neck and head ; after half an hour he became conscious, but said that he was very sleepy, (No chloroform given for operation), as his blood became thoroughly cerated this sleepiness wore off. After treatment I placed a piece of carbolic of the tube, ordered nourishment gauze over the mouth by enema, continuance of steam vapour in his room, and put an Hospital-Assistant in charge to keep tube clear, and give notice if any difficulty'of breathing occurred. Further progress of case.?27th February: Temperature 99.9 moraing. 27th Feb.?Temperature ioo^0 evening. Nutrient enemata continued; slept well but complains of cou^h. 28th Feb.?Temperature 98? morning; 98*4? evening. For
cough?
Ammon. Carb. gr. iii Tinct opij
x 77^ Aquce cough 5 t.d. s. midnight tube became blocked, the Assistant-Surgeon changed it and introduced another, which had a gentler curve than the other, and did not cause irritation. 19th Feb.?Can drink without difficulty./si March.?Enemas stopped, food given by mouth. G ?n talk when he applies his finger over mouth of
At
tube. 6th March.?Can breathe a little when mouth of tube is covered. 12th March.?Tube removed altogether, but after 5 minutes was again applied as patient showed symptoms of suffocation. 15th March. Patient having been prepared by administration of Bromide of potash, I examined again and found the parts down to vocal chords greatly congested, and the follicles standing out. 77//? March.?Ordered alum gargle gr. xx to
gi.
FEROZEPORE DISPENSARY. (EDEMA GLOTTIDIS By Surgeon
:
TRACHEOTOMY
Polden,
;
RECOVERY
Civil
Surgeon. (From notes taken by Assistant-Surgeon Malik Jowala Sahai.) Rukan Din, aged 35 years, Police Constable, was admitted into the Ferozepur Dispensary on 25th February, 1884, suffering from inflammation of the larynx. Previotis history.?About a fortnight before admission he suffered from tonsillitis, for the cure of which he had used native astringents in the form of gargles and local application This treatment did him good, but still pain was to tonsils. To cure this pain he confelt when he drank or swallowed. sulted a native midwife, who advised him to take hot chicken broth. This he did, and after it felt worse than before, however, he again consulted this woman, who told him to take an emetic; not having any emetic medicines, he tried to induce vomiting by means of his finger introduced into mouth, as a consequence he had a good deal of retching, but no vomiting ; after this he suffered from intense dyspnoea, and came at once to hospital for medical aid. Condition on admission.?On admission
"
Hoarseness of
voice,
dysphagia, great dyspnoea, pulse 72, resp. 22, temperature 98'6?, there is no enlargement of tonsils, but the fauces are reduced, tongue moist." The Assistant-Surgeon ordered a sedative and antispasmodic mixture, fomented the neck and kept
a
steaming
kettle in the
patient's
room.
Condition before operation.?On the following morning (February 26th) patient became suddenly worse, and I was sent
for by the Assistant-Surgeon. On arriving at dispensary 1 found that patient had been removed to the operation room. No pulse perceptible, He was quite unconscious and comatose. body cold and clammy, respiration 4 to 6 per minute, like the gasping breath which precedes death, and so shallow as scarcely chest walls ; face congested and eyes protruding. to move Operation.?Seeing the man's condition I immediately determined to operate. Making an incision through skin and muscles of about 2 inches in length, I opened the trachea between the 1st and 2nd ring and cut through the 2nd ring, the expulsion of frothy mucus with some force was the result, inserted closed along the knife into the a forceps was then wound, the blades were opened, the tube introduced between of blood. them, and tied in ; the patient did not lose As
gi.
had several cases of lithotomy to dispose of, the patient at once removed from operation room outside into sun, was and blankets heaped over him; very gradually his respirations became deeper and more frequent, and his pulse perceptible, a profuse perspiration burst out over his body, particularly on we
2Qth March.?Very little advantage from alum, ordered application also of nitrate of silver solution gr. xxx to ? ias far down as it can be applied. 8th April.?No permanent advantage from application, ordered Glycerium acids tannici, this application being continued, and patient is improving under it. Remarks. ?This is apparently a case of oedema glottidis coming on in follicular laryngitis, possibly as a result of irritating applications ; I should be glad if any of your readers could suggest a more speedy cure than the various solutions, astringent and caustic applied by me.
cough?
