Intra-thoracic surgery : bronchotomy through the chest-wall for foreign bodies impacted in the bronchi / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Intra-thoracic surgery : bronchotomy through the chest-wall for foreign bodies impacted in the bronchi / by De Forest Willard. 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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    After tracheotomy the wound should be kept open by blunt hooks or by stitches, never by a canula, which would block the exit and prevent the voluntary expulsion which is so common even after failure with instruments. The dressing should be simply loose gauze, to exclude the dust without interfering with the exit. The air should be heated after the operation to 8o° or 85°, as I am satisfied from experience that all tracheotomies do better in a high temperature. When the opening in the trachea gives entire relief from dyspnoea, it is very improbable that any object is fastened in the bronchus. Tracheal mirrors with electrical illumination, as well as laryngeal ones, should be employed in the diagnosis after tracheotomy. The greater the extent and duration of the dys- pnoea the greater will be the danger from pneumonia after tracheotomy. The work of Avonssohn, Gross, Durham (Holmes* Surgery), Weist, and others have made possible many successful results.^ It is certainly impossible for any surgeon to diagnosticate before- hand whether his individual case is one of those in which the obstruction will be loosened and coughed up, or whether it will remain, producing gangrene, pneumonia, or subsequent abscess, consequently each case should be most thoroughly considered. Bronchus originally meant the windpipe, while the two pri- mary divisions were named bronchia, hence the term bronch- otomy was used to designate any opening in the air-passages of either larynx, trachea, or bronchus; and Gross and other writers, even as late as Weist, still use the term to designate the high operation. It should be confined to operation upon the bronchus, as laryngotomy and tracheotomy properly desig- nate these higher operations. Weist (Trans. Amer. Surg. Assoc., Vol. I.) gives an accurate and careful analysis of 1000 cases of foreign bodies in the larynx, trachea, and bronchus, as will be remembered by all the members of this Association. In it he shows conclusively that the simple presence of a foreign body is not an absolute indica- tion for operation, as had been previously held by most surgical ^ Bourdillat gives a large collection of cases (Poulson, On Foreign Bodies, p. 33) Also, Maurice Perrin gives statistics.