slight dilatation of the chest, compared with the respiratory efforts, clearly pointed out some obstruction in the windpipe.

Under the supposition that the case was one of obstruction of the air-passages, produced by a morsel of food, and not one of mere spasm of the glottis, caused by cerebral irritation; and inasmuch, moreover, as the treatment calculated to relieve the brain, had signally failed, tracheotomy was performed. A crucial incision. having been made through the tube, and the angular portions removed, a mass of pultaceous matter was forcibly ejected through the opening, with complete and instantaneous relief of the symptoms. Respiration became easy, the lungs expanded fully and audibly, the patient breathed through the glottis, and recovery followed without an untoward occurrence.

In about four weeks, however, the man was seized with symptoms of cerebral irritation, and had a fit resembling epilepsy. These attacks recurred several times during the next three months, becoming, however, gradually more mild, and finally wholly disappearing. The treatment consisted of small bleedings, cold to the head, and the use of turpentine.

Dr. Stokes, in commenting upon the uncertain nature of this case, adduces the following reasons for concluding that it was originally one of mechanical obstruction of the windpipe: 1. The attack came on while the man was eating, and at the same time conversing, circumstances likely to cause the entrance of a foreign body into the air-passages. 2. Although in certain cases of disease, in children and in adults of a high nervous temperament, spasm of the glottis is symptomatic of cerebral disorder, yet in a young and robust man such a phenomenon is exceedingly rare. 3. Dr. Stokes lays great stress upon the presence of copious secretion from the mucous membrane, asserting that it is a most important symptom of a foreign body in the trachea, but that it is not seen in nervous affections of that tube. 4. The complete and instantaneous relief which followed the operation, and the expulsion of the soft pultaceous matter from the trachea, and the fact that the patient breathed easily through the glottis from that moment on. 5. It must be recollected, how perfectly the physical signs and the history of the case coincide with the phenomena which a foreign substance would produce. From all these circumstances, Dr. Stokes considers the case as a decided example of a foreign body in the air-passages. Mr. Read, on the other hand, inclines to

the opinion that the original attack was really cerebral, and that the extraneous matter entered the windpipe during the convulsion. The latter view of the case appears to me, after an attentive study of all the circumstances connected with it, to be, on the whole, the more probable; but, however this may be, there can be but one opinion respecting the propriety of the operation, which, unquestionably saved the man's life, and which was, therefore, most oppor

tune.

A child, aged thirteen months, while at dinner with its parents, caught hold of some herring, which it forced into its mouth. It was immediately seized with a violent fit of coughing, and threw out what it had attempted to swallow. Hoarseness soon came on, the cough continued, the child passed a sleepless night, and next morning, the breathing was stridulous. Four days afterwards, it was seen by Dr. R. T. Evanson,' who found it in the following condition: The countenance was expressive of great uneasiness, the face was pale and swollen, the skin hot, the pulse rapid, and the expiration short, but not impeded, nor accompanied by any peculiar sound. Inspiration, on the contrary, was long, forced, difficult, rough, and rather stridulous. The voice was hoarse, the throat was inflamed, and there was bronchitis on the right side. The cry was quite clear when the child screamed aloud, and the cough, instead of occurring in sudden and violent paroxysms, as it usually does when there is a foreign body in the windpipe, was of a harassing, teasing character, though, occasionally, the fits were severe enough.

As the nature of the case was obscure, and the child was in no immediate danger, the operation was not performed until about the end of the fifth day, by which time all the symptoms had become greatly aggravated, the strength being much exhausted, the surface cold and livid, and the eyes glassy. No cough was heard, but much uneasiness was apparent. The bone was carefully searched for, but could not be detected. On the morning after the operation, some amendment was manifest, though the respiration was still laborious, stridulous, and wheezing, being seventy in a minute, and accompanied by an occasional fit of coughing, excited, apparently, by the obstruction of the artificial opening by tenacious mucus.

