the expulsion of foreign bodies from the windpipe; but seldom, so far as my information extends, with any benefit. This class of remedies appears to have been employed for this purpose at a very early period of the profession. The favorite articles, for a long time, were euphorbia and white hellebore, reduced to the finest possible powder, and freely drawn into the nose. The use of even the smallest quantity of either of these substances generally produces the most severe and protracted sneezing, throwing the muscles of the chest into violent convulsive action, and causing an abundant flow of mucus from the air-passages. In one case, mentioned by Riedlinus,' success seems to have attended the use of snuff made of powdered lily-root. The patient was a child who had swallowed a small bone, which was ejected in a fit of sneezing induced by the inhalation of this substance. Baron Boyer met with an instance in which the employment of snuff appears to have aided in expelling the foreign body after the operation of laryngo-tracheotomy. After all attempts at extraction had failed, the wound was lightly covered with a piece of gauze, and the child put to bed. The respiration immediately improved, and two hours afterwards, while he was asleep, snuff was applied to his nose. The instant he awoke he began to cough and sneeze, followed presently by the ejection of the foreign substance-a kidney bean, of extraordinary size-which had been in the windpipe upwards of four days. The patient speedily recovered. In the case of a girl, aged six years and a half, upon whom Dr. A. R. P. Duchateau performed laryngo-tracheotomy, the substance, a plum-stone, was expelled under very similar circumstances. Dr. Thomas Wells and Dr. Charles Hall, on the contrary, each relate an instance in which errhines failed to do any good. Etius advised that the use of sternutatories should be aided by bitter drinks, to induce vomiting, thus causing, as it were, simultaneously violent convulsive action of the respiratory muscles and a certain amount of relaxation of the general system; circumstances favorable to the expulsion of the extraneous body. Other ancient practitioners, with a similar view, recommended the exhibition of acrid substances, capable of exciting the fauces, and thereby pro 1 Bonetus Med. Sept. Scholion. 2 Traité des Maladies Chirurgicales, t. v. p. 502. Paris, 1846. voking cough. Fabricius Hildanus,' on the contrary, condemned this treatment, on the ground that the cough was already sufficiently severe, and that anything calculated to irritate the throat and windpipe would only tend to prevent the ejection of the extraneous substance. Instead of it, he was in favor of the prompt exhibition of almond oil and of soothing syrups, such as that of liquorice and marshmallow. He was also an advocate for exciting sneezing with irritating powders, as those of euphorbia and hellebore. Muys' and Verduc3 also prescribed sternutatories and even emetics; the latter usually conjoining with them diaphoretics and volatile remedies, which he supposed to be useful in exciting the muscles of the larynx, so as to enable them to expel the extraneous body. He also suggested that the patient should swallow almond oil and fresh butter, to lubricate the air-passages, and thus favor the object in view. When these means failed, he advised a prompt resort to emetics. The folly, if so mild a term may be used in reference to so serious a matter, of trusting to so frivolous a remedy as artificial sneezing, is forcibly exhibited in a case of foreign body mentioned by Muys, in his Practical Surgery, published in 1690. A child, about seven years old, inhaled a bean, which caused the most violent cough, dyspnoea, and distress. Very soon the suffering subsided, and in a few days the little patient was able to resume his play. In stooping forward, however, he was attacked with the same symptoms as before; and after having experienced several relapses of this kind, he expired, in the third week after the accident. Muys, who, as Louis observes, had expressed himself in favor of bronchotomy in desperate quinsies, never once thought of opening the windpipe for the child's relief, but seemed to trust entirely to sneezing as the most effectual means of expelling the foreign substance. It may be here stated that Louis, whose name has just been quoted, was decidedly averse to the use of errhines and emetics in this accident. In referring to Muys's case, he observes that this surgeon was not the only one who put confidence in such a frivolous remedy as artificial sneezing. "We need but reflect for a moment," he says, "on the mode of introduction of foreign bodies 1 Cant. i. obs. 36. 2 Obs. Chirurg. sec. vii. obs. 9. 3 Pathol. Chirurg. t. ii. cap. 25. 