the relief of this affection, her attendant, Dr. Pawling, of Danville, applied nitrate of silver. While the case was thus progressing, the child, on the 21st of October, in the afternoon, inhaled a piece of thick red sewing-silk, four inches and five-eighths in length, which she happened at the time to be chewing or holding in her mouth. No increase of laryngeal, bronchial, or pulmonary embarrassment attended this second accident; but during the evening she was seized with frequent and violent paroxysms of cough and suffocative feelings, attended with severe pain in the lower part of the left lung, shifting, in a few days, to just above the nipple, where it afterwards remained fixed, extending, however, occasionally up towards the clavicle, and outwards towards the axilla. A careful examination of the corresponding side of the chest, at this period, revealed the existence of pneumonia. On the 24th of October, in a violent paroxysm of coughing, she ejected a piece of cedar, of a firm consistence, and of characteristic appearance, but of a brownish color, and scarcely one line in length. The thread (Fig. 2), was expelled, Fig. 2. in a similar manner, on the 7th of November; it was rolled up into a small flattened mass, bearing the indentations of the teeth, and slightly covered, upon one of its surfaces, with whitish lymph, or inspissated mucus. The cough, from the time the thread was inhaled until its expulsion, reappeared every afternoon, about five o'clock, and lasted until towards midnight, when the child usually fell into a tolerably sound sleep, waking up in the morning nearly well, and so continuing during the greater part of the day. The fever, which was at first of an inflammatory character, gradually assumed a hectic type, and was always followed by pretty copious sweats. The child expectorated a great deal of fetid pus, commencing soon after the inhalation of the thread, and continuing until the 25th of November, when it finally ceased. Whenever she ejected this kind of matter, she complained of a peculiar burning sensation in the armpit of the affected side. Three days after the fetid expectoration disappeared, she was seized with a violent and protracted paroxysm of coughing, in which she ejected a small body, about the size of a partridge shot, and probably, from its resemblance to the other foreign body, a piece of cedar. During the progress of the case, the child was troubled with pain. and irritation of the bowels, which, after the expulsion of the silk thread, assumed a dysenteric form, and finally disappeared, after a fortnight, under the use of nitrate of silver. It is worthy of notice that the cough ceased as soon as the enteritis subsided. It was never discovered when the sprig of cedar, which was, doubtless, the cause of the intestinal disease, was voided. On the 10th of December, when I first saw this patient, she was laboring under the effects of a slight cold, contracted on her journey from Danville to this city. She had a frequent spasmodic cough, and symptoms of subacute bronchitis, which yielded promptly to mild treatment. She had still some pain, with a sense of burning, in the left side of the chest, and absence of the respiratory murmur just above the left nipple, over a space about two inches and a half in diameter. CASE 14.- Water-melon seed; girl, aged six years; body moving up and down the trachea; spontaneous extrusion at the end of the fortieth day; recovery. (Communicated to the author by James D. Maxwell, M. D., of Indiana.) Leonora H., aged six years, a resident of Monroe County, Indiana, in 1850, while running up a hill in the act of eating a piece of water-melon, drew one of the seeds, during a hurried inspiration, into the windpipe. The symptoms at the time were of the usual character, and the body moved freely to and fro with an audible click. A neighboring physician administered emetics, but with no benefit as far as the ejection of the intruder was concerned. The seed in a few days became stationary, and such was the ame lioration of all the symptoms that it was thought probable it had been expelled unobserved. This improvement continued for about four weeks,,when the child was supposed to have contracted a cold; the cough returned, and the seed, being dislodged, was heard again passing up and down the windpipe. Several days subse quently, Dr. Maxwell was called to the patient in consultation. The substance was once more stationary; the cough was dry and hack ing, and there was considerable fever. After full deliberation, it was deemed best to leave the case to the restorative efforts of nature, prescribing merely a febrifuge and palliative for the cough. In the course of a week the seed was expelled, and the patient soon recovered. CASE 15.-Plate of brass metal; child, two years and a half old; cough, dyspnoea, and complete aphonia; expulsion at the end of six weeks, in a paroxysm of sneezing; recovery. (Dr. C. Bannister, Boston Med. and Surgical Journ., vol. xxxvi. p. 142. 1847.) Fig. 3. A child, two years and a half of age, had the misfortune, on the 18th of September, 1846, to swallow a plate of brass metal (Fig. 3), used for covering the end of a spool of thread, three-fourths of an inch in length, and three-eighths of an inch in breadth at its widest part, the angle at one of the extremities of which had been accidentally bent into a kind of hook, rendering it a very unpleasant morsel for the air-passages. From the absence of severe and well-marked symptoms, it was supposed, for a short time, that the substance had descended into the oesophagus; but the medical attendant was soon undeceived by the accession of cough, and difficulty of breathing, resembling croup. The cough after awhile abated; but the dyspnoea continued, and was followed by emaciation and total aphonia. These symptoms lasted six weeks, when the child accidentally sneezed and threw up the extraneous body. Laborious respiration, accompanied with a wheezing sound between asthma and croup, remained after the windpipe was freed; though convalescence was taking place when the case was reported in March, 1847. CASE 16.