Foreign Bodies in the Pharynx and Esophagus, Part 6

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 32 of 41)

A curious accident is that in which a foreign body thrown into the air and caught in the mouth has caused immediate asphyxiation. Suetonius transmits the history of a young man, a son of the Emperor Claudius, who, in sport, threw a small pear into the air and caught it in his mouth, and, as a consequence, was suffocated. Guattani cites a similar instance of a man who threw up a chestnut, which, on being received in the mouth, lodged in the air-passages; the man died on the nineteenth day. Brodie reported the classic observation of the celebrated engineer, Brunel, who swallowed a piece of money thrown into the air and caught in his mouth. It fell into the open larynx, was inspired, causing asphyxiation, but was removed by inversion of the man's body.

Sennert says that Pope Adrian IV died from the entrance of a fly into his respiratory passages; and Remy and Gautier record instances of the penetration of small fish into the trachea. There are, again, instances of leeches in this location.

Occasionally the impaction of artificial teeth in the neighborhood of the larynx has been unrecognized for many years. Lennox Browne reports the history of a woman who was supposed to have either laryngeal carcinoma or phthisis, but in whom he found, impacted in the larynx, a plate with artificial teeth attached, which had remained in this position twenty-two months unrecognized and unknown. The patient, when questioned, remembered having been awakened in the night by a violent attack of vomiting, and finding her teeth were missing assumed they were thrown away with the ejections. From that time on she had suffered pain and distress in breathing and swallowing, and became the subject. of progressive emaciation. After the removal of the impacted plate and teeth she soon regained her health. Paget speaks of a gentleman who for three months, unconsciously, carried at the base of the tongue and epiglottis, very closely fitted to all the surface on which it rested, a full set of lost teeth and gold palate-plate. From the symptoms and history it was suspected that he had swallowed his set of false teeth, but, in order to prevent his worrying, he was never informed of this suspicion, and he never once suspected the causes of his symptoms.

Wrench mentions a case illustrative of the extent to which imagination may produce symptoms simulating those ordinarily caused by the swallowing of false teeth. This man awoke one morning with his nose and throat full of blood, and noticed that his false teeth, which he seldom removed at night, were missing. He rapidly developed great pain and tumor in the larynx, together with difficulty in deglutition and speech. After a fruitless search, with instrumental and laryngoscopic aid, the missing teeth were found - in a chest of drawers; the symptoms immediately subsided when the mental illusion was relieved.

There is a curious case of a man drowned near Portsmouth. After the recovery of his body it was seen that his false teeth were impacted at the anterior opening of the glottis, and it was presumed that the shock caused by the plunge into the cold water had induced a violent and deep inspiration which carried the teeth to the place of impaction.

Perrin reports a case of an old man of eighty-two who lost his life from the impaction of a small piece of meat in the trachea and glottis. In the Musee Valde-Grace is a prepared specimen of this case showing the foreign body in situ. In the same museum Perrin has also deposited a preparation from the body of a man of sixty-two, who died from the entrance of a morsel of beef into the respiratory passages. At the postmortem a mobile mass of food about the size of a hazel-nut was found at the base of the larynx at the glossoepiglottic fossa. About the 5th ring of the trachea the caliber of this organ was obstructed by a cylindric alimentary bolus about six inches long, extending almost to the bronchial division. Ashhurst shows a fibrinous cast, similar to that found in croup, caused by a foreign body removed by Wharton, together with a shawl-pin, from a patient at the Children's Hospital seven hours after the performance of tracheotomy. Search for the foreign body at the time of the operation was prevented by profuse hemorrhage.

The ordinary instances of foreign bodies in the larynx and trachea are so common that they will not be mentioned here. Their variety is innumerable and it is quite possible for more than two to be in the same location simultaneously. In his treatise on this subject Gross says that he has seen two, three, and even four substances simultaneously or successively penetrate the same location. Berard presented a stick of wood extracted from the vocal cords of a child of ten, and a few other similar instances are recorded.

The Medical Press and Circular finds in an Indian contemporary some curious instances of misapplied ingenuity on the part of certain habitual criminals in that country. The discovery on a prisoner of a heavy leaden bullet about 3/4 inch in diameter led to an inquiry as to the object to which it was applied. It was ascertained that it served to aid in the formation of a pouch-like recess at the base of the epiglottis. The ball is allowed to slide down to the desired position, and it is retained there for about half an hour at a time. This operation is repeated many times daily until a pouch the desired size results, in which criminals contrive to secrete jewels, money, etc., in such a way as to defy the most careful search, and without interfering in any way with speech or respiration.

Upward of 20 prisoners at Calcutta were found to be provided with this pouch-formation. The resources of the professional malingerer are exceedingly varied, and testify to no small amount of cunning. The taking of internal irritants is very common, but would-be in-patients very frequently overshoot the mark and render recovery impossible. Castor-oil seeds, croton beans, and sundry other agents are employed with this object in view, and the medical officers of Indian prisons have to be continually on the lookout for artificially induced diseases that baffle diagnosis and resist treatment. Army surgeons are not altogether unfamiliar with these tricks, but compared with the artful Hindoos the British soldier is a mere child in such matters.

Excision of the larynx has found its chief indication in carcinoma, but has been employed in sarcoma, polyp), tuberculosis, enchondroma, stenosis, and necrosis. Whatever the procedure chosen for the operation, preliminary tracheotomy is a prerequisite. It should be made well below the isthmus of the thyroid gland, and from three to fifteen days before the laryngectomy. This affords time for the lungs to become accustomed to the new manner of breathing, and the trachea becomes fixed to the anterior wall of the neck.