2. Portion of thread spontaneously expelled from air-passages 3. Plate of brass metal spontaneously expelled from air-passages 27. Trousseau's forceps for holding apart edges of wound in trachea 30. Whalebone-mop for removing extraneous matters from larynx 31. Flexible grooved director to remove bodies from air-passages FIG. 36. Plexus of veins embracing trachea PAGE 276 37. Blunt-hooks to keep asunder edges of incision in trachea 281 38. Grain of corn discharged from air-passages four days after operation of laryngotomy 305 39. Jawbone of mackerel extracted from air-passages after operation of tracheotomy 339 342 40. Pebble expelled from air-passages after operation of tracheotomy 42. 346 43. Nail expelled from air-passages on thirty-third day after tracheotomy. 44. J 351 45. Piece of bone extracted, after tracheotomy, that had remained in airpassages six months and a half 370 46. Water-melon seed, that had remained in air-passages seven months, expelled at the end of forty-seven days after tracheotomy 373 47. Piece of sponge extracted from air-passages after tracheotomy 379 48. 380 50. Grain of corn ten days in air-passages before operation of tracheotomy; death on twentieth day subsequently, without ejection or removal 382 51. Pebble, twenty days in air-passages, ejected after tracheotomy 383 54. Patient's own molar tooth from right bronchial tube, in a case where 431 437 57. Quartz pebble in larynx. 439 58. Cockle-burr found in bronchial tube 444 59. Piece of ivory, consisting of four artificial teeth, retained in air-passages for thirteen years 451 ON FOREIGN BODIES IN THE AIR-PASSAGES. CHAPTER I. As preliminary to the study of the symptomatology, diagnosis, pathology, and treatment of foreign bodies in the air-passages, it is proper that we should make some remarks upon the nature of these substances; we may next consider the changes which they are liable to undergo in consequence of their retention; in the third place, we shall point out their more common situations; and, lastly, we shall describe the route by which they usually enter and by which they are expelled. These topics involve considerations of great practical importance, and, therefore, require separate discussion. SECTION I. NATURE OF FOREIGN BODIES. There is hardly any substance, however singular or outré, that may not enter the air-tubes, and give rise to severe, if not fatal mischief. This is true alike of the vegetable, animal, and mineral kingdom. The following catalogue, which I have been at much pains to collect, although, perhaps, not complete, comprises the most common and important of the bodies that have yet been found in these situations. A single glance will serve to show their exceedingly diversified character. These substances may be appropriately arranged into different classes, according to the nature of their composition; as the vegetable, animal, mineral, and mixed. The first comprises beans, of almost every description; grains of corn; melon-seeds; pumpkinseeds; peas; cherry-stones; acorns; prune-stones; chestnuts; filberts; tamarind-stones; apple-seeds; orange-seeds; raisin-seeds; apricotstones; persimmon-stones; almond-shells; beech-nuts; cotton-seeds; pills; bread; carrot; cabbage; ginger; mushrooms; walnut-shells; sweet and Irish potato; potato-skin; wood; bark; cedar; spikes of oat; nutmegs; sealing-wax; linen; beech-nut burs; ears of grass, rye, and barley; cockle-burs; gum elastic; butternut-shells; pipestems; wooden stopper of an inkstand; berry of the bladder-senna; pea-nut shells; charcoal; fiddle-peg; threads; locks of tow; leaves, and other substances. The second class includes animal substances; as bits of hardboiled egg, beef, veal, cartilage, tendon, and bone; clots of blood; flies; millepeds; leeches; worms; fish; lobster-claws; mussel-shell; cowry-shell; quills; button-foils; worsted yarn; locks of wool; cloth; and teeth-natural and artificial-human and animal. Under the third head are comprised mineral substances, the number of which is quite considerable; as buttons; button-moulds; pins; needles; shot; bullets; marbles; different kinds of coin, as a sixpence, half sovereign, and sous; pebbles; slate-pencils; glass; delft; carpet tacks; brass nails; horseshoe nails; glass beads; pipe-stems; dress-hooks; ring of a watch-chain; silver tube; screw nails; and porcelain teeth. The fourth class includes substances of a mixed character, or such as are partly vegetable and partly animal, partly animal and partly mineral, or partly mineral and partly vegetable. As examples of this variety may be mentioned lead-pencils, artificial teeth, with their blocks and pivots, and the remarkable instance of a puff-dart, as it is called, observed by Mr. R. S. Nunn, of England, and which will be more fully noticed hereafter. Dr. Mott,' some years ago, met with an instance in which a child, eleven months old, inhaled a large, black shawl-pin, two inches in length, with a head nearly as large as a small marble. A case occurred in New Hampshire, in 1850, in which a man lost his life 1 Cooper's Surgical Dictionary, Appendix by Dr. Reese, art. Tracheotomy. * New Hampshire Journal of Medicine, April, 1852, p. 197. |