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1921

By T. A. MacGibbon, M.D., F.R.C.S.E.

Dr. F. V. Bevan-Brown sent Miss L. A. B., aged 30, with the following notes: “Miss B. was undergoing treatment for dyspepsia. She had a septic lower molar tooth, which was extracted, under gas anæsthesia, by a competent exodontist. The tooth was a mere shell with a large amalgam filling. The extraction was very difficult, the tooth breaking in the process. The dentist was not certain that he had recovered every piece. He X-rayed the upper half of the chest, but found no evidence of any foreign body in the main air passages. The following day the patient developed a troublesome dry cough, and a sense of irritation in the throat. There was some pharyngitis secondary to the pus from the septic stump, and this was considered sufficient to account for the cough, since careful examination of the chest revealed no abnormal signs. The patient did not report herself for nine days, during which she had coughed incessantly, and had become rather exhausted. There were still no physical signs in the chest, but a sign of considerable omen had by now developed, namely, fœtor of the breath. The cough was mostly dry, with, occasionally, a little muco-pus. An X-ray examination of the whole chest was now made, and a foreign body was clearly visible lying low down in the right lung, one inch and a-half above the dome of the diaphragm. It was the size of a pea, and so opaque that it was considered to be a piece of amalgam, and not a portion of the tooth.”

During the evening of the day, after I had examined the photograph, the patient was taken into the theatre of the Christchurch Hospital, and an attempt was made to locate the foreign body by means of Chevalier-Jackson’s instruments. The patient was placed in the supine position, and the pharynx and hypo-pharynx painted with 10 per cent solution of cocaine. Dr. Hamilton Gould then took charge of the head which was brought over the end of the table. Jackson’s laryngoscope, with distal illumination, was passed down to the entrance of the larynx, the bronchoscope, also with distal illumination, passed down inside the laryngoscope and through between the cords into the trachea. The slide of the laryngoscope was withdrawn, and the laryngoscope removed. The bronchoscope was slowly pushed down until the carina was encountered. Dr. Gould then inclined the head and neck to the left, and the tip of the instrument slipped easily into the right bronchus and down the mainstem bronchus to the lower lobe bronchus. Here pus was found, and removed after Jackson’s simple but ingenious method. The body as not found, and it was decided to wait.

Two evenings later a second attempt was made to remove the piece of amalgam. The instrument was introduced as before, quite easily, but this time the patient was laid across the X-ray couch. More muco-pus was pumped out, and the small bronchus, in which the body was lying, was recognised by the pus oozing from it. The tip of the tube was now found lying over the amalgam, but this could not be felt or seen with forceps. This effort was also abandoned. The following night the same procedure was gone through. Now a right angled probe was passed over the cartilagenous lip of the bronchus and the foreign body tilted into the lumen. Jackson’s forceps were passed, and the foreign body grasped and removed.

The patient bore the operation well, and said there was no pain experienced after the discomfort of passing the tube through the glottis. No anæsthetic, beyond the concainising of the hypopharynx, was used.

The patient was taken back to bed and placed in a steam tent. Dr. Bevan-Brown’s subsequent notes:

“Hoarseness and soreness on swallowing were present for two or three days after the removal of the foreign body, but the patient’s general condition was satisfactory. The temperature remained normal, the cough grew less severe, and there was very little expectoration. The fœtor gradually improved. She was very thin and weak, however, due chiefly to her chronic dyspepsia and exhaustion following a fortnight of incessant coughing. An X-ray examination of the chest, a week after the bronchoscopy, shewed everything clear. The infiltration previously seen round the foreign body had dispersed. A few days later, however, pain began to develop in the right chest, and there was evening pyrexia ranging from 90 degrees F., to 100 degrees F. for four or five days. This and the pain both eventually subsided without giving rise to any abnormal physical signs. The patient is now—six weeks from the operation—definitely better in every way.”

This is the first time I have removed a foreign body from the lung of a living subject. This foreign body was difficult to remove because of its weight and smallness, and because it lay out of sight in a branch bronchus. The operation confirmed my opinion that distal illumination was better than proximal. With the proximal light one’s instruments and fingers constantly interfered with one’s vision, and the carrier interfered with the insertion of forceps and probes. Further, Jackson’s instruments are so made that trauma is almost exceptional, while Brüning’s instruments, unless in the hands of much practised manipulators, seemed to invite damage.

My thanks are due to Dr. Hamilton Gould for ably assisting me. Jackson used to say: “It’s team-work, gentlemen.”

