The practice of surgery . res;and on the other hand we must beware of aggravating the tendency tosinking which sooner or later becomes apparent in the majority of a general rule, bloodletting from the system is seldom if everwarrantable. Should the pharynx or oesophagus have been wounded, the use of atube becomes necessary to convey nourishment to the stomach. Inthe ordinary effort of deglutition, the ingesta would necessarily escapemore or less copiously by the wound, and so do harm in many feeding-tube cannot be inserted from the wound, although thefacility of such a procee
The practice of surgery . res;and on the other hand we must beware of aggravating the tendency tosinking which sooner or later becomes apparent in the majority of a general rule, bloodletting from the system is seldom if everwarrantable. Should the pharynx or oesophagus have been wounded, the use of atube becomes necessary to convey nourishment to the stomach. Inthe ordinary effort of deglutition, the ingesta would necessarily escapemore or less copiously by the wound, and so do harm in many feeding-tube cannot be inserted from the wound, although thefacility of such a proceeding may invite the attempt, otherwise closureof the wound must be seriously interfered with. If intended to be intro-duced and worn permanently, until the pharyngeal or oesophageal aper-ture shall have closed, it is to be passed by the nostril. But it is foundto be more expedient to introduce the tube only occasionally, by themouth, twice or thrice daily, as circumstances may seem to require. It WOUNDS OF THE THROAT. 257. is not necessary to pass the instrument com- Fg- 112- pletely down to the stomach; it is enoughthat its extremity is placed fairly beyondthe wound. And of course the precautionis not neglected of ascertaining that lodge-ment is rightly accomplished ere fluid nou-rishment is begun to be introduced. Onevery obvious objection to the permanentretention of a tube, whether passed by themouth or by the nose, is that its extremity,pressing against the posterior part of thewindpipe, is apt to occasion ulceration there,which may perforate, complicating the caseuntowardly, by the establishment of trachealfistula. Should this occur, as has happened,the ordinary test of the tube being rightlyplaced will probably fail; air, in expiration,escaping by the tube in the oesophagus, aswell as by the natural outlet (p. 228). Throughout the whole cure, the state ofrespiration must be sedulously watched. Andshould threatening of suffocation supervene,as is not unlikely, and prove o
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