A Case of Foreign Body (Gold 
Coin) engaged in the Ventri- 
cles of the Larynx. 
BY 
A. W. de ROALDES, M. D., 
NEW ORLEANS. 
REPRINTED FROM THE 
Neto Turk journal 
for October 27, 1894- Reprinted from the New York Medical Journal 
for October 57, 189f 
A CASE OF 
FOREIGN BODY (GOLD COIN) ENGAGED IN 
THE VENTRICLES OF THE LARYNX* 
By A. W. de ROALDES, M. D., 
NEW ORLEANS. 
Some months ago, Lester C., aged twenty-five years, a 
powerfully built man, in good health, but somewhat addicted 
to alcoholic abuses, was talking with some friends in a farmer's 
house near Crowley, La. One of the men present produced a 
$2.50 gold piece and displayed it somewhat as a curiosity. The 
patient snatched the coin from the hand of his friend by way 
of a joke, and, putting it in his mouth, announced that it would 
be the last seen of the coin, as he was going to swallow it. 
Something was said in the conversation which excited laughter, 
and the coin dropped down in the man's larynx. He was im- 
mediately seized with intense dyspnoea, and very severe cough 
and gagging. After a while the breathing became easier and 
the cough abated. Was seen by Dr. Morris, of Crowley, and 
another physician, who advised his removal to New Orleans; 
he was brought by his friends to my office thirty hours after 
the accident. 
The voice was simply husky, but otherwise he breathed now 
quite freely. There is a slight difficulty on swallowing. Upon 
* Read before the American Laryngological Association at its six- 
teenth annual congress. 
Copyright, 1894, by D. Appleton and Company. 2 
A FOREIGN BODY IN THE LARYNX. 
pressure of the larynx, the patient referred the position of the 
coin to a spot over the region of the ventricles and vocal cords. 
The coin was readily detected by the laryngoscopic mirror. 
Everything was prepared for its extraction and for a possible 
tracheotomy in case it slipped lower down in the attempt at re- 
moval. A five-per-cent, solution of cocaine was liberally sprayed 
into the larynx, and with the aid of a heliostat the rays of a 
bright sunlight were reflected in the larynx, and the parts were 
accurately drawn by Dr. G. Q. Kohnke, of this city, who was 
sent for and kindly consented to come to my office. 
As you will see in his excellent drawing, the coin was seen 
impacted in the larynx between the vocal cords and the ven- 
tricular bands, with its surfaces up and down, reverse upper- 
most, almost completely filling up the chink of the glottis, only 
a small, transversely oblong breathing space being left in ordi- 
nary respiration between the south pole of the coin in front 
and the hypersemic mucous membrane of the inter-aryteenoid 
space behind (inverted image). The segments of the coin cor- 
J 
responding to the extremities of its equatorial line were protrud- 
ing into the ventricles and well imbedded under the false vocal 
bands. These covered a portion of its circumference at each 
side, leaving exposed a triangular metallic surface, the base of 
which was formed by the free edge of the coin, while the apex 
was overhung by the epiglottis. 
The coin was solidly fixed, as could be demonstrated by tap- 
ping its upper surface with a stout laryngeal probe. When at- A FOREIGN BODY IN THE LARYNX. 
3 
tempting to phonate the vowel A, the arytaenoids and processus 
vocales were seen to approximate. When asked to try and emit 
forcibly a sound in the upper register, as " I," for instance, the 
coin was completely surrounded and encircled by the soft parts 
of the rima glottidis and the patient at once suffocated. This 
condition is well shown in the drawing. After demonstrating 
at leisure the case to those present, and having obtained an abo- 
lition of the laryngeal reflexes, thanks to the careful cocainiza- 
tion of the parts by my assistant, Dr. Scheppegrell, I at once 
introduced, with the help of a laryngeal mirror, a Schrotter's 
forceps with jaws, possessed of an up-and-down power of pre- 
hension, the instrument being introduced laterally at first, so 
that the lower jaw would clear the posterior edge of the coin. 
The handle was then brought in the middle line, and the jaws 
of the forceps were then closed by the lever in the handle, and 
the coin removed. 
