Intrathoracic Foreign Bodies.

Large series of patients with intrathoracic foreign bodies, especially those in the bronchi and oesophagus, have been documented (for example, the Jackson Clinic in Philadelphia has experience of well over 5,000 cases (Jackson and Jackson, 1959) ) and the management of such foreign bodies in the hands of experts is standard and safe. Series such as this do not, however, indicate the incidence of foreign bodies in the thorax in a particular population since the cases treated in Philadelphia had been attracted from a wide area and the patients were often those in whom management of the foreign body had failed elsewhere. The results of treatment in the Jackson Clinic drew attention first to the frequency of disaster when intrathoracic foreign bodies were managed by the inexpert. It has been said that the justification for specialization is the opportunity that this gives to those 'with vision and skill to probe the frontiers of knowledge." But skill is directly related to practice and is always acquired, although perhaps more quickly and easily by some. Another important justification for specialization is that it offers the opportunity for practice without which surgery is dangerous; nowhere in surgery is there room for the occasional exponent. The purpose of this paper is to review the experience of intrathoracic foreign bodies over a 10year period, 1950-59, in the Regional Thoracic Unit in Edinburgh, which serves a relatively static population of one and a half million, and from this review to emphasize some aspects of, and pitfalls in, management. The cases treated are detailed in the Table. The number is relatively small, an average of five a year, and the results of management are reasonably good. One of 50 patients treated died ; his death in 1950 was related to the erosive effect of prolonged retention of a coin in the oesophagus and failure at thoracotomy to anticipate the extent of this and to modify management accordingly.