Nothing could be seen in the throat or fauces, but the whole anterior part of the neck and chest were emphysematous, so much so, that the larynx and trachea could with difficulty be felt. On applying the ear to

the chest, the respiratory murmur was not heard at all at the upper part of the right side, and below it was feeble. Between the cartilages of the second, third, and fourth ribs, the "râle sifflant" was heard. The voice was shrill, the pulse soft and slow. From these symptoms, Dr. Reiche assured the parents, that, in all probability, a foreign body was lodged in the child's trachea, and, on strictly questioning the servant-maid, it was found that, on the preceding evening, she had put ito its mouth a quarter of a nut whilst crying, immediately after which, it was seized with so violent a fit of coughing as to threaten suffocation. After a time the paroxysm went off, and the parents of the child remarked nothing particular about it, save that it was restless, and wheezed a little in its breathing. Towards nine o'clock that evening, the child, however, became so ill that a medical man was sent for, who considered the case as one of croup, and ordered leeches to the neck, emetics, &c. On the next morning the emphysema made its appearance, and, at noon, when our author was summoned in consultation, the symptoms were those which have already

been described.

Both medical gentlemen were now convinced that, without tracheotomy, the patient must die, and stated as much to the parents. These latter however, obstinately refused to allow of its performance, influenced by a case related by the grandmamma, where a young peasant had coughed up a pea which was lodged in the windpipe. The grandmamma prevailed over the doctors, and all that was left for the latter to do was, to palliate the bronchial irritation and inflammation by leeches to the right side, demulcents, and a powder of calomel and extract of hyosciamus, together with an emetic, to second the natural efforts at expulsion of the foreign body. During the night, no aggravation of the symptoms took place, and no relief had ensued on the 9th. cough was now accompanied with expectoration, which the child invariably swallowed. In the evening the cough was so severe as to excite convulsions, the paroxysms of

The

difficult inspiration returned every five or six minutes, the wheezing was very loud, the emphysema had extended. Calomel, ext. hyosciam. digitalis, radix ipecacuanhæ, and the sulphuret of antimony, julep of the syrup of senega and bitter alimond water, and a blister, were the means employed. On the 10th, after a convulsive paroxysm of coughing, a calm ensued, and the child fell asleep. The râle sifflant now disappeared-in the afternoon, the portion of undigested nut was discovered in the stools-the little patient improved daily-the emphysema, in a fortnight or three weeks, had vanished, and, in short, the patient speedily recovered.

The

Dr. Reiche supposes, and no one can reasonably doubt the fact, that during the violent coughing, the child had ejected the portion of nut from the respiratory tube, and swallowed it with the rest of the expectorated matters. Although the grandmother proved to be right, yet the medical consultants were fully justified in proposing the operation, if not in hazarding the decided opinion they did on the probable consequence of its not being resorted to. emphysema that took place is always to be looked on as a formidable symptom, though some degree of difficulty must arise in detrmining its immediate cause. In the celebrated case recorded by M Louis, in the Mémoires of the French Academy of Surgery, it depended, not on laceration of the mucous membrane of the trachea, but in rupture of the air-cells of the lungs themselves, and escape of the air from thence to the anterior mediastinum and neck. Whether this was the case in the present instance, we leave to our readers to settle as they please.

Case 2. On this we shall touch very briefly. The patient was a girl, six years of

age, who swallowed a plumb-stone, and was instantly seized with a fit of suffocation, which returned from time to time, accompanied with violent cough and expectoration, mixed with streaks of blood. She was seen, next day, by Dr. Reiche, who found nothing but the râle sifflant during respiration, a frequent cough, and a want of the respiratory murmur betwixt the second and third costal cartilages on the right side. There were neither those

occasional difficult inspiratious, nor the emphysema noticed in the former case. The trachea was opened from its second to its sixth ring, but the foreign body could not be found. The introduction of an oiled sound into the wound occasioned such pain that it was given up, and the patient conveyed to bed. In the course of half an hour, our author made some fresh attempts to discover and extract the stone, and at length his exertions were crowned with success, the foreign body being removed by the common forceps. The wound was a considerable time in healing, but the little patient ultimately did well.

