Intubation of the larynx in laryngeal diphtheria : with notes of fifteen cases / by G. Hunter Mackenzie.

Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Intubation of the larynx in laryngeal diphtheria : with notes of fifteen cases / by G. Hunter Mackenzie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Nothing could liave been more satisfactory than the progress of this case after the first operation. The downward extension of membrane to tlie bronchi, indicated during life by the peculiar laboured wheezy expiration, and by the auscultatory phenomena, accounted for the absence of relief after the second operation, and would have rendered equally nugatory any other surgical procedure, such as tracheotomy. Case V.—Boy, aged 4^, years, 30th May 1P80, luuler the care of Dr Henry Hay. Diphtlieria of the'pliaryux and larynx, with great laryngeal obstruction. Intubation was performed. Some ditticulty was experienced in getting the tube corresponding to liis age properly located in the larynx, and it had ulti- mately to be witlulrawn and a smaller one inserted. Tlie tube was couglied np after having been in position for one hour ; it was allowed to remain out J or three hours, but the laryngeal dyspnoea liaving becc^me more intense, the larger tube was again tried, witliout, liowever, appreciably atfeiiting the breathing. The thread was lel't attached to facilitate removal of the tube should it again have l)een couglud out of tlie larynx. The child died four hours afterwards. Autopsy revealed diplitlieritic meniln-ane in the larynx, especially about the vocal cords, tlie epiglottis, and the infraglottic region. The tube could not be found in the larynx, })harynx, or mouth, but was discovered in the gullet, close to the stomach. As the result of a series of post-mortem experiments, it was found that the insertion of the tube in the larynx was not easy, principally on account of the membrane, which was very abundant about the aditus larijngis. The leading feature in this case, apart from the general result, was the swallowing of the tube. The thread was left attached, for the reasons already stated, and was bitten through by the patient. The tube must either have been expelled from the larynx by coughing, or it must have been drawn out by trac- tion on the thread. From one or other of these causes the tube changed from the larynx to the pliaiynx, and was swallowed. Similar cases have been recorded by other observers; in some of those the tubes were expelled ^c/- anum. From tlie fact that the patient swallowed milk with great ease during the last hour of life, I am inclined to suppose that the accident must have occurred shortly before death. This case is that in which I experienced the greatest difficulty in inserting the tube appropriate to the age of the patient, and of this the abundant membrane at the entrance to the larynx was evidently the principal cause. I am now of opinion that it is a mistake to persist with intubation under such circumstances, and that recourse shoidd rather be had to tracheotomy. Had this been done in the present instance, the locality of primary obstruction would have been cleared, and greater relief would consequently have been afforded to the patient. Case VI.—Child, aged 1 year, under the care of Dr Wylie, 28th October 1889. This child was reported to have been suffering for a few days previously from bronchitis, on which laryngitis with marked dyspiuta had supervened. Intubati(ni was performed with ease, and great relief to the breathing at once ensued. Nine hours after the operation he was found breathing and swallow-