This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
The intrusion of solid, or "foreign bodies," as they are commonly termed, into the windpipe are not by any means uncommon, and many fatal accidents happen in that way. Morsels of food; the stones of fruit,-of these there are many instances,-teeth; three such cases are referred to by Dr. Stokes; portions of bone; pebbles; a piece of money; a nut; a nut-shell; a button; a musket-ball; a large shot; a fragment of nutmeg; iron nails; kidney-beans; ears of grass or corn,-of these four at least have been noticed.
One of these is related by Mr. Mayo: The young son of an English nobleman was riding in a carriage, in or near Paris, and had an ear of rye in his mouth. The carriage made a sudden jolt, and the ear of corn disappeared. Little was thought about this at the time; but soon afterwards symptoms of pulmonary irritation set in, attended with hectic fever, and with the most fetid expectoration. The boy gradually sank.
The results of these accidents are various.
It may cause speedy death by suffocation.
Death may ensue, after symptoms resembling those of chronic Phthisis. Or the "foreign body" may be expelled through the glottis, after a variable period of time. Sometimes, yet not always, its expulsion ensures the patient's recovery; but he is never safe while it remains.
Death may take place in a few seconds when the substance sticks in the glottis. Death has occurred within three days when the substance has passed the glottis; and in eleven days when it has reached the lung. The intruding piece of matter has escaped, through the natural passages, after remaining imprisoned for seventeen years. In that case, the patient died, hectical and emaciated, a year and a half afterwards.
Many cases occur of people who get choked in this way at meals, and the accident often happens to persons who are drunk. The attack is very likely to be mistaken for an apoplectic seizure. This is what people generally speak of as food "going the wrong way."
In these cases of sudden choking any assistance, to be effectual, must be immediate. The following is what Dr. Marshall Hall tells us should be done:
"Pressure being made on the abdomen, to prevent the descent of the diaphram, a forcible blow should be made by the flat hand on the chest. The effect of this is to induce an effort similar to that of expiration; the larynx being closed, oesophogeal vomiting takes place, and the morsel is dislodged.
"If this plan fail, not an instant being lost, the pressure being kept up on the abdomen, the finger should be introduced into the throat, and the same smart and forcible blow made on the chest as before. By the irritation of the fauces the entrance of the stomach is opened, and by the blow on the chest (firm pressure being made on the abdomen) an effort similar to that of expiration, with a closed larynx is made, and a direct vomiting ensues, and the morsel of food is carried away."
The substance, if small, may, after it has passed the chink of the glottis, remain in the larynx; in that case it usually occasions very severe symptoms-spasmodic gasping cough, choking sensations, and pain in the larynx-symptoms which harass the patients without intermission, until death ensues, or until the substance is driven upwards into the pharynx, or drops downwards into the windpipe. There is, however, one instance on record, in which a piece of gold was lodged for years in the ventricles of the larynx, without these distressing consequences.
Having passed the upper part of the larynx, it may stop, and become fixed beneath the cricoid cartilage, or in the trachea. In these situations, unless it quite blocks up the passage, its presence may be productive of but little distress. A wheezing or croupy sound during respiration, and some degree of pain and tenderness of the part where the substance was lodged, have constituted all the evidence of its position in the air passages, in more than one instance. A singular case of this kind is related by Professor Macnamara. A boy had made a whistle, by perforating a plumb-stone, and extracting the kernel. This, during a strong inspiration, passed from between his lips, through the glottis, and became fixed transversely in the larynx. So little inconvenience did it create, that the boy, finding that he still whistled as he breathed, went about for some time, pleased to display this new accomplishment. For three days he continued to occupy himself with his childish amusements, suffering now and then a suffocating cough. He was then taken to the Meath Hospital. He had no pain in swallowing; but he said that, when the cough was severe, it caused pain in his throat. He had also uneasiness in the stomach, a bloated countenance, and a frequent pulse. The fits of coughing were followed by white, frothy expectoration. An operation was performed, but during the struggle and the convulsive cough that took place when the opening was made, the stone (so the patient declared), was coughed up and swallowed. The symptoms were relieved; and the whistling ceased. But it was found that, as the wound healed, the distress* and the whistling sound returned; which showed that the stone lay above the opening; and that the disappearance of the symptoms had been owing not to its dislodgment, but to the admission of air below the point where it was fixed. Soon after this, however, it changed its place, passed down into the right bronchus, and then up again towards the larynx. By a second operation it was extracted; and the lad recovered without any bad symptoms.
Dr. Stokes believes, and his opinion is fortified by his own experience on the subject, that smooth bodies, (beans or shots for example) are more calculated than such as are rugged and uneven to cause urgent distress when fixed in one of the bronchial tubes; inasmuch as they more completely plug and obstruct the tube, thereby depriving the patient at once of the use of half his lungs. An irregular substance, which can neither seal the passage up, nor be closely grasped at all points by its spasmodic contraction, will probably occasion less shortness of breath, and at the same time will be less likely to be dislodged by the effort of breathing.