Dr. Reiche remarks that, in both these cases, and in most of those that he has read in authors, the whistling (sifflement) of the breathing was remarkably distinct. When coupled with the other symptoms, and the circumstances under which they make their appearanee, he thinks it would be sufficient to point out the nature of the accident, even although no mention should be made of a foreign body having been swallowed. The symptoms are most easily, indeed most frequently, confounded with croup; but setting aside the absence of the "bruit sifflant" in that disease, Dr R. believes that the frequent cough, together with the alteration of sound, both in it and in the voice, would sufficiently distinguish the symptoms of croup, from those of the lodgement of foreign bodies in the larynx or trachea.

XXX.

ON THE CURATIVE EFFECTS OF CARRIAGE AND TRAVELLING EXERCISE. BY M. CoRIOLIS ; WITH OBSERVATIONS, by Dr JOHNSON.

"Longum, iter est per præcepta-breve et efficax Seneca. per exampla."

The author of this paper which is published in a late number of Magendie's Journal, is an engineer, but evidently a man of science, as well as sense. Being also an invalid, he took the advice of a celebrated Parisian physician, who recommended him carriage-exercise, for the cure of a nervous complaint with which he was afflicted. M. Coriolis set about making

a number of experiments on the different kinds of exercise, and on the effects of these on the human body, its functions and its disorders. There is a general impression on all minds that exercise is conducive to health-and the impression is founded in truth; but there is considerable diversity in the modes and effects of exercise and that which would cure one disease might aggravate another.

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The author justly observes, that exercise produces two very distinct effects, --that which results from the expenditure of power--and that which results from the movements of different parts of the body. These effects can be produced either separately or simultaneously. They are both effected in walking, and in almost every species of active exercise The expenditure of force can be effected singly, as, for instance, in the support of a burthen, where no motion is given to the muscles or other parts of the body. The same expenditure is produced by mental labour, without exercise of the body. This last kind of expenditure generally leads to exhaustion and debility. It is a common cause in civilized life, of various diseases, and requires counteracting remedial agencies. To give movement to the various parts of the body, without expenditure of power, the carriage is the best vehicle, though our author includes horsemanship, which, however, requires the action of many muscles. We agree with M. Coriolis, that passive exercise is productive of excellent effects in various chronic diseases. He thinks that these good effects are not to be solely ascribed to the change of air, and the amusement of travelling; but that much is attributable to the passive or oscillatory motion communicated to the different structures of the body. Such is the conviction produced by experiments made in his own person. He remarks, that travelling in some kinds of voitures, causes illness-at least sickness, rather than restoration of strength-while conveyance by a different kind of machine has an opposite effect.So, again, the effects of a sea voyage, where there is little motion of muscles, though plenty of fresh air, are very dif ferent from travelling in a convenient carriage, where there is more of the succussive or passive motion communicated to the body. We daily observe people liv

ing in the purest air of the country, with abundance of mental amusement, whose health is bettered, and whose strength is recruited, by travelling from home, even in carriages with the windows closed. This, he observes, proves the utility of passive motion. M. Coriolis makes many judicious remarks on the effects of carriage exercise, as modified by the construction of the vehicle. The swinging of the easy Berlin is far less salutary than the quick and rapid vibration of the common stages, where the springs are short, and the velocity of movement considerable. The author, afterthese considerations, comes to the conclusion, or rather, to the proposition, that machines should be constructed, and worked by steam, at a small expense, in which invalids might have all the vibratory movements and beneficial effects of stage-coach travelling, without going out of the environs of Paris. Here we are forced to disagree with M. Coriolis We are willing to concede to his plan all the good effects, and they are many, resulting from the passive or vibratory motion of travelling vehicles; but observation somewhat more extensive than that of M. Coriolis, convinces us that these passive movements, imparted by the most ingenious steam-engine, would prove a very poor substitute for that combinatron of salutary effects, moral and physical, which results from travelling. The following extracts from a work recently published by the Editor of this Journal, and which, for obvious reasons, could not be reviewed, will probably be pardoned, as it is the only notice the work has ever received in the MedicoChirurgical Review.

TRAVELLING.

