. Within this Membrane, or Coverlet, as it were, such extraneous or foreign Substances are moved about; and as there is a general Communication throughout the whole Extent of the Membrane, it is no ways surprizing, that they are moved from one Part to another very distant, in a long Course and Duration of Movement. Officers and Soldiers very often experience, that Bullets which do not pass through the Parts where they have entered, are transferred to very different and remote ones.

The general Communication throughout this Membrane is daily demonstrated by Facts, which the Law prohibits; this is the Butchers inflating, or blowing up, the cellular Membrane throughout the whole Carcase of a Calf, by a small Incision in the Skin, into which they introduce a Pipe or the Nozzle of a small Bellows; and then, blowing forcibly, the Air evidently puffs up the whole Body of the Calf into this artificial Tumour or Swelling.

Some very criminal Impostors have availed themselves of this wicked Contrivance, thus to bloat up Children into a Kind of Monsters, which they afterwards expose to View for Money.

In this cellular Membrane the extravasated Waters of hydropic Patients are commonly diffused; and here they give Way to that Motion, to which their own Weight disposes them. But here I may be asked—As this Membrane is crossed and intersected in different Parts of it, by Nerves, Veins, Arteries,&c.the wounding of which unavoidably occasions grievous Symptoms, how comes it, that such do not ensue upon the Intrusion of such noxious Substances? To this I answer, 1, that such Symptoms do sometimes really ensue; and 2, that nevertheless they must happen but seldom, by Reason that all the aforesaid Parts, which traverse and intersect this Membrane, being harder than the Fat it contains; such foreign Substances must almost necessarily, whenever they rencounter those Parts, be turned aside towards the Fat which surrounds them,whose Resistance is very considerably less; and this the more certainly so, as these Nerves,&c.are always of a cylindrical Form.——But to return from this necessary Digression.

§ 428. To all these Methods and Expedients I have already recommended on the important Subject of this Chapter, I shall further add some general Directions.

1. It is often useful, and even necessary, to take a considerable Quantity of Blood from the Arm; but especially if the Patient's Respiration, or Breathing, is extremely oppressed; or when we cannot speedily succeed in our Efforts to remove the obstructing Substance; as the Bleeding is adapted to prevent the Inflammation, which the frequent Irritations from such Substances occasion; and as by its disposing the whole Body into a State of Relaxation, it might possibly procure an immediate Discharge of the offending Substance.

2. Whenever it is manifest that all Endeavours, either to extract, or to push down the Substance stopt in the Passage, are ineffectual, they should be discontinued; because the Inflammation occasioned by persisting in them, would be as dangerous as the Obstruction itself; as there have been Instances of People's dying in Consequence of the Inflammation; notwithstanding the Body, which caused the Obstruction, had been entirely removed.

3. While the Means already advised are making Use of, the Patient should often swallow, orif he cannot, he should frequently receive by Injection through a crooked Tube or Pipe, that may reach lower down than theGlottis, some very emollient Liquor, as warm Water, either alone or mixed with Milk, or a Decoction of Barley, of Mallows, or of Bran. A two-fold Advantage may arise from this; the first is, that these softening Liquors smooth and sooth the irritated Parts; and secondly, an Injection, strongly thrown in, has often been more successful in loosening the obstructing Body, than all Attempts with Instruments.

4. When after all we are obliged to leave this in the Part, the Patient must be treated as if he had an inflammatory Disease; he must be bled, ordered to a Regimen, and have his whole Neck surrounded with emollient Pultices. The like Treatment must also be used, though the obstructing Substance be removed; if there is Room to suppose any Inflammation left in the Passage.

5. A proper Degree of Agitation has sometimes loosened the inhering Body, more effectually than Instruments. It has been experienced that a Blow with the Fist on the Spine, the Middle of the Back, has often disengaged such obstructed and obstructing Bodies; and I have known two Instances of Patients who had Pins stopt in the Passage; and who getting on Horseback to ride out in Search of Relief at a neighbouring Village, found each of them the Pin disengaged after an Hour's riding: One spat it out, and the other swallowed it, without any ill Consequence.

6. When there is an immediate Apprehension of the Patient's being suffocated; when bleeding him has been of no Service; when all Hope of freeing the Passage in time is vanished, and Death seems at Hand, if Respiration be not restored; the Operation ofBronchotomy, or opening of the Wind-pipe, must be directly performed; an Operation neither difficult to a tolerably knowing and expert Surgeon, nor very painful to the Patient.

7. When the Substance that was stopt passes into the Stomach, the Patient must immediately be put into a very mild and smooth Regimen. He should avoid all sharp, irritating, inflaming Food; Wine, spirituous Liquors, all strong Drink, and Coffee; taking but little Nourishment at once, and no Solids, without their having been thoroughly well chewed. The best Diet would be that of farinaceous mealy Soups, made of various leguminous Grains, and of Milk and Water, which is much better than the usual Custom of swallowing different Oils.

§ 429. The Author of Nature has provided, that in eating, nothing should pass by theGlottisinto the Wind-pipe. This Misfortune nevertheless does sometimes happen; at which very Instant there ensues an incessant and violent Cough, an acute Pain, with Suffocation; all the Blood being forced up into the Head, the Patient is in extreme Anguish, being agitated with violent and involuntary Motions, and sometimes dying on the Spot. AHungarianGrenadier, by Tradea Shoemaker, was eating and working at the same time. He tumbled at once from his Seat, without uttering a single Word. His Comrades called out for Assistance; some Surgeons speedily arrived, but after all their Endeavours he discovered no Token of Life. On opening the Body, they found a Lump, or large Morsel, of Beef, weighing two Ounces, forced into the Windpipe, which it plugged up so exactly, that not the least Air could pass through it into the Lungs.

§ 430. In a Case so circumstanced, the Patient should be struck often on the Middle of the Back; some Efforts to vomit should be excited; he should be prompted to sneeze with Powder of Lilly of the Valley, Sage, or any cephalic Snuffs, which should be blown strongly up his Nose.

A Pea, pitched into the Mouth in playing, entered into the Wind-pipe, and sprung out again by vomiting the Patient with Oil. A little Bone was brought up by making another sneeze, with powdered Lilly of the Valley.

In short, if all these Means of assisting, or saving the Patient are evidently ineffectual,Bronchotomymust be speedily performed (SeeNº. 6, of the preceding Section.) By this Operation, some Bones, a Bean, and a Fish-bone have been extracted, and the Patient has been delivered from approaching Death.

§ 431. Nothing should be left untried, when the Preservation of human Life is the Object. In those Cases, when an obstructing Body can neither be disengaged from the Throat, the Passageto the Stomach, nor be suffered to remain there without speedily killing the Patient, it has been proposed to make an Incision into this Passage, theOesophagus, through which such a Body is to be extracted; and to employ the like Means, when a Substance which had slipt even into the Stomach itself, was of a Nature to excite such Symptoms, as must speedily destroy the Patient.

When theOesophagusis so fully and strongly closed, that the Patient can receive no Food by the Mouth, he is to be nourished by Glysters of Soup, Gelly, and the like.

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