Laryngology : stricture of the larynx : clinical lecture delivered at the Jefferson Medical College / by J. Solis-Cohen.

  • Solis-Cohen, Jacob da Silva, 1838-1927.
Date:
[between 1890 and 1899]
Catalogue details

Licence: Public Domain Mark

Credit: Laryngology : stricture of the larynx : clinical lecture delivered at the Jefferson Medical College / by J. Solis-Cohen. 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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    CLINICAL LECTURE DELIVERED AT THE JEFFERSON MEDICAL COLLEGE. BY J. SOLIS-COHEN, M.D., Honorary Professor of Laryngology, Jefferson Medical College, Philadelphia. Gentlemen,—As the principal subject-matter for to-day I will present to you a case as an object-lesson from which you will be taught some very important practical points not detailed in your ordinary text-books nor discussed in your didactic lectures. You will notice that this boy, a well-nourished lad, thirteen years of age, wears a hand- kerchief around his throat, and that he has a whispering voice. You will also note that the voice is a laryngeal whisper and not an oral one. You should always notice the difference between these two forms of whispers. An oral whisper indicates that the vocal bands are not in action at all. A laryngeal whisper indicates that there is some ob- struction preventing approximation of the vocal bands. One of you will be good enough to remove the handkerchief from the neck of the lad, and it at once becomes evident that it has been worn to hide something. This something is a silver tube which pro- jects from within the trachea. You will note also, please, that the orifice of the tube is plugged with a cork. Nevertheless, the lad breathes freely without any impediment. A tube in the trachea, and yet the fact that the patient breathes through his nose despite occlusion of the tube, shows that he gets enough air alongside of the tube in the trachea, without having to depend upon his breathing through the tube at all. Here is an important point to bear in mind,—the size of the tracheal tube. It should be as large as is compatible with perfect freedom of movement in the trachea. You should never use a tube large enough to fill up the entire calibre of the trachea, as you may cause ulceration from pressure. You must not use one so loose that the lower orifice shall press anywhere on the wall of the trachea. Cases are on record of fatal results from ulcerations of the walls of the trachea and penetration into blood-vessels.