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Foreign Bodies En the Air-Tubes

substance, lung, inflammation, trachea, affected and formed

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passage of solid substances into the air-tubes is a far from uncommon accident and one to which children, for obvious reasons, are peculiarly liable. Articles of the most varied description have been inadvertently drawn into the trachea, and their retention in the bronchi may not only produce the most serious distress but set up profound disorganization in the affected ltuig.

Fruit-stones, as might be expected, are perhaps the commonest things to make their way into the trachea ; also peas, beaus, grains of corn, vari ous seeds, bits of solid food, fish-bones, portions of nut-shell, and any small articles which lie about in a room or can be picked up from the floor, such as little coins, tin tacks, dress-hooks, buttons—all of these objects, and many others, have been known to pass between the vocal cords and be imprisoned in a bronchus. It is at first difficult to understand how a; substance as large as a plum- or date-stone can pass through the narrow aperture formed by the vocal cords in a young child. It must be remem bered, however, that when the chest-walls are expanded in the act of inspi ration, if a solid body is drawn into the opening, a strong pressru:e from the external atmosphere forces it onwards, while resistance is very trifling on account of the tendency to form a vacuum inside the chest. Consequently, the substance is driven through the opening with consider able force.

Morbid Anatomy.—The morbid changes which result from the presence of a foreign substance in the air-passages are often very extensive. The immediate consequences are congestion and irritation of the mucous mem brane lining the trachea, and if the substance is small enough to penetrate into them, of the bronchi. Secretion then takes place of a thin frothy fluid which soon becomes purulent, and may be so profuse that after death the air-tubes are found filled with yellow puriform matter. Thick lymph may be also thrown out so as partly to coat the obstruCtion. In a case re corded by Mr. Bullock the lymph became organized into fibrinous casts and almost closed the upper portion of the windpipe. The muco-pus is

thick and ropy and in long-standing cases may be inexpressibly fetid.

A substance capable of passing into the larger bronchi soon sets up inflammation in the lung. The inflammation may be limited to one lobe or may spread to the entire organ. Sometimes both lungs are affected simultaneously, to the offending substance being dislodged by the repeated cough and railing back into one or the other bronchus indiscrim inately. The affected part becomes.consolidated, and if the irritation per sist, soon disintegrates and breaks down. Cavities are thus produced which are filled with offensive and even gangrenous debris and much puru lent matter. If there be no sufficient communication with an air-passage, the contents may be retained;,but usually an opening becomes established with the bronchus and much fetid matter is expectorated. In scrofulous or tubercular subjects gray granulations may be developed in the hepatizecl tissue around the cavity, and it has happened that the child has died from general tuberculosis. The bronchial glands also become enlarged and cheesy.

Besides pneumonia, other pulmonary lesions may be present. More or less emphysema is usually produced, and collapse of portions of the lung may occur. The inflammatory action may not be confined to the lung. Empyema is a common consequence of the presence of the irritant ; and enormous quantities of purulent fluid have been found distending the pleural cavity. Pericarditis has also been known to occur, and in a case recorded by Mr. Solly a large abscess had formed in the mediastinum as a consequence of the pericardial inflammation. Sometimes the abscess of the lung becomes adherent to the chest-wall and points in an intercostal space or elsewhere. Dr. Wilks has referred to a case in which an ear of corn es caped in this manner from an abscess which had formed in the supra scapular region ; and other cases of a similar kind are on record.

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