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pneumonia, bronchitis, or pleuro-pneumonia supervene, they must be promptly met by the ordinary remedies, particularly the lancet, active purgatives, and tartar-emetic, aided, if necessary, by leeches and blisters. In short, nothing is to be omitted that is calculated to save the part and system from irreparable injury. By watching the patient in this way, the respiratory organs may be protected from mischief, and the extraneous substance be expelled spontaneously; or, should an operation become necessary, he will be in a much better condition to undergo it with impunity.

The cough produced by the presence of the extraneous substance is sometimes promptly allayed by a sup of cold water, or, in fact, by a draught of almost any fluid. The relief is, of course, only temporary, but the circumstance is not, therefore, the less worthy of remembrance. The probability is that the effect occurs very frequently, but the only recorded instance of the kind, so far as my reading extends, is that mentioned by Dr. Houston,' of Dublin. The patient was a girl, aged sixteen years, who in a fit of laughter allowed a piece of wood which she held in her mouth to slip into the windpipe. Her fits of coughing, which were frequent and severe, especially at night, were always promptly relieved by a sup of any liquid.

Dr. Laserrie Pagen2 mentions an instance in which similar effects always followed the administration of a teaspoonful of olive oil. The relief is said to have been as if by enchantment. The good effects of the remedy were displayed as often as the paroxysms recurred, until finally, at the expiration of forty days, the foreign substance, a bean, was expelled in fragments by the sole efforts of the child.

But, although the foreign body may have been thus happily gotten rid of, yet the patient is by no means always safe. The airpassages, irritated by its presence, may have taken on inflammation before its expulsion, or this action may be set up soon after; and in either case the danger to life may be very great. A knowledge of this fact is of great practical importance, and cannot be too strongly enforced upon the mind of the professional attendant in all cases of this character. From inattention to this subject there is reason to believe that much harm has occurred that might otherwise have

Dublin Journal of Medicine, vol. xxv. p. 532, 1844.

2 Archives Générales de Médecine, 2d series, t. vii. p. 369, 1840.

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been easily prevented. The following case, which fell under my observation more than twenty years ago, illustrates, in a very striking manner, the truth of this remark.

A little girl, aged five years and a half, the daughter of an Irishman, one evening just before dark drew into her windpipe one of several small round beans which she happened, at the moment, to have in her mouth. Violent coughing, difficulty of breathing, and partial insensibility were the immediate result of the accident. Recovering in about three-quarters of an hour from her suffering, she passed the night in tolerable comfort, but in the morning the fit of coughing and dyspnoea returned, and thus the case continued for nearly three days. At the end of this period she was suddenly seized with a violent paroxysm of coughing, apparently threatening instant suffocation, but happily followed, in a few minutes, by the expulsion of the offending substance. The breathing being thus relieved, the child in a short time became as lively and merry as a cricket. The parents, supposing all danger to be over, neglected my injunctions to watch her, and to regulate her diet and bowels; in fact, she was permitted to have her own way in everything. On the morrow she began to droop a little; there was some cough and fever, and she complained of pain and soreness in the right side of the chest. The symptoms gradually increased, and when I saw her again, three days after the commencement of her illness, she was laboring under violent pneumonia, which, despite all I could do for her, went on to a fatal termination.

The above instance is not a solitary one; the records of surgery are crowded with them. Had the child been carefully watched, she would not have perished from an accident, from the effects of which, under proper management, hundreds have recovered. But a spark had been kindled in her lungs, which a drop of water might have extinguished in its incipiency, but which, having once spread, nothing could afterwards subdue.

CHAPTER VIII.

INVERSION OF THE BODY.

ANOTHER expedient occasionally resorted to, especially of late years, for promoting the expulsion of the foreign substance, is inversion of the body. The operation, as the name implies, consists in suspending the patient by the heels, or in securing his body, with the head inclined downwards, to a chair, narrow table, or other suitable object. While in this position, the chest and back are repeatedly and smartly struck with the hands, to aid, first, in dis lodging the offending substance, and, next, in propelling it through the glottis; or, in case of bronchotomy, through the artificial opening in the neck. With the same view, the thorax is sometimes suddenly and forcibly compressed, the patient having previously taken a full inspiration. The object of this manoeuvre is to empty the lungs, as rapidly and as completely as possible, of air, in order that, as it rushes through the windpipe, it may carry the intruder before it. The compression is usually effected with the hands, applied at opposite points of the trunk; but, perhaps, a better method is to make it with a broad bandage, arranged so as to encircle the chest, and slit at the ends, after the fashion of the bandage used in tapping the abdomen. The patient having taken a full inspiration, the extremities of the bandage are suddenly drawn in opposite directions, thereby compressing the thoracic walls equably and forcibly at every point.

