A FENCE STAPLE IN THE LUNG
Journal of the American Medical Association
patient had little prostration and no fever and got well in two days with rectal irrigations. 3. Catarrhal colitis in adults with serous fluid the chief inflammatory product. This condition differs clinically from the foregoing. The passages are copious, from one-fourth to one pint, at first soft fecal, then simply gushes of watery fluid, either green or brown, often preceded by colic Camera lucida sketch of section of colon, showing outlines of the larger lymph channels in submucosa; X 15. but
... ubmucosa; X 15. but unassociated with tenesmus. Blood does not occur, and mucus is absent or nearly so. The patients are prostrated and may even faint after a large passage. There is little or no fever. The condition lasts longer than the mucoid form, and if untreated, may run for weeks. The following case, also from my private records, serves to illustrate the condition. Case 2.-Man, aged 35, without known cause, was taken with abdominal cramps and chilly sensations followed by fourteen large watery movements in twenty-four hours. The passages contained a few flakes of fecal matter but no mucus or blood. He did not suffer with tenesmus. He vomited once, was nauseated and much prostrated. With rest in bed and appropriate drugs the symptoms promptly subsided. The lesion of this form of colitis has, I believe, not been described. I wish, therefore, to report the following case from the second medical division of Bellevue Hospital : Case 3.-A laborer, aged 41, was sick and died of a lobar pneumonia on the eighth day. On the sixth day of his illness, following a dose of salts, he began to have frequent copious watery discharges, without pain or tenesmus, which continued to the time of his death. In the two days he had about twenty passages of brown or green fluid, containing no fecal matter, no blood, and practically no mucus. He did not vomit. At necropsy, three hours after death, the heart was found normal. The whole right lung was consolidated. The stomach was distended with gas and a quart of light green, turbid, serous fluid, and its wall was coated with thick, tena¬ cious mucus but not at all congested. The small intestine con¬ tained a moderate amount of viscid yellow chyle throughout. There was moderate gaseous distention of the jejunum; it was normal. The colon contains«! a little gas and was nowhere tightly contracted, though rather smaller than usually seen at necropsy. It was empty through its entire length, containing altogether about a half ounce of soft mucoid fecal matter, mostly in the caput. The mucosa was strikingly clean and edematous, looking as if it had just been washed in running water. There were no congestion, no ulcers, no hypertrophied lymph follicles. Under the microscope the mucosa and muscle coat were normal. The submucosa, only, was markedly thickened by edema, and its lymph spaces truly enormous. The accompanying illustration shows the relative dimensions of the larger ones. There were no congestion, no diapedesis of red or white cells and no follicular hypertrophy. There was marked thickening of the walls of the larger vessels, not due to muscular or connec¬ tive tissue hypertrophy, but to a homogeneous swelling of their elements. It is, of course, uncertain, with the bowel symptoms only an incident in the course of a lobar pneumonia and beginning after a saline, whether the lesion is characteristic of serous colitis or not. But necropsies are so rare and the pathologic features of the colon so definite and peculiar and yet so intelligibly associated with a copious serous exúdate, that I have thought it proper to put the case on record as a contribution to the pathology of the condition. The mechanical problem of the bronchoscopic extraction of an open safety-pin lodged point upward in the trachea or the bronchi is readily solved because of the ease with which the pin can be closed or cut in two for removal. With the double-pointed staple, however, we have to deal with a rigid body of tough steel that cannot be bent, sprung or broken. The author has succeeded in three cases in turning and withdrawing the staple by a method which is best illustrated by the last and most difficult case.1 Mr. W., aged 44, was referred to me by Dr. L. P. Warren of Wichita for the removal of a fence-wire staple which Fig. 1.-Anteroposterior view of chest showing staple in a posterior branch of the inferior-lobe bronchus. (From roentgenogram by Dr. George W. Grier.) had been in the right lung for fifteen days, having been aspirated while being held in the mouth. There were no symptoms after the accident. Roentgenograms made for me by Dr. George W. Grier showed the staple to be in the lower lobe of the right lung (Figs. 1 and 2). Overlaying with my positive films of the tracheobronchial tree showed the 1. Since the foregoing was written, a fourth case has been similarly successfully dealt with. The points of a very large staple were turned down into the opposite main bronchus.