Case of laryngo-tracheitis, terminating favourably after tracheotomy / by James D. Gillespie, M.D.

  • Gillespie, James Donaldson.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Case of laryngo-tracheitis, terminating favourably after tracheotomy / by James D. Gillespie, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    It is a subject for consideration in this instance, whether tracheo- tomy should not have been resorted to, as a chance of saving the patient's hfe. When we reflect on the obstructed condition of the a;lottis in acute laryngeal affections, we must at once see the extreme difficulty, if not utter impossibility, of any considerable amount of membranous exudation being expectorated through the greatly narrowed or closed orifice; and it is surely better to give the patient a chance of relief, by performing tracheotomy, than to leave him to certain and immediate suffocation. The difficulty of ascertaining whether any membrane has been formed cannot be urged as an excuse for the non-performance of tracheotomy; for if, as is now almost universally admitted, we are authorised to open the trachea, in the uncompHcated acute laryngitis, whenever the danger of suflb- cation becomes imminent, that operation is surely more strongly indicated, when we have reason to suspect that the obstruction of a false membrane in the larynx or trachea is superadded to the con- stricted state of the glottis. These remarks will not apply to the treatment of croup in child- ren, for many circumstances tend to render the propriety of opera- tion in their cases much more doubtful. The lungs are so frequently seriously affected in the infantile disease, and the bronchi plugged up with adventitious membrane, that careful examination of all the features in each particular case must be made, ere we can resort to tracheotomy, even as a forlorn hope ; for we should always keep in view the fact, of the truth of which every practical man must be well aware, that, when a case terminates unfavourably, after sm'gical interference, the fatal event is certain to be ascribed to the opera- tion ; and thus discredit may be brought on what, when employed with judgment, might prove a valuable acquisition in surgery. That Mrs Donald's case, though it has some features in common, cannot be strictly ranked as an illustration of primary croup, is, I imagine, sufficiently evident. I am inclined to consider it as an extension of the common acute inflammation of the larynx to the trachea, where, owing to some idiosyncrasy on the part of the patient, it assumed the form of lymphatic exudation. On inquuy, I find that Mrs Donald, when an infant, bad a most severe attack of croup, from which she recovered, under the treatment of the late Dr Abercrombie. It is worthy of remark, that the intense inflammation of the bron- chial tubes and left lung, which became developed after tracheotomy was performed, did not px'ove fatal. This appears to me to corrobor- ate the opinion, that inflammation, induced by direct injury, though it almost invariably proves of a most acute chai'acter, is not actually so much to be dreaded as when it occurs idiopathically. I have never seen, and never wish to see, in my own practice, bronchitis of a more intense nature affecting so universally both sides of the chest. That the infant in utero retained its vitality is certainly most sur-