1. History.-Inversion of the body, with or without succussion, compression, and percussion of the chest, has probably been practised from time immemorial. The first account of it, however, which I have been able to find, is contained in the third volume of Birch's History of the Royal Society of London. The case referred to was that of an individual, who, having inhaled a plum-stone, was suspended by the feet, when the foreign substance was almost im

mediately expelled. A similar instance is mentioned by Deschamps.' In this country, the experiment appears to have been first tried by Dr. John Newman, of Salisbury, North Carolina. This gentleman resorted to it soon after the commencement of the present century, in the case of a child, aged four years, who, while at play, let a bullet pass into the windpipe.

When this mode of treatment was employed by others I have not the means of judging; but Dr. Newman's case, no doubt, soon attracted the attention of professional men, and induced them to try the expedient upon their patients. Be this as it may, it is certain that it has met with considerable countenance of late years, and that it has been frequently employed by some of the most distinguished practitioners both in America and Europe.

2. Objections.-The great objection to the operation is the risk which the patient incurs from suffocation, occasioned by spasm of the glottis from the contact of the extraneous body in its attempt to pass through the larynx. In the case which occurred in the practice of Dr. Newman, the distress induced by it was so sudden and alarming that, had it not been instantly desisted from, the child would probably have perished from its effects. This result will, I think, generally follow the operation, and the only way of preventing it is to make a preliminary opening into the trachea. By this procedure, all danger of producing spasm of the glottis will be removed, and the foreign body will have a chance of escaping either through the larynx, or at the wound in the neck. Without this precaution, inversion of the body, unless practised with the greatest possible care, may be attended with very serious, if, indeed, not fatal consequences. What effect chloroform might exert in lessening the danger consequent upon the operation, without previously opening the windpipe, cannot be stated with any degree of certainty; for, so far as I know, no one has given the treatment a trial, and, until this be done, it would be idle to indulge in any speculation concerning it. The expedient thus modified is, I think, worthy of consideration, and I shall certainly employ it the first opportunity that may present itself.

3. Successful cases.-The following cases are appended in illustration of this mode of practice. It will be noticed that the extra

1 Journal de Médecine Continué, t. ii. p. 555.

neous body, in two, was a bullet, a shot in one, a corn in another, and in the fifth a water-melon seed.

CASE 1.-Leaden bullet; boy, four years old; tracheotomy on the eighth day; inversion of the body, and the passage of the foreign substance into the stomach; recovery. (John Newman, M. D. Medical Repository, vol. iv. p. 250, second hexade. New York, 1807.)

A child, aged four years, while at play with his companions, allowed a leaden bullet which he happened to hold in his mouth to pass into the windpipe. Strong symptoms of suffocation instantly took place, and continued by paroxysms, with a few hours remission, until the seventh day. At the end of this period, and after every expedient had been tried unsuccessfully to expel the foreign substance, the father of the child sent for Dr. Newman. The child was now laboring under great dyspnoea, attended with a croaking, gulping sound; the eyes had a distorted appearance; and the countenance was of a dark purple color. Next day, the eighth after the accident, the little patient was suspended by the feet and legs, and his head and shoulders inverted, when the body was agitated, and repeated strokes were applied to the back with the hand. In a few minutes the bullet was dislodged, passing with considerable force, and with a noise like that of a popgun, against the larynx. The face of the child immediately became purple, the respiration laborious and very difficult, and the other symptoms of strangulation so alarming as to excite apprehensions of speedy dissolution. Without any loss of time, an incision, reaching nearly to the top of the sternum, and embracing four or five of the rings of the trachea, was made into the windpipe. A probe, curved at the end, was introduced into the tube, with a view of searching for the bullet; but as this excited cough and pain, the instrument was immediately withdrawn. The body was now again inverted, as before the operation, and while in this situation the probe was carried upwards towards the throat, where its extremity could be clearly seen. All operative proceedings were now stopped, and the child, being placed upon the lap of an assistant, soon began to breathe with much greater ease. The wound being kept open, gave vent to fetid air and purulent mucus at every effort at coughing, which recurred at short intervals, but in other respects the symptoms were very flattering.

Believing that the bullet had passed into the stomach, Dr. New

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