4 Pract. Chirurg. Ration. Decad. vii. obs. ix. into the trachea, to see how little we can count on sneezing or vomiting in such a case."' It is possible that this class of remedies might occasionally be beneficial, if conjoined with the use of chloroform. The proper plan would be to make the patient inhale this fluid until he is nearly or wholly insensible, and to irritate the Schneiderian membrane with snuff or some other substance the moment he begins to regain his consciousness. Should sneezing ensue while he is in this condition, with the air-tubes in a state of perfect relaxation, it is easy to conceive how the foreign body might be ejected. Nature would be taken, as it were, by surprise, as she has sometimes been by a dream, as in the remarkable case occurring in the practice of Mr. Cock, of London. As the use of sternutatories, exhibited in the ordinary manner, has hitherto been almost invariably unsuc cessful, I merely throw out this hint for the consideration of the reader, without feeling inclined to place much confidence in it. SECTION III. INHALATION OF IODINE. A very interesting case, in which a piece of fish-bone was expelled from the windpipe under the influence of the inhalation of iodine, occurred in 1832, in the practice of Mr. Day, a surgeon at Isleworth, England. The following are the particulars of it. The plan of treatment was both novel and ingenious. The patient, a lady, sixty years old, had been ill about four years at the time she first sent for Mr. Day. She had been treated by many of the most eminent professional men in London without benefit, and the only relief which she had obtained, during the last few months, was from a dose of opium at bedtime. She was, at the period here referred to, very weak and emaciated, and apparently in the last stage of phthisis; being in a state of great nervous irri tability, and laboring under copious expectoration of mucus, slightly intermixed with pus. When requested to take solid food, she de 1 Second Memoir on Bronchotomy, op. cit. p. 263. clared her inability to swallow it. As all the ordinary remedies had been employed in vain, Mr. Day determined to try the inhalation of iodine, according to the plan recommended by Sir Charles Scudamore in diseases of the mucous membrane. The first inhalation, which was rather strong, was continued for five minutes, and produced violent coughing and nausea. The operation was repeated the same evening, and in the paroxysm of coughing induced by it, the foreign body was ejected from the windpipe. It proved to be the vertebra of a fish, which she had swallowed on the 24th of February, 1828, and which had remained in the air-passages until the middle of April, 1832. The length of the bone was five-six Fig. 13. Fig. 14. Fig. 15. teenths of an inch, and the width in proportion. The annexed figures, 13, 14, and 15, giving different views of it, are somewhat magnified for the sake of perspicuity. The above case, so far as my information extends, is the only one in which this mode of treatment has yet been tried. Considering the prompt and happy effects which it exerted in that instance, it is surprising that it has not attracted more attention. It should certainly not be relied upon, perhaps not even employed, in recent cases; but I can perceive no objection why the remedy might not be tried in the chronic form of the accident. SECTION IV. ANTIPHLOGISTIC MEANS. It is well known that no patient is safe as long as the foreign body remains in the windpipe. If he do not perish from suffocation, as he may at any moment in a paroxysm of coughing, forcing the substance into the larynx, he will be in danger of losing his life eventually by inflammation. The period at which this action supervenes after the accident is too variable to admit of any definite statement; it may take place in a few hours, or it may be postponed for several days or even weeks. In one case it may be slight, perhaps scarcely appreciable; while in another it may be so severe as to cause the most serious structural lesion, and even death, and that, too, before the patient and his physician are aware of the true nature of the case. It is for this reason that every patient, thus affected, should be most sedulously watched from the moment of the accident until the final riddance of the foreign substance, and of the mischief produced by its presence. The neglect of this precaution has caused the loss of many lives that might otherwise have been saved. A want of care here even for a few hours may be followed by the most mischievous consequences, which no remedies, however skilfully or energetically employed, may afterwards be able to arrest. The old maxim, "an ounce of prevention is worth a pound of cure," is eminently applicable to all cases where the foreign body is permitted to remain in the windpipe, either from the unwillingness of the patient to submit to an operation, or from the inability of the professional attendant to perform it. The very moment the substance has entered the tube it becomes a source of mischief, fretting and irritating not only the parts with which it is in contact, but even, in many instances, those at a distance, and thus gradually but steadily undermining the very foundations of life. The practitioner who, under such circumstances, contents himself with the use of a little expectorant medicine, and the occasional exhibition of an emetic, has no just appreciation of his duty, and is unworthy of his position. Every individual who has a foreign body in his windpipe should be regarded as an invalid, unfit to leave his room, or to attend to business. The treatment, in the early stage of the complaint, should be limited to a general supervision of the patient's health; that is, his diet should be carefully regulated, the bowels should be moved from time to time with mild purgatives, and the utmost attention should be paid to the temperature of the apartment, which should be uniformly maintained at about 65° of Fahrenheit's ther mometer. The chest should be thoroughly examined at least twice a day by auscultation and percussion, to ascertain the condition of the lungs and bronchial tubes. Cough should be subdued by mild expectorants, containing, if there be frequent spasm, a suitable quantity of opium, morphia, or laudanum. Should symptoms of |