fortnight afterwards, the wound of the neck was nearly healed.*

The different results which foreign bodies produce when admitted into the trachea, may be referred chiefly to the differences of their size, weight, and figure. If it be of large dimensions, the foreign body will be lodged, and probably impacted, in the trachea itself, causing, in the first instance, more or less obstruction to the respiration, which becomes aggravated afterwards by the too abundant secretion of mucus from the lining membrane. If it be of small size, it will descend to the lower part of one bronchus (generally the right), or even into one of the subdivisions of it, of course obstructing the respiration in a less degree. If it be of light weight, and of moderate size, having no great irregularity of figure, on every fit of coughing it will be made to ascend to the glottis, threatening, and probably at last inducing, suffocation. If it be more ponderous, it will not ascend in the act of coughing, and the inconveniences which it causes, and the immediate danger, will in one respect be less. In

*For the early part of this history, I have availed myself of the notes of my friend Dr. Seth Thompson, who is nearly related to the patient, and to whom, also, I feel deeply indebted for the kind and zealous assistance which he afforded us during the whole progress of the case.

the case which I have just related, the symptoms described by the patient led all those who were consulted to believe that the foreign body lay in the right bronchus; and this opinion derived confirmation from some experiments made formerly by Mr. Aston Key, and lately repeated by myself and others, in which it was ascertained, that a coin of the size of a sixpence or half-sovereign, if dropped into the trachea of the dead body, almost invariably fell, by its own weight, into this part of the air-passages. It was evident that the weight of the half-sovereign rendered it nearly stationary in the ordinary position of the body; and to this circumstance may mainly be attributed the comparatively trifling inconvenience which the patient suffered. But it is not to be supposed that the ultimate danger of the case, if the foreign body had been allowed to remain, would have been therefore less; and the records of surgery furnish abundant evidence that, under such circumstances, disease of the lungs sooner or later is induced, and that the death of the patient invariably

ensues.

The narrow space which a half-sovereign would occupy in the bronchus, sufficiently explains the failure of the stethoscope as the means of diagnosis. It would appear, however, that even under more favourable circumstances, we cannot, in cases of this description, rely on the information which is afforded to us by the use of this instrument. Mr. Hodgson of Birmingham has furnished me with the history of a case which fell under his observation, in

which the berry of a plant called the bladder-senna, of the size of a large pea, had found its way into the trachea of a boy six years of age. On repeated examinations with the stethoscope, nothing unusual was observed in the state of the respiration; yet, on the seventh day after the occurrence of the accident, the child suddenly expired, and on inspecting the trachea afterwards, the berry was found lodged in it about an inch below the cricoid cartilage. Mr. Phillips, surgeon to the St. Mary-le-bone Infirmary, and librarian of this Society, has informed me of another case, occurring in a little girl two years of age, in which a physician, much accustomed to the use of the stethoscope, had examined the chest with that instrument several times, and in the most careful manner, without detecting anything peculiar in the respiration; yet it was ascertained after death, that a portion of the claw of a lobster was firmly fixed in the trachea, a little above the level of the upper margin of the sternum.

I have already stated, that in making the artificial opening into the trachea, we had two objects in view; and it has been shown, that in the attainment of one of these, our success was as great as our most sanguine desires could have led us to anticipate. Although, before the opening was made, the experiment of inverting the patient on the platform was productive of a most distressing and long-continued spasm of the muscles of the glottis, no such spasm occurred afterwards. The half-sovereign escaped through the aperture of the

glottis, as easily as it would have done in the dead body; and the small quantity of blood which was ejected at the same time, and which had been manifestly furnished by the granulations of the external wound, sufficiently explains how this happened: as it is not to be supposed that blood could have been drawn into the trachea without the admission of air into it at the same instant. As connected with this part of the case, it may be well here to mention, that the distressing sensations arising from congestion in the vessels of the brain, while the head was in a depending position, were immediately and completely relieved by supporting the forehead with the hand, so as to keep the occiput in some degree inclined towards the back of the neck.

In the other object, for which the artificial opening was made, it must be confessed that we were wholly disappointed. In the dead body, with the assistance of proper forceps, there is no great difficulty in extracting a sixpence or a half-sovereign from the bronchus. But even here it is not always accomplished on the first trial. If the forceps be, as they ought to be, carefully and gently handled, the blades may actually slide over the surface of the coin without any sensation being communicated to the hand of the surgeon which will make him aware of the circumstance: or they may be passed downwards on one side of the bronchus, while the coin lies on the other. In the attempt to seize it, the forceps sometimes grasps the bifurcation of the trachea, or one of the subdivisions of the bronchus, instead of the foreign body.

Nor will these things appear remarkable to any one who bears in mind, that the parts in which the forceps is to be used are not only out of sight, but at a considerable distance from the surface. Including the depth of the external wound, the instrument must be introduced to the distance of from four and a half to five inches before it reaches the upper extremity of the bronchus, and in order that the whole of the bronchus should be explored, it must penetrate still one inch and a half further. But in the living person, there are difficulties of which no knowledge can be obtained from experiments on the dead body. We found that every attempt to use the forceps occasioned a convulsive action of the diaphragm and abdominal muscles, and violent coughing; and (contrary to the observations of M. Magendie on what happens in experiments on dogs) the result was nearly the same, whether the extremity of the instrument was directed upwards towards the glottis, or downwards towards the lungs. Dr. Williams has shown that the fibres of the whole of the bronchial tubes are endued with a high degree of contractility. The heart and its great vessels, the lungs, and the pulmonic plexus of the pneumo-gastric nerves, are immediately contiguous to the bronchi, and the phrenic nerves are only at a short distance on the forepart. How easy would it be for some unfortunate thrust of the forceps, for which, during a paroxysm of coughing, the hand of the surgeon could be in no wise responsible, to cause some such injury to these important organs as would prove