Inhaled and Swallowed Foreign Bodies

' By KENNEDY HUNTER, M.B., F.R.C.S., D.L.O. Hon. Assistant Surgeon, E.N.T. Dept., Royal Victoria Hospital, Hon. Surgeon, E.N.T. Dept., Belfast Ophthalmic Hospital IN reviewing the early medical literature, one is impressed with the relative scarcity of references to foreign bodies in the air passages; practically all the earlier cases were cesophageal. This must be due to failure of recognition. This assumption seems reasonable, when one reflects that thoracic percussion was discovered by Auenbrugger in 1753, but was not accepted generally until 1839, when Skoda further investigated this method of diagnosis; and Laennec's discovery of auscultation of the chest in 1816. Anotiter important factor, particularly in the diagnosis of laryngeal foreign bodies in adults, was the development of mirror laryngoscopy. This was first attempted in 1829, but was not satisfactory till after 1854. The very early accounts of the removal of foreign bodies from the air passages are of doubtful authenticity. Muys in 1690 reported in his "Practical Surgery" a case of a child of seven who died from suffocation three weeks after aspirating a bean. In 1759, Louis read his "Memoir on Bronchotomy" before the Royal Academy of Surgery at Paris. He collected all the then known cases of foreign body, twenty-eight in number, and presented all that had been learned concerning the subject up to that time. An elaborate study of the subject was published by Samuel Gross in 1854 entitled "Treatise on Foreign Bodies in the Air Passages." Certain of the physical signs and the important observations which were made during the early part of the nineteenth century are still fundamentally sound. With the development of X-rays, the d-iagnosis of foreign bodies has become, in great part, a problem for the radiologist. It was Mr. Goodall of Dublin in 1844 who directed attention to the part played by the carina in influencing the passage of foreign bodies in their descent to the bronchi. The significance and mechanism underlying the production of obstructive emphysema was described by Lescure in 1843. Early in the nineteenth century, Allan Burns noticed the tendency for foreign bodies under certain conditions to play up and down the trachea, and later Cooper described a flapping noise which is heard over the cricoid cartilage by placing the ear over that structure, and is produced by the foreign body striking against the rima of the glottis. In Gross's time, the treatment for foreign bodies in the air passages was, firstemetics and sternutatories to promote the expulsion of the foreign body, and, second-bleeding, expectorants, purgatives, and counter-irritation to prevent the effects induced by the presence of the foreign substance. The danger of the foreign body being coughed up and impacted in the larynx