It is a horrid custom immediately to consign over to death every person who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy person, instead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in an house that is inhabited. What the ground of this superstition may be, we shall not pretend to inquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense.
When a person seems to be suddenly deprived of life, our first business is to inquire into the cause. We ought carefully to observe whether any substance be lodged in the wind-pipe or gullet; and, if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or the like.
I should now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy sufferers; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice.
OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.
Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effect of carelessness. Children should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the substance before the person is aware[[202]].
When any substance is detained in the gullet, there are two ways of removing it, viz. either by extracting it, or pushing it down. The safest and most certain way is to extract it; but this is pot always the easiest; it may therefore be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature, that there is no danger from its reception into the stomach. The substances which may be pushed down without danger are, all common nourishing ones, as bread, flesh, fruits, and the like. All indigestible bodies, as cork, wood, bones, pieces of metal, and such like, ought if possible to be extracted, especially if these bodies be sharp pointed, as pins, needles, fish-bones, bits of glass, &c.
When such substances have not passed in too deep, we should endeavour to extract them with our fingers, which method often succeeds. When they are lower, we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descended far into the gullet.
If the fingers and nippers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. These may be made at once, by bending a piece of pretty strong iron wire at one end. It must be introduced in the flat way; and for the better conducing it, there should likewise be a curve or bending 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 operator’s hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient, when a substance somewhat flexible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them.
When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straiten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conduced about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it out. Several of these rings passed through one another may be used, the more certainly to lay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have 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 twitted, as to be moved every way, which must in many cases be a considerable advantage.
Another material employed on these unhappy occassions is the sponge. Its property of swelling considerably on being wet is the principal foundation of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which 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. Afterwards it is to be drawn back by the handle to which it is fastened; and as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstructing body along with it.