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Q^1 PKOME HOSPITAL.
\J CASE OF
FOREIGN BODY
By C. G. R. NAYLOR,
IN THE
M.R.C.S., ENG., edin.,
WINDPIPE.
L. R'.C.P. and S.
Civil Surgeon, Prome, Lower Burma. A NATIVE child, aged 13 months, was brought to the out-door dispensary in a lifeless state with its limbs relaxed and its lips livid ; but no account could be rendered by its father, in whose arms it was conveyed, as to the cause of its sudden death. The infant was seen by him to make two or three gasps, and then to assume the condition above described. Previous to this the child had been quite well. Finding no foreign body impacted above the laryngeal orifice, to explain the appearancc presented by the deceased, i made an incision into the trachea for the insertion of a tracheotomy tube, for which my assistant was despatched with all speed. On his return, it
asphyxiated
found that the smallest tube available was for the calibre of the trachea. "Necesis the mother of invention," and came to sity the rescue, by aiding me to improvise a tube I cut a sufficient suitable to the circumstances. of India-rubber length drainage-tubing, which was held in position by my assistant, after it was adjusted through the incision in the trachea. The child was now placed on a firm support (made by its father's forearms being placed under its back, while he assumed a squatting attitude), and artificial respiration was performed for about five minutes, without intermission. I was delighted to hear a sudden inspiratory action of the lungs. The artificial respiration was prolonged ; but with each inspiration there was greater effort than there should have been, considering the free passage the drainage-tube I was
too
large
afforded for the entrance of air. I therefore concluded that the obstruction must be lower down than my incision, and told my assistant to move the tube gently up and down, so as to tickle the lining membrane of the trachea, while I continued the artificial respiration. This had the effect of exciting the lungs to make a mighty expiratory effort, which not only ejected the tube, but with it a custard-apple seed. The latter measured J of an inch long and of an inch wide, and being of an oval form, must have been impacted at the bifurcation of the trachea, and with its long axis placed transversely, occluded both branches, thereby arresting the ordinary efforts of respiration in the infant. Immediately sifter the expulsion of the seed, the father of the child remembered that its mother had allowed it to play with some of these seeds. They have a black, shining and rather attractive appearance, well known to all who have lived any time in India. The obstructing foreign body having been dislodged, the child's respiration soon became natural in character. The wound was closed and dressed, and the patient detained in hospital for 18 days, after which the case was discharged, quite well. The operation and resuscitation were performed while the child lay in its father's arms. 4th
PllOME, May, 1888.
f
Q^1 PKOME HOSPITAL.
\J CASE OF
FOREIGN BODY
By C. G. R. NAYLOR,
IN THE
M.R.C.S., ENG., edin.,
WINDPIPE.
L. R'.C.P. and S.
Civil Surgeon, Prome, Lower Burma. A NATIVE child, aged 13 months, was brought to the out-door dispensary in a lifeless state with its limbs relaxed and its lips livid ; but no account could be rendered by its father, in whose arms it was conveyed, as to the cause of its sudden death. The infant was seen by him to make two or three gasps, and then to assume the condition above described. Previous to this the child had been quite well. Finding no foreign body impacted above the laryngeal orifice, to explain the appearancc presented by the deceased, i made an incision into the trachea for the insertion of a tracheotomy tube, for which my assistant was despatched with all speed. On his return, it
asphyxiated
found that the smallest tube available was for the calibre of the trachea. "Necesis the mother of invention," and came to sity the rescue, by aiding me to improvise a tube I cut a sufficient suitable to the circumstances. of India-rubber length drainage-tubing, which was held in position by my assistant, after it was adjusted through the incision in the trachea. The child was now placed on a firm support (made by its father's forearms being placed under its back, while he assumed a squatting attitude), and artificial respiration was performed for about five minutes, without intermission. I was delighted to hear a sudden inspiratory action of the lungs. The artificial respiration was prolonged ; but with each inspiration there was greater effort than there should have been, considering the free passage the drainage-tube I was
too
large
afforded for the entrance of air. I therefore concluded that the obstruction must be lower down than my incision, and told my assistant to move the tube gently up and down, so as to tickle the lining membrane of the trachea, while I continued the artificial respiration. This had the effect of exciting the lungs to make a mighty expiratory effort, which not only ejected the tube, but with it a custard-apple seed. The latter measured J of an inch long and of an inch wide, and being of an oval form, must have been impacted at the bifurcation of the trachea, and with its long axis placed transversely, occluded both branches, thereby arresting the ordinary efforts of respiration in the infant. Immediately sifter the expulsion of the seed, the father of the child remembered that its mother had allowed it to play with some of these seeds. They have a black, shining and rather attractive appearance, well known to all who have lived any time in India. The obstructing foreign body having been dislodged, the child's respiration soon became natural in character. The wound was closed and dressed, and the patient detained in hospital for 18 days, after which the case was discharged, quite well. The operation and resuscitation were performed while the child lay in its father's arms. 4th
PllOME, May, 1888.