Physical Effects. The first beneficial influence of travelling is perceptible in the state of our corporeal feelings. If they were previously in a state of morbid acuteness, as they generally are in ill health, they are rendered less sensible. The eye, which was before annoyed by a strong light, soon becomes capable of bearing it without inconvenience; and so of hearing, and the other senses. In short, morbid sensibility of the nervous system generally is obtunded or reduced. This is brought about by a more regular and free exposure to all atmospheric impressions and changes than before, and that under a condition of body, from exercise,

which renders these impressions quite harmless Of this we see the most striking examples in those who travel among the Alps. Delicate females and sensitive invalids, who, at home, were highly susceptible of every change of temperature and other states of the atmosphere, will undergo extreme vicissitudes among the mountains, without the smallest inconvenience, I will offer an example or two in illustration. In the month of August, 1823 the heat was excesive at Geneva and all the way along the defiles of the mountain, fill we got to Chamouni, where we were at once, among ice and snow, with a fall of 40 or more degrees of the thermometer, experienced in the course of a few hours, between mid-day at Salenche, and evening at the foot of the Glaciers in Chamouni. There were upwards of fifty travellers here, many of whom were females and invalids; yet none suffered inconvenience from this rapid atmospheric transition. This was still more remarkable in the journey from Martigny to the Great St. Bernard. On our way up, through the deep vallies, we had the thermometer at 92 degrees of reflected heat for three hours. I never felt it much hotter in the East Indies. At9 o'clock that night, while wandering about the Hospital of the St. Bernard, the thermometer fell to six degrees below the freezing point, and we were half frozen in the cheerless apartments of the monastery. There were upwards of forty travellers there-some of them in very delicate health; and yet not a single cold was caught, nor any diminution of the usual symptoms of a good appetite for breakfast next morning.

"This was like a change from Calcutta to Melville Island in one short day! So much for the ability to bear heat and cold by journeying among the Alps. Let us see how hygrometrical and barometrical changes are borne. A very large concourse of travellers started at day-break from the village of Chamouni to ascend the Montanvert and Mer de Glace. The morning was beautiful; but before we got two-thirds up the Montanvert, a tremendous storm of wind and rain came on us, without a quarter of an hour's notice, and we were drenched to the skin in a very few minutes. Some of the party certainly turned tail; and one

Hypochondriac nearly threw me over a precipice, while rushing past me in his precipitate retreat to the village. The majority, however, persevered, and reached the Chalet, dripping wet, with the thermometer below the freezing point. There was no possibility of warming or drying ourselves here; and, therefore, many of us proceeded on to the Mer de Glace, and then wandered on the ice till our clothes were dried by the natural heat of our bodies. The next morning's muster for the passage over the Col de Balme, showed no damage from the Montanvert expedition. Even the Hypochondriac above mentioned regained his courage over a bottle of Champagne in the evening at the comfortable "Union," and mounted his mule next morning to cross the Col de Balme. This day's journey shewed, in a most striking manner the acquisition of strength which travelling confers on the invalid. The ascent to the summit of this mountain pass is extremely fatiguing; but the labour is compensated by one of the sublimest views from its highest ridge, which they eye of man ever beheld. The Valley of Chamouni lies behind, with Mont Blanc and surrounding mountains apparently within a stone's throw, the cold of the Glaciers producing a most bracing effect on the whole frame. In front, the Valley of the Rhone, flanked on each side by snow-clad Alps, which, at first sight, are taken for ranges of white clouds, presents one of the most magnificent views in Switzerland, or in the world. The sublime and the beautiful are here protended before the eye, in every direction, and in endless variety, so that the traveller lingers on this elevated mountain pass, lost in amazement at the enchanting scenery by which he is surrounded on every point of the compass. The descent on the Martingy side, was the hardest day's labour I ever endured in my life-yet there were three or four invalids with us, whose lives were scarcely worth a year's purchase when they left England, and who went through this laborious, and somewhat hazardous descent, sliding, tumbling, and rolling over rocks and through mud, without the slightest ultimate injury. When we got to the goat-herds' sheds in the valley below, the heat was tropical, and we all threw ourselves on the ground and slept soundly for two hours--rising refreshed to pursue our jour

ney.

"Now these and many other facts which I could adduce, offer incontestible proof, how much the morbid susceptibility to transitions from heat to cold-from drought to

drenchings-is reduced by travelling. The vicissitudes and exertions which I have described would lay up half the effeminate invalids of London, and kill, or almost frighten to death, many of those who cannot expose themseves to a breath of cold or damp air, without cough or rheumatisms, in this country. These facts may suggest some important indications to the physician who has charge of patients labouring under, or threatened with, certain affections of the chest."