Ammon. Carb. gr. iii Tinct opij
x 77^ Aquce cough 5 t.d. s. midnight tube became blocked, the Assistant-Surgeon changed it and introduced another, which had a gentler curve than the other, and did not cause irritation. 19th Feb.?Can drink without difficulty./si March.?Enemas stopped, food given by mouth. G ?n talk when he applies his finger over mouth of
At
tube. 6th March.?Can breathe a little when mouth of tube is covered. 12th March.?Tube removed altogether, but after 5 minutes was again applied as patient showed symptoms of suffocation. 15th March. Patient having been prepared by administration of Bromide of potash, I examined again and found the parts down to vocal chords greatly congested, and the follicles standing out. 77//? March.?Ordered alum gargle gr. xx to
gi.
FEROZEPORE DISPENSARY. (EDEMA GLOTTIDIS By Surgeon
:
TRACHEOTOMY
Polden,
;
RECOVERY
Civil
Surgeon. (From notes taken by Assistant-Surgeon Malik Jowala Sahai.) Rukan Din, aged 35 years, Police Constable, was admitted into the Ferozepur Dispensary on 25th February, 1884, suffering from inflammation of the larynx. Previotis history.?About a fortnight before admission he suffered from tonsillitis, for the cure of which he had used native astringents in the form of gargles and local application This treatment did him good, but still pain was to tonsils. To cure this pain he confelt when he drank or swallowed. sulted a native midwife, who advised him to take hot chicken broth. This he did, and after it felt worse than before, however, he again consulted this woman, who told him to take an emetic; not having any emetic medicines, he tried to induce vomiting by means of his finger introduced into mouth, as a consequence he had a good deal of retching, but no vomiting ; after this he suffered from intense dyspnoea, and came at once to hospital for medical aid. Condition on admission.?On admission
"
Hoarseness of
voice,
dysphagia, great dyspnoea, pulse 72, resp. 22, temperature 98'6?, there is no enlargement of tonsils, but the fauces are reduced, tongue moist." The Assistant-Surgeon ordered a sedative and antispasmodic mixture, fomented the neck and kept
a
steaming
kettle in the
patient's
room.
Condition before operation.?On the following morning (February 26th) patient became suddenly worse, and I was sent
for by the Assistant-Surgeon. On arriving at dispensary 1 found that patient had been removed to the operation room. No pulse perceptible, He was quite unconscious and comatose. body cold and clammy, respiration 4 to 6 per minute, like the gasping breath which precedes death, and so shallow as scarcely chest walls ; face congested and eyes protruding. to move Operation.?Seeing the man's condition I immediately determined to operate. Making an incision through skin and muscles of about 2 inches in length, I opened the trachea between the 1st and 2nd ring and cut through the 2nd ring, the expulsion of frothy mucus with some force was the result, inserted closed along the knife into the a forceps was then wound, the blades were opened, the tube introduced between of blood. them, and tied in ; the patient did not lose As
gi.
had several cases of lithotomy to dispose of, the patient at once removed from operation room outside into sun, was and blankets heaped over him; very gradually his respirations became deeper and more frequent, and his pulse perceptible, a profuse perspiration burst out over his body, particularly on we
2Qth March.?Very little advantage from alum, ordered application also of nitrate of silver solution gr. xxx to ? ias far down as it can be applied. 8th April.?No permanent advantage from application, ordered Glycerium acids tannici, this application being continued, and patient is improving under it. Remarks. ?This is apparently a case of oedema glottidis coming on in follicular laryngitis, possibly as a result of irritating applications ; I should be glad if any of your readers could suggest a more speedy cure than the various solutions, astringent and caustic applied by me.
