It is questionable how far spasm occasioned by the contact of noxious or irritating sub , stances can justly be termed sympathetic, for they are the results of an application of a di rect stimulus : it is immediate in its effects, and more or less complete according to the nature or quality of the exciting cause. Death from total submersion in carbonic acid gas occurs so quickly as almost to seem instan taneous, and the spasm entirely occludes the glottis. The mildest form of spasm seems to be that occasioned by the accidental admission of some particle of food which is usually expelled again very quickly by a cough suf ficiently distressing but seldom dangerous : yet 1 instances have been known of the apparently 1 trifling occurrence of the introduction of a ticle of salt being attended by a fatal result.
However, when spasm is, or appears to be produced by the presence of a foreign body in the oesophagus or the trachea, or by the pres sure of an aneurismal tumour, it is evidently sympathetic, and it may he interesting to in quire into the evidence by which such relation of cause and effect is established.
I had formerly entertained the opinion that spasm of the glottis should be the consequence of some irritation applied to the larynx itself, and not external to or at a distance from it, and therefore that the presence of a foreign body 1 in the esophagus ought not to hold a place amongst its exciting causes. I have since, however, altered my views on the subject, and kideed, when we consider the number of cir cumstances under which this morbid action may occur, we cannot be justified in denying it in this case in opposition to most respectablw testimony. Mr. Kirby has published a case in the Dublin Hospital Reports, in which death was apparently produced by spasm of the glot tis in consequence of the lodgment of pieces of meat and bone in the oesophagus: and Dr. Stokes saw an instance in which a piece of money was lodged in the esophagus and where croupy breathing and other laryngeal sym ptoms were manifestly the result. In this lat ter instance the foreign body was not lodged in the fauces or _pharynx. I myself seen cases to corroborate the above, but it is need less to swell this article with proofs of a patho logical fact that will probably not be called in question.
It is probably a new observation—at all events it is one of great pathological interest, that spasm of the glottis may be produced by the presence of a foreign body lodged within the bronchi. In the month of May, 1836, a child was brought from the country and placed under the Care of my friend me. Cu sack : his father's account of the case was that he had swallowed a small pebble, was instantly seized with a violent paroxysm of cough, had croupy or sonorous breathing ever since the accident with occasional remissions and exacer bations, but was sometimes brought to the verge of suffocation. The stethoscopic indi
cations were that the foreign body was loose and mobile within the trachea. I assisted Mr. G. in performing the operation of tracheotomy on this child ; but, although the aperture in the windpipe was made very large, no stone was expelled, and the size of the organ did not admit of the employment of any forceps with which we were furnished. Immediately on the opening into the windpipe being perfected the croupy breathing disappeared, neither was there a severe paroxysm of cough experienced afterwards, and the father, either doubting that the foreign body had ever obtained admittance, or dissatisfied at its not being removed, car ried him off to the country contrary to the wishes and advice of his medical attendants. We afterwards heard that the little pebble had been coughed up in about three weeks after he left town, but have not been informed as to the ultimate termination of the case.
On the 13th of September, 1839, a child, aged three years and a half, was brought to the Meath Hospital : he had, half an hour pre viously, swallowed a small stone, and was in stantly seized with a violent cough which con tinued up to the period of admission. His breathing was quite stridulous—countenance expressive of great distress—face and lips lived—efforts at respiration hurried and gasp ing. The left side of the chest heaved vio lently, the right was comparatively quiet: re spiration very weak and interrupted in the right lung, in the left loud and puerile I no dulness over either lung on percussion. I per formed the operation of tracheotomy, but no foreign body was expelled, and yet the little patient experienced the greatest relief. The trachea was too small to allow of the intro duction of any instrument for the extraction of the offending substance if such was there, so I merely satisfied myself with keeping the wound open, in the hope of its being coughed up. Whenever from any accident the wound in the throat became obstructed, the breathing became dreadfully oppressed, but he obtained instant relief when it was opened again and cleaned. Such were the phenomena of the case generally up to the lath of October, when it was found that the wound had gradually closed and healed so as to leave the artificial opening very small, and on that day, in con sequence of the increased difficulty of breath ing, I was obliged to open up the whole wound anew. This second operation afforded im mediate relief. On the 6th of December the wound being again nearly healed, in a despe rate fit of coughing he expelled a small stone about half an inch long by about two lines broad, through the rima glottidis.