Is the operation of tracheotomy in diphtheritic croup dangerous? : when should the operation be performed? / by Joseph E. Winters.

  • Winters, Joseph Edcil, -1922.
Date:
1884[-1885]
Catalogue details

Licence: Public Domain Mark

Credit: Is the operation of tracheotomy in diphtheritic croup dangerous? : when should the operation be performed? / by Joseph E. Winters. 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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    view, it may be taken hold of with the double hook below where it is to be opened, and drawn upward and forward until brought into sight. The hook must, however, be held by an assistant, and the operator should keep his thumb and finger on the trachea. On page 237 Dr. Gross says: “Great care is to be taken not to permit any blood to enter at the artificial opening, as the smallest quantity of this fluid may not only induce violent cough and spasm, but instant suf- focation.” Further: “The best plan to avoid this oc- currence is not to injure any vessels, but to hold them carefully out of harm’s way; or, where this is imprac- ticable, to wait until all Imnorrhage has ceased before we penetrate the wmdpipe. ” With reference to the first of these statements, it is known that the entrance into the trachea of a small quantity of blood is not dangerous, and many operators purposely introduce a quantity of fluid into it to excite cough in order to expel mucus and membrane. Bret- tonneau even recommended washing out the tube with a solution of nitrate of silver. Next to the hissing sound with which the air enters the opening in the trachea, one of the most striking things in connection with tracheot- omy is tlie violence with which anything entering the trachea is ejected. To wait until all hemorrhage has ce5,se^ before opening the windpipe, would, in many cases, be to wait until the patient is dead. The surest way of arresting hemorrhage is to admit air freely to the lungs, so as to relieve the embarrassed venous circula- tion, and thus allow the blood to return to the heart. Time spent in trying to stanch the bleeding before open- ing the windpipe is generally to the injury of the patient. With reference to this Professor Gross himself says on page 279 : “ It is worthy of remark that, when the hem- orrhage is venous, it generally instantly ceases, even when it is copious, the moment the knife penetrates the windpipe.” And again on page 266 he says: “I have never experienced the slightest inconvenience from any occurrence of this kind. Several of my operations, in fact, have been nearly bloodless.” Allow me to turn back and repeat a former quotation from Professor Gross, page 231, in order to make a com- parison : “ I know hardly an operation in all surgery I