usually present in tracheal foreign
bodies, and is often louder and of lower pitch than the asthmatoid
wheeze of bronchial foreign bodies. It is heard at the open mouth, not
at the chest wall; and prolonged expiration as though to rid the lungs
of all residual air, may be necessary to elicit it.
8. Pain is not a common symptom, but may occur and be accurately
localized by the patient, in case of either tracheal or bronchial
foreign body.

EARLY SYMPTOMS OF IRRITATING FOREIGN BODY SUCH AS A PEANUT KERNEL IN
THE BRONCHUS

1. Initial laryngeal spasm is almost invariably present with foreign
bodies of organic nature, such as nut kernels, peas, beans, maize,
etc.
2. A diffuse purulent laryngo-tracheo-bronchitis develops within 24
hours in children under 2 years.
3. Fever, toxemia, cyanosis, dyspnea and paroxysmal cough are
promptly shown.
4. The child is unable to cough up the thick mucilaginous pus
through the swollen larynx and may "drown in its own secretions"
unless the offender be removed.
5. "Drowned lung," that is to say natural passages idled with pus
and secretions, rapidly forms.
6. Pulmonary abscess develops sooner than in case of mineral foreign
bodies.
7. The older the child the less severe the reaction.

SYMPTOMS OF PROLONGED FOREIGN BODY SOJOURN IN THE BRONCHUS

1. The time of inhalation of a foreign body may be unknown or
forgotten.
2. Cough and purulent expectoration ultimately result, although
there may be a delusive protracted symptomless interval.
[130] 3. Periodic attacks of fever, with chills and sweats, and
followed by increased coughing and the expulsion of a large amount of
purulent, usually more or less foul material, are so nearly diagnostic
of foreign body as to call for exclusion of this probability with the
utmost care.
4. Emaciation, clubbing of the fingers and toes, night sweats,
hemoptysis, in fact all of the symptoms of tuberculosis are in most
cases simulated with exactitude, even to the gain in weight by an
out-door regime.
5. Tubercle bacilli have never been found, in the cases at the
Bronchoscopic Clinic, associated with foreign body in the bronchus.*
In cases of prolonged sojourn this has been the only element lacking
in a complete clinical picture of advanced tuberculosis. One point of
difference was the almost invariably rapid recovery after removal of
the foreign body. The statement in all of the text-books, that foreign
body is followed by phth