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Nil.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

1921

By T. A. MacGibbon, M.D., F.R.C.S.E.

Dr. F. V. Bevan-Brown sent Miss L. A. B., aged 30, with the following notes: “Miss B. was undergoing treatment for dyspepsia. She had a septic lower molar tooth, which was extracted, under gas anæsthesia, by a competent exodontist. The tooth was a mere shell with a large amalgam filling. The extraction was very difficult, the tooth breaking in the process. The dentist was not certain that he had recovered every piece. He X-rayed the upper half of the chest, but found no evidence of any foreign body in the main air passages. The following day the patient developed a troublesome dry cough, and a sense of irritation in the throat. There was some pharyngitis secondary to the pus from the septic stump, and this was considered sufficient to account for the cough, since careful examination of the chest revealed no abnormal signs. The patient did not report herself for nine days, during which she had coughed incessantly, and had become rather exhausted. There were still no physical signs in the chest, but a sign of considerable omen had by now developed, namely, fœtor of the breath. The cough was mostly dry, with, occasionally, a little muco-pus. An X-ray examination of the whole chest was now made, and a foreign body was clearly visible lying low down in the right lung, one inch and a-half above the dome of the diaphragm. It was the size of a pea, and so opaque that it was considered to be a piece of amalgam, and not a portion of the tooth.”

During the evening of the day, after I had examined the photograph, the patient was taken into the theatre of the Christchurch Hospital, and an attempt was made to locate the foreign body by means of Chevalier-Jackson’s instruments. The patient was placed in the supine position, and the pharynx and hypo-pharynx painted with 10 per cent solution of cocaine. Dr. Hamilton Gould then took charge of the head which was brought over the end of the table. Jackson’s laryngoscope, with distal illumination, was passed down to the entrance of the larynx, the bronchoscope, also with distal illumination, passed down inside the laryngoscope and through between the cords into the trachea. The slide of the laryngoscope was withdrawn, and the laryngoscope removed. The bronchoscope was slowly pushed down until the carina was encountered. Dr. Gould then inclined the head and neck to the left, and the tip of the instrument slipped easily into the right bronchus and down the mainstem bronchus to the lower lobe bronchus. Here pus was found, and removed after Jackson’s simple but ingenious method. The body as not found, and it was decided to wait.

Two evenings later a second attempt was made to remove the piece of amalgam. The instrument was introduced as before, quite easily, but this time the patient was laid across the X-ray couch. More muco-pus was pumped out, and the small bronchus, in which the body was lying, was recognised by the pus oozing from it. The tip of the tube was now found lying over the amalgam, but this could not be felt or seen with forceps. This effort was also abandoned. The following night the same procedure was gone through. Now a right angled probe was passed over the cartilagenous lip of the bronchus and the foreign body tilted into the lumen. Jackson’s forceps were passed, and the foreign body grasped and removed.

The patient bore the operation well, and said there was no pain experienced after the discomfort of passing the tube through the glottis. No anæsthetic, beyond the concainising of the hypopharynx, was used.

The patient was taken back to bed and placed in a steam tent. Dr. Bevan-Brown’s subsequent notes:

“Hoarseness and soreness on swallowing were present for two or three days after the removal of the foreign body, but the patient’s general condition was satisfactory. The temperature remained normal, the cough grew less severe, and there was very little expectoration. The fœtor gradually improved. She was very thin and weak, however, due chiefly to her chronic dyspepsia and exhaustion following a fortnight of incessant coughing. An X-ray examination of the chest, a week after the bronchoscopy, shewed everything clear. The infiltration previously seen round the foreign body had dispersed. A few days later, however, pain began to develop in the right chest, and there was evening pyrexia ranging from 90 degrees F., to 100 degrees F. for four or five days. This and the pain both eventually subsided without giving rise to any abnormal physical signs. The patient is now—six weeks from the operation—definitely better in every way.”

This is the first time I have removed a foreign body from the lung of a living subject. This foreign body was difficult to remove because of its weight and smallness, and because it lay out of sight in a branch bronchus. The operation confirmed my opinion that distal illumination was better than proximal. With the proximal light one’s instruments and fingers constantly interfered with one’s vision, and the carrier interfered with the insertion of forceps and probes. Further, Jackson’s instruments are so made that trauma is almost exceptional, while Brüning’s instruments, unless in the hands of much practised manipulators, seemed to invite damage.

My thanks are due to Dr. Hamilton Gould for ably assisting me. Jackson used to say: “It’s team-work, gentlemen.”

