Again the intruding substance may not be fixed anywhere, but may shift its place from time to time; and this, in fact, is what most frequently happens; and when it does happen, it gives rise to very striking symptoms. Paroxysms of suffocating cough and extreme distress, when the substance is driven up into or near the larynx; with intervals of comparative quiet, and sometimes indeed of apparent health, when it subsides into the trachea or bronchial tubes.

When we know that a solid body has been entrapped in the air-tubes, our business is plain; there is no room for hesitation; we must let the substance out through an artificial opening. There is danger, so long as it remains in these vital passages, of speedy suffocation; of fatal damage to the larynx, or to the lungs; of cerebral mischief during the violent paroxysms of coughing. Convulsions and apoplexy have, under such circumstances, actually occurred. Against these perils there is no security, except in the early performance of tracheotomy. If the included substance be loose and smooth, it will be shot forth at the new orifice; if it be fixed, or angular, it may generally be extracted by a skilful and delicate hand.

In 1843, Mr. Brunei, the celebrated engineer, came near losing his life by an accident of this kind. In amusing the children of a friend with some tricks of legerdemain, he put a half sovereign into his mouth; and the coin slipped, as from its size and shape it might easily do, through the opening of the windpipe. It seems to have occasioned no very urgent distress. The patient was made aware by some internal sensation, that it lay towards the right side. After more than three weeks had passed, the windpipe was opened; but the piece of money did not come forth. Probably its weight prevented its being driven up and down the windpipe; and, when it lay edgeways, its form did not oppose much impediment to the breath. The same weight, however, brought it back to the larynx whenever Mr. Brunei placed himself with his head downwards. In some of these experiments it produced most violent cough, and feelings of impending suffocation. But at length, in one of these trials, at the end of six weeks, it dropped out again through the natural passage, just as a coin may sometimes, by good luck, be shaken out of a box through a slit in the lid.

For Mr. Brunei's convenience a sort of platform was constructed, movable upon a central hinge. To this platform he was bound in the prone position, by a broad strap passing across his shoulders; and then his head was lowered until the platform was brought to an angle of about 80 degrees with the horizon. This did not succeed until after the opening was made in his windpipe.

The invention of the laryngoscope is calculated, henceforth, to throw light, in a two-fold sense, upon the character and requirements of these accidents, whenever the foreign substance happens to be fixed either in the gullet or in the windpipe. By help of this instrument, Dr. G. Johnston discovered a copper penny sticking in the upper part of the gullet of a boy twenty months old, who had swallowed the coin two days previously. At first the boy seemed on the brink of being choked to death. This distress, however, soon subsided, but left behind it utter inability to swallow solid food, and great difficulty in swallowing at all. Using a pair of long, slender, curved forceps, opening front and back, Dr. Johnson was able to seize the visible edge of the penny, and to pull it out. The boy was soon well.

Dr. Sanderson and Mr. Hulke narrate a case where a man had a sixpence in his mouth, which, during a fit of laughter, suddenly disappeared. After ten weeks its position was discovered by the aid of the laryngoscope, and an operation was performed with the aid of chloroform,

A man was admitted into King's College Hospital, on December 15th, 1870, under the care of Mr. Henry Smith. Four days before, while drunk, he had put into his mouth a half-sovereign, which slipped into his windpipe. By the aid of the laryngoscope, its position was discovered, and, an operation being performed, the coin was recovered. This time without chloroform.

Oases occasionally happen, where individuals are fortunate enough to get rid of the intruding substance without an operation. An instance of this kind has been recorded by Dr. James Duncan in the "Northern Journal of Medicine." A man was amusing himself with tossing up a shilling and catching it in his mouth. Suddenly it fell into his windpipe, and produced violent cough and severe shortness of breath, which gradually subsided. The difficulty of breathing returned in paroxysms, upon his making a deep inspiration, or after certain movements of the body. He was now held with his head downwards by three strong men, was shaken once or twice in that position, and his windpipe was moved from side to side, when the shilling re-entered his mouth, and dropped out upon the floor.

An almost similar case has been related by Dr. G. B. Halford, In the year 1852, when he was house-surgeon to the Westminster Hospital, a man was admitted about noon, who stated that on the previous evening, while entertaining his children by throwing a shilling into the air and attempting to catch it in his mouth, the shilling slipped into his windpipe. He had been to several medical men, and had taken emetic after emetic in vain. The shilling could be felt in his windpipe, and the man's voice was reduced to a whisper. Dr. Halford directed the porters of the Hospital to turn him upside down in the corner of the surgery, when, after several expiratory efforts, the shilling rolled out of his mouth.