infective laryngotracheitis, and many other
diseases.
10. Deductive decisions are dangerous.
11. If the roentgenray is negative, laryngoscopy (direct in
children, indirect in adults) without anesthesia, general or local, is
the only way to make a laryngeal diagnosis.
12. Before doing a diagnostic laryngoscopy, preparation should be
made for taking a swab-specimen and for bronchoscopy and
esophagoscopy.

_Tracheal Foreign Body_.--(1) "Audible slap," (2) "palpatory thud,"
and (3) "asthmatoid wheeze" are pathognomonic. The "tracheal flutter"
has been observed by McCrae in a case of watermelon seed. Cough,
hoarseness, dyspnea, and cyanosis are often present. Diagnosis is by
roentgenray, auscultation, palpation, and bronchoscopy. Listen long
for "audible slap," best heard at open mouth during cough. The
"asthmatoid wheeze" is heard with the ear or stethoscope bell (McCrae)
at the patient's open mouth. History of initial choking, gagging, and
wheezing is important if elicited, but is valueless negatively.

_Bronchial Foreign Body_.--Initial symptoms are coughing, choking,
asthmatoid wheeze, etc. noted above. There may be a history of these
or of tooth extraction. At once, or after a symptomless interval,
cough, blood-streaked sputum, metallic taste, or special odor of
foreign body may be noted. Non-obstructive metallic foreign bodies
afford few symptoms and few signs for weeks or months. Obstructive
foreign bodies cause atelectasis, drowned lung, and eventually
pulmonary abscess. Lobar pneumonia is an exceedingly rare sequel.
Vegetable organic foreign bodies as peanut-kernels, beans, watermelon
seeds, etcetera, cause at once violent laryngotracheobronchitis, with
toxemia, cough and irregular fever, the gravity and severity being
inversely to the age of the child. Bones, animal shells and inorganic
bodies after months or years produce changes which cause chills,
fever, sweats, emaciation, clubbed fingers, incurved nails, cough,
foul expectoration, hemoptysis, in fact, all the symptoms of chronic
pulmonary sepsis, abscess, and bronchiectasis. These symptoms and some
of the physical signs may suggest pulmonary tuberculosis, but the
apices are normal and bacilli are absent from the sputum. Every acute
or chronic chest case calls for the exclusion of foreign body.

_The physical signs_ vary with conditions present in different cases
and at different times in the same case. Secretions, normal and
pathologic, may shift f