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IMPACTION OF A SMALL WHISTLE IN THE RIGHT BRONCHUS; RECOVERY.
148 wall of the chest both anteriorly and posteriorly by recent adhesions. On cutting into the lung itself, it appeared riddled with small abscesses, with two large cavities in the upper lobe; weight 33 oz. Over the lower lobe of the lef, lung there was a cicatrix about three inches in length, and, on cutting into the lung at this part, a large cavity was seen filled with pus, as well as several cavities at other parts; weight 22 oz. The liver was fatty, and weighed 45 oz. Spleen and kidneys normal. . These cases are faithful examples of the use of the hypophosphites in phthisis, either in the form of lime or soda. That the medicine is not inert its power of checking nightsweats evidences, and also its influence in giving tone to the system, if by this is meant increase of appetite and general cheerfulness. Without expressing a definite view on the subject, I have been somewhat forced to the conclusion that if the hypophosphites did no good, they certainly did harm, and in some measure hastened a final issue by increased fever, as indicated by a higher temperature. While acknowledging the benefit derived from their use, as testified to by patients themselves and by competent witnesses, I am of opinion that they should by no means be used indiscriminately, and that when given their effect should be carefully watched by daily thermometric observation. In further alluding to the difference of temperature in the sides affected in phthisis, the following results have been noted :-In one extreme case, following an attack of pleurisy of the left lung, and where the right was unaffected, the average increase of the evening temperature for a month was 96°, or very nearly a dpgree. In another, where the right lung appeared alone affected at the apex, the result of ten observations showed a difference of 38° in the morning and 90° in the evening. In another case, at present in the hospital, and where there are absolutely no other physical signs of phthisis except weakness and emaciation, the following facts have been recorded as the result of temperatures taken morning and evening, and extending over a period of ten days:-Evening: left side, average 10186°; right side, 10156°. Morning: left side, 100 36° right side, 99 96°. Health certainly gives no variation like this, and no other disease simulates phthisis so much as enteric fever. A case of enteric fever was admitted into my wards on the same day as the one last mentioned, and the temperature was taken carefully on both sides, with the result of finding no appreciable difference. the average being on both sides 994° in the morning and 1012° in the evening, and, as convalescence was reached, 98.2° in the morning and 996° in the evening. Blythswood-square, Glasgow.
IMPACTION OF A SMALL WHISTLE IN THE RIGHT BRONCHUS; RECOVERY. BY SOLOMON CHARLES
SMITH,
SURGEON TO THE HALIFAX INFIRMARY.
ON January 14th, 1876, I was asked to see a boy, eight years old, the history of whose illness was somewhat curious. Six days before, while out walking, he swallowed a whistle which he had in his mouth. He stated that the whistle was as thick as a penholder, and about half an inch long; that it would whistle only when air went one way through it, and that at the time he swallowed it it was so placed be. tween his lips that he had to suck air in to make it sound. For two hours after the accident it, whistled loudly every time he breathed. When he arrived at home the whistling was still gling on. The boy wna frightened, but did not appear to have any pain or to be short of breath. An emetic was administered, but before it acted the whistling ceased. A purgative was then given, which acted, but did not bring away the whistle; it was, however, thought that it had probably been lost when he vomited, and, as he appeared not to suffer any inconvenience, no further attention The whistling hd now, however, was given to the case. after nearly a week’s interval, returned, and I was sent for. Although there had been no symptoms which the parents had associated with the accident, I found that, during the later part of the week, he had had frequent attacks of violent croupy ’cough with some expectoration-a thing he had not
bad before.
When I arrived there was to be seen
was no
pain
or
feelingof
felt in the pharynx; there was no dulness on percussing the chest. The right side of the chest did not expand as freely as the left; there was almost complete absence of respiratory murmur and voice sound over the lower six inches of the right lung, the respiratory sounds being good in the upper lobe of the same lung, and markedly puerile in the whole of the left lung. Tne diagnosis was impaction of the whistle in that division of the right bronchus which leads to the lower half of the lung. The treatment recommended was inversion of the body, with the view of dislodging the whistle. I did not, however, think it right to adopt this course without having everything at hand for immediate tracheotomy, should it be necessary. Nothing was done, therefore, until Jan. 16th, when my father and Mr. Teale, of Leeds, met me in con. sultation. The physical signs remained unchanged, and by laryngoscopic examination the larynx and trachea were seen to be free from any foreign body. Seeing, then, that only a portion of the right lung was deprived of air, and that the obstruction was therefore in all probability at or beyond the first division of the bron. chus, and consequently out of reach by any fishing apparatus, and considering the absence of all urgent symptoms of distress, we decided to make a fair endeavour to dislodge the whistle (having the table spread ready for immediate tracheotomy if it should be required), and then, if unsuc. cessful, to leave it alone, unless fresh symptoms should occur. We made a very complete attempt to dislodge the obstruction, but without effect ; we therefore enjoined rest and quietness. On Jan. 20th I was present while the whistling was going It did not occur when he was breathing quite on. but he could bring it on by a cough or a deep respiration. The sound was only produced during expiration, was hardly heard at all through the stethoscope applied to the chest walls, was very loud, and gave one the impression that it was generated within the mouth. On Jan. 31st, and for a week afterwards, he complained of a nasty taste in the mouth Hfter coughing. The accident happened on Jan. 8th, and from that date till May 7th he was occasionally troubled by the whistling, which sometimes occurred many times in the day, and sometimes was many days absent. All the time, however, he had more or less cough, and during the last six weeks he got decidedly thinner, although he took cod-liver oil. For two or three days before May 7th he had a good deal of expectoration, and that morning, after vomiting a quantity of mucus, the cough became almost contitinuous. tili at last, during a violent coughing-fit, the whistle was ejected. When I saw him again at the end of a week his condition was much improved, his appetite was better, and he was gaining flesh, but there was still some diminution of the respiratory sounds at the base of the right lung. Remarks. - The very slight amount of discomfort produced by so serious an accident is a point worth noting. It is very questionable whether attention would have been at all drawn t) it, but for the singular fact that the impacted substance was a whistle, and was therefore capable, by the sound it produced, of demonstrating its own pre sence in the lung.
distress; nothing
or
quietly,
Halifax.
