Tracheotomy in membranous laryngitis : the indications for its adoption, and some special points as regards its after-treatment / by Robert William Parker.

  • Parker, Robert William, -1913.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Tracheotomy in membranous laryngitis : the indications for its adoption, and some special points as regards its after-treatment / by Robert William Parker. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    express regret that the surgeon is only too often called iu after all therapeutic measures have failed, and the more so because these measures have generally included the use of depressants, which if not at once beneficial, have by their continued administration tended greatly to increase prostra- tion, so often a predominant feature of the disease. Briefly put, one may say, that tracheotomy is indicated in cases of increasing or persistent dyspnoea, due to mechanical obstruction in the larynx or trachea j the best test of the degree of this mechanical obstruction not being the apparent distress of the patient, but rather the amount of the reces- sion of the chest wall, and supraclavicular spaces, especially in conjunction with suppression of voice, more or less complete. The loud clanging cough, which is such a source of terror to the anxious parent, is really far less ominous than the hoarse whisper and the almost inaudible cough, which mean direct implication—one might almost say, with Niemeyer, inflammatory infiltration and paralysis—of the narrow chink of the glottis. The indications for tracheotomy are the more urgent, when expiration, as well as inspiration, are alike laboured; for neither spasm nor paralysis will explain impeded expiration. To wait for distension of the jugular veins, and until general cyanosis have supervened, is postponing the operation beyond the limits of mere mechanical obstruction; it is waiting for the advent of pronounced carbonic acid poi- soning After deciding upon the operation, the first point, which has to be settled is, shall the patient be chloroformed ? I have never seen any harm result from this proceeding; a very little chloroform usually suffices, and therefore advan- tage ought to be taken of the facilities, which it undoubtedly offers for a careful and deliberate operation. Care and judgment must of course be exercised in each individual case Coming to the operation itself, I agree with those authors who advise the high operation. In young children, the high