"The next effect of travelling which I shall notice is its influence on the organs of digestion. This is so decided and obvious, that I shall not dwell long on the subject. The appetite is not only increassd; but the powers of digestion and assimilation are greatly augmented. A man may eat and drink things while travelling, which would make him quite ill in ordinary life. A strong proof of its effects on assimilation is affordmuch more food is taken in while travelling, ed by the universal remark that, although much less fæcal remains are discharged, and costiveness is a very general symptom among those who make long and repeated journeys, especially in a carriage or on horseback. The motions, which were previously of bad colour and consistence, soon become formed, or even solid, and of a perfectly healthy appearance. The constipation, which often atcasions, is hardly ever accompanied by any tends passive or mixed exercise, on these ocinconvenience; and travellers will go two or three days without a motion, and experi ence no disagreeable sensation, although the same degree of confinement of the bowels, at other times, would render them ill, or at least very uncomfortable.

"These unequivocally good effects of travelling on the digestive organs account satisfactorily for the various other beneficial influences on the constitution at large. Hence dyspepsia, and the thousand wretchde sensations and nervous affections thereon dependent, vanish before persevering exercise in travelling, and new life is imparted to the whole system, mental and corporeal."

"This kind of exercise has a marked in

fluence on the absorbent system, exerting it into great activity. The fluids from the intestinal canal are rapidly taken up into the circulation, and thrown off by the skinwhich is one cause of the constipation to which most travellers are subject. This effect of travelling exercise points out the benefits which may be obtained from it in certain tropical complaints, and in obesity. The activity of the absorbents causes the fat to be taken up, while exercise and improved digestion increase the force and firmness of the muscles. Thus corpulent people become thinner while travelling, (especially where active exercise is combined with passive) but what they lose in weight they gain in strength.

"The effects of travelling on the circulation are peculiar. Active exercise quickens, no doubt, the pulse-while passive exercise in a carriage renders it slower. In those diseases of the heart, therefore, where there is enlargement of the organ, with increase of force in the circulation, there can be little doubt, that a combination of active and passive exercise would be hazardous. In such cases the exercise should be entirely passive, and then the effects would be beneficial. There are many cases, however, where the irritability of the heart depends on disordered states of other organs, and especially of the stomach-in which cases, the exercises of travelling, active and passive, offers a powerful remedy. In such instances, the exercise should be, at first, passive ;-and afterwards the active kind gradually ventured on.

certain in what consists this difference of one air from another, since the composition of the atmosphere appears to be nearly the same on all points of earth and ocean. But we know, from observation, that there are great differences in air, as far its effects on the human body are concerned. Hence it would appear that the human body, confined to one particular air, be it ever so pure, languishes at length, and is bettered by a change. This idea is supported by analogy. The stomach, if confined to one species of food, however wholesome, will, in time languish, and fail to derive that nutriment from it, which it would do, if the species of food were occasionally changed. The ruddy complexion then of travellers, and of those who are constantly moving from place to place, as stage-coachmen, for example, does not, I think, solely depend on the mere action of the open air on the face, but also on the influence which change of air exerts on the blood itself in the lungs. I conceive, then, what Boerhave says of exercise, may be safely applied to change of air. 'Eo magis et densum, et purpureum sanguinem esse, quò validius homo se exercuerit motu musculorum.'”

As medical men are often consulted as to the propriety or salubrity of a tour on the Continent, the following rapid outline of one, in which some of the most interesting parts of the world were travelled over in the course of three Autumnal months, may not prove uninteresting.

"There is but one other effect of travelling to which I shall allude before I close this Essay, but I think it a very important one-if not the most important of all It is the influence which constant change of air exerts on the blood itself. Fvery one knows the benefits which are derived from change of air, in many diseases, when that change is only from one part to another, a few miles separated. Nay, it is proved, beyond all possibility of doubt, that the change from what is considered a good, to what is thought a bad air, is often attended with marked good effects. Hence it is very reasonable to conclude, that the mere change of one kind of air for another has an exhilarating or salutary effect on the animal economy. It is true that we have no instruments to as

"The experiment was tried, whether a constant change of scene and air, combined with almost uninterrupted exercise, active and passive, during the day-principally in the open air, might not ensure a greater stock of health, than slow journeys and long sojourns on the road. The result will be seen presently. But in order to give the reader some idea of what may be done in a three month's tour of this kind, I shall enumerate the daily journeys, omitting the excursions from and around those places at which we halted for the night, or for a few days. Our longest sojourn was that of a week, and that only thrice at Paris, Geneva, and Brussels. In a majority of places, we only stopped a night and part of a day, or one or two days, according to local interest. But I may remark that, as far as I was concerned,