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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    cases among poorer children there will be found a total absence of all recuperative power; the wound will remain gaping, paloj and flabby, and show no sign of granulating, I have seen three or four such cases at the Children's Hospital, Shadwell. The patients come from a very poor class of the population. In the case related below every possible sort of stimulant was tried without any success. The wound could not be got to show any signs of repair. Case.—Diphtheria—Tracheotomy—Regurgitation of food throiigh tracheal wound—Total absence of all reparative power—Death on twenty-fifth day after operation, and nineteenth after removal of the tube.—Matilda R—, set. 3, a pale, thin, delicate deaf and- dumb child, first showed symptoms of diphtheria on April 6th. She was admitted under the care of my colleague, Dr. Eustace Smith. The symptoms rapidly became well marked, and patches of membrane over the soft palate and tonsils with a livid ulceration were found. The glands at the angles of the jaws became much enlarged (they ultimately sup- purated and discharged stinking pus). There was also a copious muco-sanious discharge from the nostrils. On the 8th the child was hoarse; she had a barking croupy cough, and there was slight recession of the chest walls. On April 10th aU the symptoms had increased in severity, notwithstanding active treatment. Mr. Battams, the Resident Medical Officer, therefore opened the trachea above the isthmus; membrane was feathered up. The child appeared to go on very well for five or six days; the active manifestations of the diphtheria cleared up; there was no further deposit of membrane; the ulceration in the pharynx bega^n to heal. The child's appetite, however, remained bad. On April 16th she quite refused all solid or semi-solid food; while liquid food passed into the pharynx and came out through the tracheotomy wound. The child was exceedingly weak and apathetic, very pale and blanched, but free from pain or dis- comfort. In the chest there was some slight bronchitis; her temperature was low. Mr. Battams tried feeding by means of a tube passed into the stomach through the nostril, and from April 18th she was fed in this manner entirely until her death, which took place on May 5th, of gradual exhaustion and a low form of spreading pleuro-pneumonia. The child never resisted being fed; she laid back in the nurse's arms quite indifferent;