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"On the afternoon of July 10, 1891, a boy five years old, having three cloves in his mouth, ran and fell, striking the back of his head, and crying drew the three cloves into the larynx. He was immediately turned upside down and pounded upon his back expelling two of the cloves; but all efforts failed to dislodge the third one. He breathed fairly well except upon taking a long inspiration a wheezing sound was heard. He was taken that evening to Dr. W, who made an examination of the larynx and pharynx, but failed to discover the clove, and advised waiting, thinking the child would cough it up. About noon on the 11th of July, the child complained of feeling tired, coughed a good deal; temperature, 100°; child grew more feverish, thirsty and restless. Evening temperature, 103°; pulse, 120; headache, throat painful. The child grasps the throat with his hands during his sleep, and moans. Aconite 3x given with cold. compresses to the larynx and head. Morning temperature, 100°; child bright, fever died away and did not return for two days, when it came on in the morning; temperature, 103°; thirst, headache, throat painful, limbs aching, restless, no appetite; aconite 3x, cold compresses. Towards evening, temperature grew gradually less, and next morning was normal. For more than a week the child continued in much the same condition, fever coming on sometimes at night, sometimes in the morning, the cough continued, the attacks lasting over an hour at times. On the 23d of July, he went out for a while in the morning, but came in about noon, complaining of feeling tired. He coughed a good deal, sleepy, tossing and moaning in his sleep. Evening temperature, 105°; pulse, 150; respiration, 48; complains of pain in chest near right nipple. Throat very painful, dreadful headache all over the head, especially at the base of the brain. Child coughed, vomited, sneezed and purged. Put cold water on head, throat, and chest, gave bry. 3x. Morning temperature, 101°; very drowsy. A surgeon advised operating immediately; but Dr. Woodvine found the child breathing quietly and advised waiting. The clove could be located all the time by a wheezing sound in the larynx, and the child could taste it for some time, and thought he could feel it all the time. After a long fit of coughing it would seem to be displaced and interfere with his breathing for some time, but would finally settle back, probably into the vocal process. The child grew better after the 24th of July, appetite gradually returned, and aside from occasional fits of coughing he seemed very well, only weak. On the morning of Aug. 13th he awoke coughing, and the cough continued troublesome until about noon, he had a severe cough and expelled the clove, much swollen, somewhat spongy, but still perfect in shape, the round seed at the top never having become

dislodged, the clove having been in the larynx five weeks lacking one day. There was an irritation of the throat and a little cough several days following the expulsion of the clove; but that is all well now, and the child seems to be perfectly well."

The object in giving a detailed statement of the above case is that we might see the result of patient waiting and careful watching. The natural feeling of the parent in such a case is, to have something done that will at once relieve the child of the foreign object in the larynx. The careful and prudent physician feels that it is his duty to give the earliest possible relief without permanent injury to the child. With this thought in mind he seeks to locate the object by making, if practicable, a laryngoscopic examination and to reach the same by means of instruments through the mouth and pharynx. When a careful examination has been made, and the object has not been definitely located, the question that naturally arises is, what is the next best thing to do? The answer to this question will depend upon circumstances. First, what is the condition of the patient? If the patient's life is in immediate danger, and the foreign object can be definitely located, an operation should be undertaken for the relief of the patient, if practicable. If the patient is breathing comfortably then it is better to wait, hoping that the object may be expelled by a paroxysm of cough. The nature and character of the substance lodged in any portion of the air passage, when it does not materially interfere with breathing, will have something to do with encouraging us to wait. When the object is known to be a vegetable substance, although dry and hard, as in the case of the clove, we may expect that the substance will sooner or later absorb moisture, soften and probably be expelled during a fit of coughing. If the object be a tack, pin, needle, button, or bit of bone, then the case does not promise as much from patient waiting. When the object is smooth, there is always a possibility that it may be expelled by the act of coughing. The writer remembers a case in which a young lady went to have a tooth extracted, and after its removal the tooth was dropped accidentally into the throat and she supposed that she had swallowed it; soon after, she was taken ill with pneumonia, and during this sickness, while coughing expectorated the tooth. Another case occurs to us; that of a man who, unfortunately, while eating, drew a piece of bone into the larynx; he, however, was not aware of this fact at the time; he did not know what it was that was lodged in the larynx; this was before the days of laryngoscopy. His was considered a peculiar case of laryngeal phthisis, which after two years of severe suffering terminated in death, after which an examination was made and a piece of

chicken bone was found lodged in the larynx. We have no doubt that the latter case might have been saved in these days with the use of improved appliances. We are pretty well convinced that where the object has passed into the bronchial tube it is far better to leave the case to the efforts of nature for expulsion than to undertake to remove by cutting down upon. the parts. We believe that the chances are decidedly in favor of waiting. It may be that the patient will die; but how many have died within the last year or two from the effects of the attempt to remove what the physician was not able to locate definitely; the shock of the operation to the nervous system proving too much for the patient to bear. We feel that too much haste to operate where foreign objects are lodged in the larynx may result either in injury to the vocal organs, or in death. We believe that it is practical to lash such patients to a properly prepared board and invert them, and when in this position, raise them a little distance from the floor and suddenly let the board drop, recommending them to cough at the same time. The reason we have for recommending this experiment is, the fact that during the act of coughing, the object would be more likely expelled than when sitting, standing or lying.