-Three artificial teeth, with their block and two wooden pivots; gentleman; copious purulent expectoration; ejection at the end of the forty-sixth day, in a fit of coughing; recovery. (Dr. Thomas Wallace, Boston Med. and Surg. Journ., vol. xvi. p. 206. 1837.) On the 10th of February, 1837, Dr. T., of Derry, New Hampshire, drew into his trachea, whilst in the act of coughing, three artificial teeth, on one block, with two wooden pivots, which had accidentally separated from his jaw, and lodged, as was supposed, near the bifurcation of the right bronchial tube. Here they remained forty-six days, when they were coughed up with about half a teacupful of purulent matter. The symptoms, during the first week, were, occasional irritative cough, difficulty of breathing, and soreness in the right side. After that period, he had severe paroxysms of coughing in the morning, with expectoration of from a pint to a pint and a half of greenish pus in the twenty-four hours. The breath was fetid throughout; and for the last fortnight he had felt the irritation from the teeth very sensibly while coughing. For nearly a month after their expulsion, he raised about eight ounces of matter a day; notwithstanding which his health and strength were gradually increasing. The length of the teeth and pivots was five-eighths of an inch, and the breadth of the block seven-eighths of an inch. CASE 17.-Piece of bone; girl, ten months old; cough, dyspnœa, and saw-like noise in breathing; expulsion at the end of the forty-eighth day, in a fit of coughing; recovery. (Mr. Thomas Stabb, London Medical Gazette, for December, 1830.') Mr. Thomas Stabb, the reporter of this case, states that, on the 20th of September, 1830, S. H. S., aged ten months, while playing with a bone of a neck of mutton, put it into her mouth, and detached a small portion, about the size of a large marrow-fat pea, which slipped into her windpipe, and produced violent coughing and irritation for about five minutes, when it ceased, leaving a noise in breathing like that caused by a saw. These symptoms recurred with increased severity the next day, accompanied with constitutional excitement. The same saw-like noise of breathing and some cough continued, but did not appear to give pain after the fourth day; the child's health and spirits after that time appearing as good as usual, except this constant wheezing. On the 3d of November, upwards of six weeks after the accident, in consequence of exposure, violent tracheal irritation, with cough, returned. To relieve these symptoms, antimony was given; and on the 7th, while the system was relaxed from the effects of this medicine, and while the nurse was briskly rubbing the throat with a volatile embrocation, the head being bent back over her lap, the child was seized with a violent fit of coughing, and threw up the piece of bone, imbedded in mucus. Her breathing almost immediately became natural, and the next day she was as well as ever. 1 Amer. Journ. Med. Sciences, vol. vi. p. 251. Phila., 1830. The piece of bone was very rough, with sharp edges, and of a triangular shape. CASE 18.-Patient's own molar tooth; girl, from ten to twelve years of age; cough and dyspnea; expulsion at the end of the sixth week; recovery. (J. B. Borsieri, Institut. Medicin. Pract. 3, cap. 17. Leipsic, 1786.') In this case, the first molar tooth, extracted by a surgeon, slipped from the forceps into the throat, whence it was carried into the glottis, the patient narrowly escaping suffocation. After the lapse of some hours, during which there was an agonizing struggle between life and death, the tooth passed the larynx, and lodged in the lower part of the windpipe, with considerable relief to the patient, who was now distressed only by a very harassing cough, attended with a constant wheezing and rhonchus. Subsequently, the girl experienced pleuritic pain and fever, and raised some blood with her sputa. The cough was never absent, and the difficulty of breathing was always worse at night, the exacerbation appearing regularly as soon as the patient went to bed and assumed the horizontal posture, the tooth being then, as it seemed, carried higher up towards the larynx. About the end of the sixth or seventh week from the time of the accident, the tooth was ejected in a violent fit of coughing. CASE 19.-Ear of grass; girl, aged eleven years; purulent and fetid expectoration; expulsion on the fiftieth day, in a fit of coughing; recovery. (Dr. W. Donaldson, Edinb. Med. and Surg. Journ., vol. xlii. p. 102. 1834.) Miss E. F., aged eleven, on the 1st of August let an ear of grass slip into her windpipe. She was immediately seized with a fit of coughing, which almost choked her. Her pulmonary distress continued in a mitigated form, attended with derangement of the stomach and bowels, until the 4th of September, when she began to throw up purulent matter, which was so offensive that the smell was almost insupportable. She also experienced, for the first time since the accident, some pain in the chest, similar to what might be produced by some rough substance passing up and down behind the sternum. On the 19th of September, she had a violent paroxysm 1 Dr. Craigie, Edinb. Med. and Surg. Journ., xliii. 380. |