The resistance offered by the vocal bands was such that, 
feeling that my hold was slipping, and fearing a repetition of 
the accident which happened in Dr. Ives's case (swallowing of 
the coin), or falling of the coin into the trachea, I hastily put 
aside the mirror, as Grazzi did in his observation, and strength- 
ened my hold by additional pressure with my left hand on the 
handle of the instrument, and jerked out the coin, as it were, 
from its bed. The patient was discharged the next day in very 
good condition. 
With this experience I can not recommend too highly 
the use of a strong Schrotter's forceps, and advise the 
operator to lay aside his laryngeal mirror after having- 
grasped the coin, in order to strengthen his hold at the 
handle with the fingers of the left hand, which might also 
be used to lift up the instrument on the course of its stem. 
Bibliographical References. 
Duncan, J. Removal of a Coin from the Larynx by Inver- 
sion of the Body. Northern Journal of Medicine, Edinburgh, 
1845, vol. ii, p. 220. 
Geoghegan, T. G. Expulsion of a Coin from the Larynx 
by an Act of Coughing. Dublin Medical Press, 1854, p. 225. 4 
A FOREIGN BODY IN THE LARYNX. 
Adams, A. L. A Sovereign Impacted in the Larynx; Re- 
moval Two Months afterward. Lancet, 1859, vol. ii, p. 395. 
Sanderson, J. B., and Hulke, J. W. Case in which a Six- 
pence was Lodged in the Larynx during Ten Weeks. Lancet, 
1865, vol. ii, p. 39; also Medico-chirurgical Transactions, Lon- 
don, 1865, vol. xlviii, p. 201. 
Cameron, J. Case of Removal of a Penny which had been 
Impacted for Six Years in the Larynx. Liverpool Medical and 
Surgical Reports, 1870, vol. iv, p. 180; reported also by James 
Petrie in British Medical Journal, August 20, 1870, pp. 186-187. 
Smith, Henry. Case where Half a Sovereign was Impacted 
in the Larynx. British Medical Journal, 1871, vol. i, p. 7. 
Grazzi, Vittorio. Storia della penetrazione nella larynge d 
una moneta di due centesimi estratta dopo 43 giorni per le vie 
naturali. Bolletino delle malatie dell' orecchio, della gala e del 
naso, 1882, vol. ii, p. 77. 
Ives, Frank L. Two Cases of Foreign Body (Coins) in the 
Larynx: Removal. Archives of Laryngology, New York, 1883, 
vol. iv, p. 204. 
Weir. Removal from the Larynx of a Two-cent Piece and 
a Penny, fiew York Medical Journal, 1890, vol. ii, p. 243. The New York Medical Journal. 
A WEEKLY REVIEW OF MEDICINE. 
EDITED BY 
FRANK P. FOSTER, M.D. 
THE PHYSICIAN who would keep abreast with the advances ir. 
medical science must read a live weekly medical journal, in which 
scientific facts are presented in a clear manner; one for which the 
articles are written by men of learning, and by those who are good and 
accurate observers ; a journal that is stripped of every feature irrelevant 
to medical science, and gives evidence of being carefully and conscien- 
tiously edited ; one that bears upon every page the stamp of desire to 
elevate the standard of the profession of medicine. Such a journal 
fulfills its mission-that of educator-to the highest degree, for not 
only does it inform its readers of all that is new in theory and practice, 
but, by means of its correct editing, instructs them in the very important 
yet much-neglected art of expressing their thoughts and ideas in a clear 
and correct manner. Too much stress can not be laid upon this feature, 
so utterly ignored by the " average " medical periodical. 
Without making invidious comparisons, it can be truthfully stated 
that no medical journal in this country occupies the place, in these par- 
ticulars, that is held by The New York Medical Journal. No 
other journal is edited with the care that is bestowed on this ; none 
contains articles of such high scientific value, coming as they do from 
the pens of the brightest and most learned medical men of America. A 
glance at the list of contributors to any volume, or an examination of 
any issue of the Journal, will attest the truth of these statements. It 
is a journal for the masses of the profession, for the country as well as 
for the city practitioner ; it covers the entire range of medicine and 
surgery. A very important feature of the Journal is the number and 
character of its illustrations, which are unequaled by those of any other 
journal in the world. They appear in frequent issues, whenever called 
for by the article which they accompany, and no expense is spared to 
make them of superior excellence. 
Subscription price, $5.00 per annum. Volumes begin in 
January and July. 
PUBLISHED BY 
D. APPLETON & CO., 72 Fifth Avenue, New York.