Albucasis describes the operation similarly to the Greeks. He directs the operator to get the patient’s tongue pressed down by an assistant; when the operator is to seize upon the uvula and cut off as much as is proper of it. He gives a drawing of an instrument for the operation with caustic medicines. (Chirurg. ii, 37.)
Avicenna’s description is to the same effect, but not so circumstantial. (iii, 9, 15.) Mesue directs us to perform the operation with a heated scalpel of gold. (De Ægr. Gutturis, 3.)
Rhases states that when the uvula is enlarged, but is not red, the operation may be performed without danger. He mentions that some preferred the actual or potential cautery, but that he preferred excision. He describes, but not distinctly, an instrument for applying the caustic medicines. He states that loss of the entire uvula impairs the voice and exposes the lungs to danger from cold. (Contin. vii; and Divis. i, 49.)
SECT. XXXII.—ON THORNY SUBSTANCES FIXED IN THE PHARYNX.
Thorns, or the bones of fishes, or other substances, are often swallowed in eating, and fix in different places. Wherefore, such as can be seen we are to extract with the forceps for that purpose; but those which are lower down in the gullet we must manage differently. Some are of opinion that the patient ought to be made to swallow large morsels, such as the stalk of lettuces, or pieces of bread; but others direct us to bind a thread about a small piece of clean soft sponge and give it to the patient to swallow, and then taking hold of the thread to draw it up, and to do this frequently in order that the thorn may get fixed in the sponge and be brought up. Leonidas orders suppurative cataplasms to be applied, such as those from raw barley-flour, in order that the part may be converted into pus and the thorn fall out of its own accord. If we see the patient at the time of swallowing, before digestion has taken place in the stomach, and cannot perceive the substance which is fixed, we may order him to vomit by pushing the fingers or feathers down the throat, for sometimes the thing which is fixed will be brought up with the matters that are vomited.
Commentary. Our author’s directions are mostly taken from Aëtius. (viii, 50.)
Albucasis repeats our author’s directions, and further recommends us, when they fail, to introduce an instrument made of lead, which he gives a drawing of, and either to extract the substance or push it downwards. (Chirurg. ii, 38.) A similar plan of treatment is recommended by Mesue (de Ægr. Gutturis); by Avicenna (iii, 9, 43); and by Alsaharavius (Pract. xii.) When a morsel of food sticks to the œsophagus, Alsaharavius directs that the person should be struck on the back, which will facilitate the descent of it. (6.)
SECT. XXXIII.—ON LARYNGOTOMY.
The most famous surgeons have also described this operation. Antyllus, therefore, says, “In cases of cynanche (as we will explain under the head of Dietetics) we entirely disapprove of this operation, because the incision is utterly unavailing when all the arteries (the whole of the trachea?) and the lungs are affected; but in inflammations about the mouth and palate, and in cases of indurated tonsils which obstruct the mouth of the windpipe as the trachea is unaffected, it will be proper to have recourse to pharyngotomy, in order to avoid the risk of suffocation. When, therefore, we engage in the operation we slit open a part of the arteria aspera (for it is dangerous to divide the whole) below the top of the windpipe, about the third or fourth ring. For this is a convenient situation, as being free of flesh, and because the vessels are placed at a distance from the part which is divided. Wherefore, bending the patient’s head backwards, so as to bring the windpipe better into view, we are to make a transverse incision between two of the rings, so as that it may not be the cartilage which is divided, but the membrane connecting the cartilages. If one be more timid in operating, one may first stretch the skin with a hook and divide it, and then, removing the vessels aside, if they come in the way, make the incision.” These are the words of Antyllus. We judge that the windpipe has been opened from the air rushing through it with a whizzing noise, and from the voice being lost. After the urgency of the suffocation has passed over, we pare the lips of the incision so as to make them raw surfaces again, and then have recourse to sutures, but sew the skin only, without the cartilage. Then we use the applications proper for bloody or fresh wounds, but if it does not unite we must treat it with incarnants. We must follow the same plan of treatment if we should meet with the case of a person who had cut his own throat from a wish to commit suicide.
Commentary. Aretæus makes mention of this operation in such terms as proves that it must have been practised occasionally in his time. He, however, does not approve of it, at least in cases of angina. (De Curat. Morb. Acut. i, 7.)