Tracheotomy in laryngeal diphtheria : after-treatment and complications / by Robert William Parker.

  • Parker, Robert William, -1913.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Tracheotomy in laryngeal diphtheria : after-treatment and complications / by Robert William Parker. Source: Wellcome Collection.

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    In the milder degrees, this inflammation occurs in nearly- all cases of tracheotomy and especially in the asthenic form of the disease, while in a few it assumes the pseudo-diph- theritic (membraniform) character already alluded to. The normal distance from the surface of the neck to the trachea is very greatly increased by this swelling of the tissues, as may be well seen when the cannula has been removed for the purpose of being cleaned. This swelling, again, is sometimes so great that there is difiiculty in retaining the cannula in situ, and it is well for the surgeon to be provided with tubes of varying lengths ready for this emergency. Case. Diphtheria—Tracheotomy—Acute cedema of neck—Its treatment—Recovery.—J. W—, set. 3, a pale, flabby child, was admitted, under the care of Dr. West, into the Hospital for Sick Children, suffering from diphtheria. In this case there was no difficulty at the operation, the trachea being rapidly and fully exposed before being incised. The child was completely relieved by the operation, and for the first few days appeared to be doing very well. But his temperature remained high. On the fourth day after the operation he was obviously less well, and there was an amount of depression which caused us considerable anxiety. There did not appear to be any chest complication to account for this. On removing the tube, the edges of the wound were found to be gaping and cedematous, and there was a copious and offensive tracheal discharge. On he fifth day an inflammatory cedema of the anterior part of the neck supervened, and rapidly increased in extent, so that the chin, neck, and sternum presented one continuous level. The tissues were brawny, and slightly reddened. There was a troublesome cough, and at each effort the tube was dislodged from the trachea, upon which a 'choking fit' immediately supervened. Owing to this swelling, our longest tube barely sufficed to reach the trachea, hence it had to be constantly held in situ by a nurse, but the boy was, nevertheless, nearly suffocated on several occasions. For- tunately the inflammation, having got to this stage, began to recede, and there was neither sloughing nor suppuration. We diligently applied lead lotion made with milk. One drachm of liq. plumbi was mixed with one ounce of fresh milk; this mixture 6