A treatise on the diseases and injuries of the larynx and trachea : founded on the essay to which was adjudged the Jacksonian prize for 1835 / by Frederick Ryland.

  • Ryland, Frederick (Surgeon)
Date:
1838
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases and injuries of the larynx and trachea : founded on the essay to which was adjudged the Jacksonian prize for 1835 / by Frederick Ryland. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    medicines that at various times have been upheld by different authors as specifics in croup. An attentive and careful investigation of the symptoms and of the pathological effects of the disease, together with the energetie application of well known remedies, are Jar more likely to conduce to successful treatment than the indis- criminate use of medicines that are vaunted by their discoverers as infallible, and raised by unmerited praise to ephemeral reputation, only to sink into a deeper oblivion. I have hitherto spoken only of the medical treatment of croup, but as there are cases on record in which tracheotomy has been successful, it becomes necessary to enquire under what circum- stances this operation is justifiable, or likely to afford relief; at what period of the disease is its performance to be resorted to; what has been its usual success; and what are the objections that may be urged against its adoption. Dr. Home,1 the first historian of croup, proposed this operation as a last resource in the treatment of the disease, supposing that it would favour the expulsion of the false membranes, and thus pro- long the life of children who were in danger of instant suffocation. Since the publication of his opinions they have been adopted by many authors, who have talked largely of the probable advantages of such an operation, without adducing any successful cases in support of their assertions. As a last resource in croup, when the stage of collapse has begun, and when the symptoms of suffocation are imminent, what relief can be expected from tracheotomy? At this period of the disease the lungs are generally loaded with blood, the vessels of the brain are gorged with an imperfectly oxygenated blood; and probably effusion of serum into the ventricles will have commenced; under these circumstances tracheotomy cannot cure; it cannot even be expected to afford temporary relief. Immediately after incising the trachea, a large quantity of mucus will probably be expelled through the wound, and the labour of respiration will, for a time, be diminished; this is the most favourable result that can be expected; and the occurrence of this degree of relief must depend upon the disease in the air tube not having extended below the larynx. If the inflammation and exudation of lymph exists throughout the trachea, or are continued into the bronchi, the patient will, in all probability, perish miserably under the hands of the operator; and, unfortunately, we cannot decide by the symp- toms before death what is the exact situation and extent of the membranous effusion. In the earlier stages, before lymph has been poured out, and when the mucous membrane is red and tumid, nothing but an aggravation of the inflammation can be expected from the operation in question; besides, we are not justified in having recourse to it, whilst so many other remedies are in our possession, unless it can be shown that the probability of success is very great. 1 An Enquiry into the Nature, &c. of Croup, p. 59.