EPIDEMIC AMONG CATS IN DELHI, RESEMBLING CHOLERA. BY SURGEON-MAJOR J. CIVIL
FAIRWEATHER, M.D.,
SURGEON,
(Concluded from
DELHI.
page 117.)
NOTWITHSTANDING that the last mentioned experiments failed to confirm the earlier ones, I see no reason to reject the latter as fallacious; for even if we kuew much more than we do about the times and the seasona and the peculiar conditions under which the poison of cholera takes effect, it is not likely we should ever be able to obtain results with anything like the certainty of a chemical experiment. And here I may mention that in the second experiment, where the cholera discharges proved successful
IMPACTION OF A SMALL WHISTLE IN THE RIGHT BRONCHUS; RECOVERY. BY SOLOMON CHARLES
SMITH,
SURGEON TO THE HALIFAX INFIRMARY.
ON January 14th, 1876, I was asked to see a boy, eight years old, the history of whose illness was somewhat curious. Six days before, while out walking, he swallowed a whistle which he had in his mouth. He stated that the whistle was as thick as a penholder, and about half an inch long; that it would whistle only when air went one way through it, and that at the time he swallowed it it was so placed be. tween his lips that he had to suck air in to make it sound. For two hours after the accident it, whistled loudly every time he breathed. When he arrived at home the whistling was still gling on. The boy wna frightened, but did not appear to have any pain or to be short of breath. An emetic was administered, but before it acted the whistling ceased. A purgative was then given, which acted, but did not bring away the whistle; it was, however, thought that it had probably been lost when he vomited, and, as he appeared not to suffer any inconvenience, no further attention The whistling hd now, however, was given to the case. after nearly a week’s interval, returned, and I was sent for. Although there had been no symptoms which the parents had associated with the accident, I found that, during the later part of the week, he had had frequent attacks of violent croupy ’cough with some expectoration-a thing he had not
bad before.
When I arrived there was to be seen
was no
pain
or
feelingof
felt in the pharynx; there was no dulness on percussing the chest. The right side of the chest did not expand as freely as the left; there was almost complete absence of respiratory murmur and voice sound over the lower six inches of the right lung, the respiratory sounds being good in the upper lobe of the same lung, and markedly puerile in the whole of the left lung. Tne diagnosis was impaction of the whistle in that division of the right bronchus which leads to the lower half of the lung. The treatment recommended was inversion of the body, with the view of dislodging the whistle. I did not, however, think it right to adopt this course without having everything at hand for immediate tracheotomy, should it be necessary. Nothing was done, therefore, until Jan. 16th, when my father and Mr. Teale, of Leeds, met me in con. sultation. The physical signs remained unchanged, and by laryngoscopic examination the larynx and trachea were seen to be free from any foreign body. Seeing, then, that only a portion of the right lung was deprived of air, and that the obstruction was therefore in all probability at or beyond the first division of the bron. chus, and consequently out of reach by any fishing apparatus, and considering the absence of all urgent symptoms of distress, we decided to make a fair endeavour to dislodge the whistle (having the table spread ready for immediate tracheotomy if it should be required), and then, if unsuc. cessful, to leave it alone, unless fresh symptoms should occur. We made a very complete attempt to dislodge the obstruction, but without effect ; we therefore enjoined rest and quietness. On Jan. 20th I was present while the whistling was going It did not occur when he was breathing quite on. but he could bring it on by a cough or a deep respiration. The sound was only produced during expiration, was hardly heard at all through the stethoscope applied to the chest walls, was very loud, and gave one the impression that it was generated within the mouth. On Jan. 31st, and for a week afterwards, he complained of a nasty taste in the mouth Hfter coughing. The accident happened on Jan. 8th, and from that date till May 7th he was occasionally troubled by the whistling, which sometimes occurred many times in the day, and sometimes was many days absent. All the time, however, he had more or less cough, and during the last six weeks he got decidedly thinner, although he took cod-liver oil. For two or three days before May 7th he had a good deal of expectoration, and that morning, after vomiting a quantity of mucus, the cough became almost contitinuous. tili at last, during a violent coughing-fit, the whistle was ejected. When I saw him again at the end of a week his condition was much improved, his appetite was better, and he was gaining flesh, but there was still some diminution of the respiratory sounds at the base of the right lung. Remarks. - The very slight amount of discomfort produced by so serious an accident is a point worth noting. It is very questionable whether attention would have been at all drawn t) it, but for the singular fact that the impacted substance was a whistle, and was therefore capable, by the sound it produced, of demonstrating its own pre sence in the lung.
distress; nothing
or
quietly,
Halifax.
EPIDEMIC AMONG CATS IN DELHI, RESEMBLING CHOLERA. BY SURGEON-MAJOR J. CIVIL
FAIRWEATHER, M.D.,
SURGEON,
(Concluded from
DELHI.
page 117.)
NOTWITHSTANDING that the last mentioned experiments failed to confirm the earlier ones, I see no reason to reject the latter as fallacious; for even if we kuew much more than we do about the times and the seasona and the peculiar conditions under which the poison of cholera takes effect, it is not likely we should ever be able to obtain results with anything like the certainty of a chemical experiment. And here I may mention that in the second experiment, where the cholera discharges proved successful