Part 43

Sec. 407. Very dangerous Symptoms arise from this Stoppage, which are frequently attended with a most acute Pain in the Part; and at other Times, 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 the Glottis is 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 the Oesophagus, or Gullet. But if the Passage is absolutely closed, and the Obstruction cannot be removed for many Days, a terrible Death is the Consequence.

Sec. 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.

Sec. 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 this is 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.

Sec. 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 usual Consequences of them are violent Pains of the Stomach, and in the Guts; Inflammations, Suppurations, Abscesses, a slow Fever, Gangrene, the Miserere or Iliac Passion; external Abscesses, through which the Bodies swallowed down have been discharged; and frequently, after a long Train of Maladies, a dreadful Death.

Sec. 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 small Forceps; 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 the Oesophagus, and if the Substance be of a flexible Nature, which exactly applies itself to, and fills up the Cavity or Chanel of it.

Sec. 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 any Instrument 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.

Sec. 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 made of 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.

Sec. 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 the obstructing 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 greater Staitness 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.

Sec. 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 the Oesophagus; since under this latter Circumstance vomiting might occasion further Mischief.

If the Patient can swallow, a Vomiting may be excited with the Prescription No. 8, or with No. 34, or 35. 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's Visage 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.

Sec. 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.

Sec. 417. In the Circumstances mentioned Sec. 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 and blunted 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.