Diseases of the chest and the principles of physical diagnosis . ee Figs. 225 and 226). The passagedownward of the foreign body is facilitated by gravity and by the in-spiratory widening of the trachea and main bronchi. The rapiditywith which the foreign substance passes downward is due in part to its 1 Peroral Endoscopy and Laryngeal Surgerj^, 1915. - Trans, of Sec. on Laryngology, Otology and Rhinology, 1917, p. 36. DISEASES OF THE BRONCHI 299 size and part to the shape of the object. In any case there is producedirritation and spasm of the larynx and trachea and more or less severeparoxysms
Diseases of the chest and the principles of physical diagnosis . ee Figs. 225 and 226). The passagedownward of the foreign body is facilitated by gravity and by the in-spiratory widening of the trachea and main bronchi. The rapiditywith which the foreign substance passes downward is due in part to its 1 Peroral Endoscopy and Laryngeal Surgerj^, 1915. - Trans, of Sec. on Laryngology, Otology and Rhinology, 1917, p. 36. DISEASES OF THE BRONCHI 299 size and part to the shape of the object. In any case there is producedirritation and spasm of the larynx and trachea and more or less severeparoxysms of coughing in the effort to dislodge the object. As a rulethe severity of the symptoms subside with the final lodgment of theforeign body in one of the larger branches of the bronchial tree. Spontaneous expulsion of the foreign substance may occur at anearly period or months or years may elapse. In one case under my carea tooth was coughed up eighteen months after it had aspirated into thebronchi; in another case a brass-headed tack was expelled four or five. Fig. 225.—Trachea and bronchi viewed from behind. Note the larger size of the rightbronchus and its straighter course. The nail shown in the glass tube had lodged in theright bronchus at A where it ulcerated through into the lung. {Jefferson Medical CollegeMuseum.) years after it had entered the bronchus. In 124 cases recorded by Dur-ham in which recovery followed spontaneous expulsion, the interval in 28of the cases was from one to seventeen years. Jackson has reportedcases in which the foreign body was removed some years after the initialaccident; in one case an interval of twenty-six j^ears had elapsed. Spontaneous expulsion will depend on the nature of the foreign it is small and devoid of sharp points it may be coughed up but if itis long, narrow and sharp-pointed, such as a hair pin or a safety pin, theonly hope of relieving the patient lies in turgical interference or the useoi the bronchoscope. If the f
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