A "QUIZ CASE."

BY E. I. HALL, M.D., BRISTOL, VT.

If the readers of the GAZETTE are not tired of " quiz cases,' I should like to submit for their consideration, a case which is unique in my experience, and the counterpart of which I have been unable to find in any text-book.

Was called Nov. 16th to see H. L, a young lad of sixteen years, The previous night he retired feeling perfectly well, and was awakened in the night with pains in his bowels. Next day I found him suffering apparently from an attack of indigestion - no fever, pulse very slow, 64; tongue coated, nausea and vomiting, pain in lower abdomen more intense in right inguinal region, intense thirst, and a feeling of great prostration.

The peculiar feature of the case was the extremely slow pulse. I prescribed bryonia alba 3x, and in the evening all the symptoms seemed better. He passed a very restless night, having more or less grumbling pain in the bowels.

In the morning the pain was better, the pulse remained at 64, and the temperature was still normal. While at dinner I was hastily summoned, and found my patient suffering agony from

pain in the right inguinal region. The abdominal walls were drawn spasmodically inward, and were very hard. The arms. and hands were also in a state of spasmodic rigidity, and the perspiration stood in drops upon his face and body. I immediately administered an hypodermic injection of morphine gr., but the pain did not abate in the least until another had been given, and then only became less intolerable, and he was put upon colocynth 3x for the afternoon. This with the constant use of the hot-water bag made him more comfortable, though he passed another restless night, and the next morning the temperature was 102°, and the pulse 80, and the right inguinal region was so tender that the hot-water bag could no longer be tolerated, though the abdominal walls were still retracted and hard. My remedy was changed to acon. 3x, and the day passed with very little pain, but in the evening the boy's father gave him a piece of ice, "only as big as my thumb," with the almost immediate effect of bringing on another attack of that same cramplike pain in the right inguinal region, though it was not as severe as the first and was subdued by colocynth 3x, frequently given. That night a profuse diarrhoea set in, of the kind that patients call "clear bile," and was attended with griping pains. Merc. sol. 6x trit. was given and finally podo. 3x. The stools were frequent and exhausting for three days, but finally the bile began to disappear and the stools to lessen in frequency, while the face and conjunctive - which became intensely icteric at about the time the diarrhoea began gradually assumed their natural color, but the tenderness of the abdomen persisted so that for some days the young man could not bear the weight of his hand upon his body, and moved with the greatest caution for fear of jarring the tender spot.

It was easy to determine on account of the retracted abdomen that there was no enlargement in the region of the ileocæcal valve, which if found might have explained the persistence of the pain and tenderness there. It was noticed as the diarrhoea abated and the period of convalescence began, that the act of urination was followed by a dull aching pain which extended through the region of the bladder to the back, and this continued as did also the sunken, hard condition of the abdomen, until Dec. 3rd, when both seemed to disappear suddenly and together. The urine was somewhat turbid and yellow, but has cleared and seems perfectly normal..

During the entire illness the abdomen was not once distended, and only once did the temperature stand above the normal. He received bry., acon., merc. sol., podo., colocy., and at last ant. crud., and is now convalescing slowly.

Will some one kindly supply a name which shall suggest a

solution of this puzzle of (to me) contradictory symptoms? I think I hear more than one reader exclaim "simple enough,' but I am sure if they will carefully consider the case, they will conclude wisely that it is not one favorable for a "snap-shot diagnosis.

AXIOMS FOR CONSUMPTIVES.

BY T. C. DUNCAN, M.D., CHICAGO, ILL.

In the study of the subject of climate cure in all of its bearings, there have come to be current among specialists in the treatment of consumption, certain truths that are recognized and regarded essentially as axioms.

AXIOM I. That a change of climate offers the best chances for the cure of this disease.

The usual immediate mortality of this disease is about 38 per cent. Some schools claim to lose ten per cent. less. Some physicians think that diet will overcome climate, but the sudden cool changes in the atmosphere of the "consumptive belt " has led to the formation of this Axiom I.

Put the consumptive or person with weak lungs in the best climate with the best local surroundings. Change of climate is usually imperative.

It

AXIOM II. Change of climate should be made early in the disease. Climate has been looked upon as a dernier ressort. has often so proved, but that does not change the force of the axiom.

AXIOM III. The change should be directed by the best informed on the subject.

Especially is this true when the disease is well advanced. Where to go cannot be decided by the patient himself, for the well-informed medical adviser knows that all cannot go to the same place with benefit. On this great continent there are various climates and localities from which to choose. The selection is of the most vital importance and should be made after careful inquiries.

AXIOM IV. Those with weak lungs should be under medical supervision wherever they are.

This would seem to the sensible, self-evident; yet people with weak lungs are often both reckless and headstrong. They often unnecessarily expose themselves. Many more might be cured at home if they always acted under medical advice. When they make a change they often act on their own judg ment to their detriment. It is the general opinion of those physicians who have these cases to direct, that the best results

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