isis pulmonalis is a relic of the days when
the bacillary origin of true tuberculosis was unknown, hence the
foreign-body phthisis pulmonalis, or pseudo tuberculosis, was confused
with the true pulmonary tuberculosis of bacillary origin.
6. The subjective sensation of pain may allow the patient accurately
to localize a foreign body.
7. Foreign bodies of metallic or organic nature may cause their
peculiar taste in the sputum.
8. Offensive odored sputum should always suggest bronchial foreign
body; but absence of sputum, odorous or not, should not exclude
foreign body.
9. Sudden complete obstruction of one main bronchus does not cause
noticeable dyspnea provided its fellow is functionating.
[131] 10. Complete obstruction of a bronchus is followed by rapid
onset of
symptoms.
11. The physical signs usually show limitation of expansion on the
affected side, impairment of percussion, and lessened trans-mission or
absence of breath-sounds distal to the foreign body.

* The exceptional case has at last been encountered. A boy with a tack
in the bronchus was found to have pulmonary tuberculosis.

SYMPTOMS OF GASTRIC FOREIGN BODY

Foreign body in the stomach ordinarily produces no symptoms. The
roentgenogram and the fluoroscopic study with an opaque mixture are
the chief means of diagnosis.

DIAGNOSIS OF FOREIGN BODY IN THE AIR OR FOOD PASSAGES

The questions arising are:
I. Is a foreign body present?
2. Where is it located?
3. Is a peroral endoscopic procedure indicated?
4. Are there any contraindications to endoscopy?

In order to answer these questions the definite routine given below is
followed unvaryingly in the Bronchoscopic Clinic.
1. History.
2. Complete physical examination, including mirror laryngoscopy.
3. Roentgenologic study.
4. Endoscopy.

The history should note the date of, and should delve into the details
of the accident; special note being made of the occurrence of
laryngeal spasm, wheezing respiration heard by the patient or others
(asthmatoid wheeze), fever, cough, pain, dyspnea, dysphagia,
odynphagia, regurgitation, etc. The amount, character and odor of
sputum are important. Increasing amounts of purulent, foul-odored,
sometimes blood-tinged sputum strongly suggest prolonged bronchial
foreign body sojourn. The mode of onset of the persisting symptoms,
whether immediately following the supposed accident or delayed in
their occurrence, is to be noted. Do attacks of