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Nil.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

1921

By T. A. MacGibbon, M.D., F.R.C.S.E.

Dr. F. V. Bevan-Brown sent Miss L. A. B., aged 30, with the following notes: “Miss B. was undergoing treatment for dyspepsia. She had a septic lower molar tooth, which was extracted, under gas anæsthesia, by a competent exodontist. The tooth was a mere shell with a large amalgam filling. The extraction was very difficult, the tooth breaking in the process. The dentist was not certain that he had recovered every piece. He X-rayed the upper half of the chest, but found no evidence of any foreign body in the main air passages. The following day the patient developed a troublesome dry cough, and a sense of irritation in the throat. There was some pharyngitis secondary to the pus from the septic stump, and this was considered sufficient to account for the cough, since careful examination of the chest revealed no abnormal signs. The patient did not report herself for nine days, during which she had coughed incessantly, and had become rather exhausted. There were still no physical signs in the chest, but a sign of considerable omen had by now developed, namely, fœtor of the breath. The cough was mostly dry, with, occasionally, a little muco-pus. An X-ray examination of the whole chest was now made, and a foreign body was clearly visible lying low down in the right lung, one inch and a-half above the dome of the diaphragm. It was the size of a pea, and so opaque that it was considered to be a piece of amalgam, and not a portion of the tooth.”

During the evening of the day, after I had examined the photograph, the patient was taken into the theatre of the Christchurch Hospital, and an attempt was made to locate the foreign body by means of Chevalier-Jackson’s instruments. The patient was placed in the supine position, and the pharynx and hypo-pharynx painted with 10 per cent solution of cocaine. Dr. Hamilton Gould then took charge of the head which was brought over the end of the table. Jackson’s laryngoscope, with distal illumination, was passed down to the entrance of the larynx, the bronchoscope, also with distal illumination, passed down inside the laryngoscope and through between the cords into the trachea. The slide of the laryngoscope was withdrawn, and the laryngoscope removed. The bronchoscope was slowly pushed down until the carina was encountered. Dr. Gould then inclined the head and neck to the left, and the tip of the instrument slipped easily into the right bronchus and down the mainstem bronchus to the lower lobe bronchus. Here pus was found, and removed after Jackson’s simple but ingenious method. The body as not found, and it was decided to wait.

Two evenings later a second attempt was made to remove the piece of amalgam. The instrument was introduced as before, quite easily, but this time the patient was laid across the X-ray couch. More muco-pus was pumped out, and the small bronchus, in which the body was lying, was recognised by the pus oozing from it. The tip of the tube was now found lying over the amalgam, but this could not be felt or seen with forceps. This effort was also abandoned. The following night the same procedure was gone through. Now a right angled probe was passed over the cartilagenous lip of the bronchus and the foreign body tilted into the lumen. Jackson’s forceps were passed, and the foreign body grasped and removed.

The patient bore the operation well, and said there was no pain experienced after the discomfort of passing the tube through the glottis. No anæsthetic, beyond the concainising of the hypopharynx, was used.

The patient was taken back to bed and placed in a steam tent. Dr. Bevan-Brown’s subsequent notes:

“Hoarseness and soreness on swallowing were present for two or three days after the removal of the foreign body, but the patient’s general condition was satisfactory. The temperature remained normal, the cough grew less severe, and there was very little expectoration. The fœtor gradually improved. She was very thin and weak, however, due chiefly to her chronic dyspepsia and exhaustion following a fortnight of incessant coughing. An X-ray examination of the chest, a week after the bronchoscopy, shewed everything clear. The infiltration previously seen round the foreign body had dispersed. A few days later, however, pain began to develop in the right chest, and there was evening pyrexia ranging from 90 degrees F., to 100 degrees F. for four or five days. This and the pain both eventually subsided without giving rise to any abnormal physical signs. The patient is now—six weeks from the operation—definitely better in every way.”

This is the first time I have removed a foreign body from the lung of a living subject. This foreign body was difficult to remove because of its weight and smallness, and because it lay out of sight in a branch bronchus. The operation confirmed my opinion that distal illumination was better than proximal. With the proximal light one’s instruments and fingers constantly interfered with one’s vision, and the carrier interfered with the insertion of forceps and probes. Further, Jackson’s instruments are so made that trauma is almost exceptional, while Brüning’s instruments, unless in the hands of much practised manipulators, seemed to invite damage.

My thanks are due to Dr. Hamilton Gould for ably assisting me. Jackson used to say: “It’s team-work, gentlemen.”

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

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