AN

ACCOUNT OF A CASE

IN WHICH

A FOREIGN BODY

WAS

LODGED IN THE RIGHT BRONCHUS.

BY SIR BENJAMIN C. BRODIE, BART., F.R.S.,

SERJEANT-SURGEON TO THE QUEEN, ETC., ETC.

READ JUNE 27TH, 1843.

I AM induced to communicate the following history to the Royal Medical and Chirurgical Society, believing that it embraces some points of considerable practical importance, which may be deemed not unworthy of their attention.

On the 3rd of April 1843, Mr. B. being engaged immediately after dinner in amusing some children, placed a half-sovereign in his mouth. By some accident it slipped behind the tongue, and a violent fit of coughing, in which he had the appearance of being nearly choked, was the consequence. This was immediately followed by vomiting, the contents

of the stomach being ejected with considerable force. He strained two or three times afterwards, but did not again vomit. In the course of the evening he coughed at intervals: but the cough was not violent. A sense of soreness and stiffness of the throat remained for the first twenty-four hours. He experienced little or no inconvenience during the two following days. He was not observed to cough, and he employed himself as usual, being able to entertain some friends at dinner.

On the 6th of April, he was again troubled with a cough. On the 7th he went on a journey into the country, and was more or less exposed to a cold north-east wind for two days and nights. The cough now became aggravated. He expectorated some mucus slightly tinged with blood, and small portions of a substance answering to the description of a thin membrane. He experienced, also, a pain in the right side of the chest, referred to a spot corresponding to the situation of the lower portion of the right bronchus.

On the evening of the 9th of April, he took two aperient pills, one of which was rejected by vomiting some time afterwards. In the act of vomiting, he experienced a sensation as if a loose substance had shifted its place in the chest; and for some time afterwards the cough was much relieved, and the pain in the chest entirely ceased.

On the 11th of April, the cough was again troublesome. There was little or no expectoration. At this time the chest was repeatedly examined,

with the stethoscope by Dr. Seth Thompson, but no unusual sounds were detected in any part of it.

On Monday the 17th of April, Mr. B. again went into the country, exposed to a cold easterly wind. On his return to London, the cough was again much aggravated.

On the 18th of April, by the advice of Dr. Seth Thompson, he consulted Dr. Chambers, and afterwards myself. From the detail of the symptoms, we were all of us led to believe that the half-sovereign had passed into the trachea, and that it remained lodged in the right bronchus.

On the 19th, this opinion seemed to be confirmed by a very simple experiment, which Mr. B. had himself made in the interval. He had placed himself in the prone position, with his sternum resting on a chair, and his head and neck inclined downwards, and, having done so, he immediately had a distinct perception of a loose body slipping forward along the trachea. A violent convulsive cough ensued. On resuming the erect posture, he again had the sensation of a loose body moving in the trachea, but in the opposite direction, that is, towards the chest.

On the 20th, I saw the patient again, with Dr. Thompson. I now suggested that a further consultation should be held on the case; and, accordingly, on the following day there was a meeting of Dr. Chambers, Dr. Seth Thompson, Mr. Stanley, Mr. Aston Key, and myself. The chest was again carefully examined by means of the stethoscope,

but no difference in the state of the respiration could be detected. The other indications of the existence of a foreign body in the air-passages, however, seemed to be so strong, that no one entertained any doubt on the subject. At this meeting it was agreed that the experiment, which Mr. B. had himself made, should be repeated in a more complete manner. Accordingly, on the 25th of April, he was placed in the prone position, on a platform made to be moveable on a hinge in the centre, so that on one end of it being elevated, the other was equally depressed. The shoulders and body having been fixed by means of a broad strap, the head was lowered until the platform was brought to an angle of about 80 degrees with the horizon. At first no cough ensued; but on the back, opposite the right bronchus, having been struck with the hand, Mr. B. began to cough violently. The half-sovereign, however, did not make its appearance. This process was twice repeated, with no better result; and, on the last occasion, the cough was so distressing, and the appearance of choking was so alarming, that it became evident that it would be imprudent to proceed further with this experiment, unless some precaution were used to render it more safe.

On the 27th of April, in a consultation of Dr. Seth Thompson, Mr. Aston Key, and myself, it was agreed that an artificial opening should be made in the trachea, between the thyroid gland and the sternum. In proposing this, we had a two-fold object; the one, that if the coin were lodged in any

part from which it might be safely extracted by the forceps, this method might be had recourse to; and the other, that, if relief could not be obtained in this manner, the artificial opening might answer the purpose of a safety-valve, and enable us to repeat the experiment of inverting the body on the moveable platform, without the risk of causing suffocation. The operation was immediately performed by myself, with the assistance of Mr. Aston Key and Mr. Charles Hawkins; and on it being completed, some attempts were made, both by Mr. Key and by myself, to reach the coin with the forceps introduced through the opening. The contact of the instrument with the internal surface of the trachea, however, induced on any occasion the most violent convulsive coughing. The coin was not seized, nor even felt; and our apprehensions of producing some serious mischief were such, that we did not deem it prudent, at that time, to persevere in our endeavours to remove it.

On the 2nd of May, we again made some trials with the forceps, but always with the same result. A violent convulsive action of the diaphragm and abdominal muscles ensued, on each introduction of the instrument; and the danger of groping in the bronchus, under such circumstances, surrounded as it is by the most remarkable assemblage of vital organs in the whole body, appeared to us to be so great, that we did not think ourselves justified in proceeding further. We were the more inclined to abandon the experiment with the forceps, as we had a strong expectation that a recurrence to the first