On the fourth night after the operation, the mother of the child,

Dublin Journal Med. and Chemical Science, vol. v. p. 19. 1834.

removed from the wound, as she informed Dr. Evanson, what appeared to be a piece of fish bone. She stated that the bone was soft, of a greenish color, and very brittle, with a sharp hook at one of its extremities. A part of this substance Dr. Evanson saw, and he feels satisfied, both from this fact and from the whole history of the case, that there must have been a foreign body in the windpipe. It was only by accident that the woman gave this information, being apprehensive that, if she revealed the fact, the medical attendants might wish to perform another operation. The child gradually improved, and at length completely recovered.

In the following case, the operator was the late lamented Dr. J. Kearny Rodgers, of New York. For the particulars of it I am indebted to the kindness of my friend, Professor Van Buren, at whose request it was drawn up for me by Dr. C. R. Agnew.

Caroline Hoogleman, a German, aged thirty-two years, was admitted into the New York Hospital on the 18th of January, 1848, under the care of Dr. J. K. Rodgers. About two weeks previously, while holding some pins in her mouth, she was seized with a fit of coughing, in which one of them slipped into the larynx, where it has remained ever since. During breathing she thought she could feel it move slightly about. Its presence was attended with soreness of the throat and difficulty of swallowing, the latter of which, however, came on only two days ago. The pain was constantly referred to one spot. A week since she began to have huskiness of the voice, although previously it had been clear.

The day after her admission, a probang was passed down the oesophagus, without, however, affording any relief, or encountering any foreign body. Exploration with the finger and with curved forceps eventuated in no better success. Laryngotomy was then performed at the crico-thyroid space, the patient having been previously placed under the influence of chloroform. This agent caused a good deal of congestion of the head and neck, leading to considerable hemorrhage, and the necessity of tying several vessels. The opening was subsequently enlarged to a sufficient extent to admit the introduction of the finger; but no foreign substance could be detected, and all further interference was therefore abandoned; coldwater dressing was applied until the oozing had ceased, when the edges of the wound were approximated by four sutures and adhesive strips. The patient passed a comfortable night, and next morning left the hospital for her residence in the country. Some time

after her physician informed Dr. Rodgers that the woman had suffered severely, for a number of days, from the effects of chloroform, that the wound did well and finally healed, that the voice had never regained its natural tone, that she was very liable to attacks of laryngitis and bronchitis, and that, in short, her general health was almost completely revived.

In a case operated upon by Dr. Allen, of Rockville, Indiana, and for the particulars of which I am indebted to Dr. James D. Maxwell, of Bloomington, in that State, no foreign body was found. For several days there was no alleviation of the symptoms, when suddenly, after a severe, convulsive cough, immediate relief ensued. It is very probable that, in this case, the body, supposed to have been a piece of the hard part of a water-melon, was expelled through the glottis, and swallowed.

CHAPTER XV.

CASES OF DEATH WITHOUT OPERATION, AND WITHOUT EXPULSION OF THE FOREIGN BODY.

THE cases arranged under this division of the subject are designed to illustrate, not so much the symptomatology as the pathological effects of extraneous bodies in the air-passages. They amount to twenty-one in number, and the period which intervened between the occurrence of the accident and the fatal termination varied from a few hours to thirteen years. The post-mortem appearances are noted in only seventeen of the cases.

Ten of the patients were males, and eight females, the sex in three not being mentioned. The ages varied from six months to seventy-three years. The foreign bodies were, beans in four of the cases, teeth in two, coins in two, bone in three, pebbles in two, and in the remainder, respectively, a cockle-bur, prune-stone, cherrystone, brass nail, grain of corn, a leech, a piece of ginger, and an apricot-kernel. In nine of the cases, the extraneous substance was situated in the right bronchia, in four in the larynx-once in the right ventricle, and once in the left, and in the other instances, in the cavity of the organ-in three in the trachea, in one partly in the larynx and partly in the trachea, in one in the left bronchia, in one in the third branch of the right bronchia, in one in the lung, and in one in the right thoracic cavity. The period at which death happened varied from a few hours to a number of years. In one, it occurred "soon" after the accident; in one, the following night; in one, in forty-one hours; and in one, at sixty hours; in five, it happened on the ninth, eleventh, nineteenth, thirty-second, and thirty-third days; in five, in six weeks, seven weeks, eight weeks, eighty-three days, and five months; in seven, in one year, nearly thirteen months and a half, two years, four years and a half, five years and a half, ten years, and thirteen years. The cause of death