The compressibility of sponge is another foundation of its usefulness in such cases. A pretty large piece of sponge may be compressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, after the sponge has been introduced. A bit of sponge may likewise be, compressed by a piece of whale-bone split at one end; but this can hardly be introduced in such a manner as not to hurt the patient.
I have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is safer than swallowing sponge, and will often answer the purpose equally well.
When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply engaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion further mischief. If the patient can swallow, vomiting may be excited by taking half a drachm or two scruples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling an ounce of tobacco in a sufficient quantity of water: this has often been found to succeed, when other attempts to excite vomiting had failed.
When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible; or a piece of whale-bone, wire, or flexible wood, with a sponge fastened to one end.
Should it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least of two evils, and rather run the hazard of pushing them down than suffer the patient to perish in a few minutes; and we ought to scruple this resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances has been followed by no disorder.
Whenever it is manifest that all endeavours either to extract or push down the substance must prove ineffectual, they should be discontinued; because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the body which caused the obstruction had been entirely removed.
While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by injection through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and sooth the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments.
When, after all our endeavours, we are obliged to leave the obstructing body in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed.
A proper degree of agitation has sometimes loosened the inhering body more effectually than instruments. Thus, a blow on the back has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the wind-pipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage.
When any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, as wine, punch, pepper, and such like; and his drink should be milk and water, barley-water, or whey.