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