lts, and buttons, beads, sweets, coins,
and portions of toys in children. These are drawn from the mouth into
the air-passage during a sudden inspiratory effort, for example while
laughing or sneezing. If the glottis is completely blocked, rapidly
fatal asphyxia ensues. If the obstruction is incomplete, the patient
experiences severe pain, difficulty of breathing, and a terrifying
sensation of being choked. The irritation of the foreign body causes
spasmodic coughing and retching, and may induce spasm of the glottis,
with threatening suffocation.

Small round bodies may lodge in the upper aperture or in one of the
ventricles, and give rise to hoarseness and repeated attacks of
dyspnoea and spasmodic cough. Wherever the body is situated, the
symptoms may suddenly become urgent from its displacement into the
glottis, or from the onset of oedema. The position of the body may
often be ascertained by the use of the X-rays.

_Treatment._--If the symptoms are urgent, laryngotomy, which consists
in opening the larynx below the glottis by dividing the crico-thyreoid
membrane, or tracheotomy must be performed at once, and an attempt
made to remove the foreign body thereafter. In less severe cases in
adults, the throat should be sprayed with cocain, and the larynx
examined with the mirror; in children, the direct method must be
employed. In both instances an attempt should be made to extract the
body by the direct method. As these manipulations are liable to induce
sudden spasm of the glottis, the means of performing tracheotomy must
be at hand. If it is found impossible to remove the body through the
mouth, laryngotomy or tracheotomy should be performed, and the body
extracted through the wound, or pushed up into the pharynx and removed
by this route. In the case of small bodies, a strand of gauze pushed
up from the tracheotomy wound, through the larynx and out of the
mouth, catches the foreign body and carries it out (Walker Downie).

The foreign bodies that are most likely to become impacted _in the
trachea_ are tooth-plates with projecting hooks, and small coins. The
position of the foreign body may be ascertained by the use of
Killian's tracheoscope, or by means of the X-rays. If the body remains
movable in the trachea, it is apt to be displaced when the patient
moves or coughs, and it may be driven up and become impacted in the
glottis, setting up violent attacks of coughing and spasmodic
dyspnoea.

Tracheotomy should b