Case of laryngismus stridulus, in which tracheotomy was performed with success / by Alexander Fleming.

  • Fleming Alexander, 1824-1875.
Date:
[1844?]
Catalogue details

Licence: Public Domain Mark

Credit: Case of laryngismus stridulus, in which tracheotomy was performed with success / by Alexander Fleming. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    3/4 (page 3)
    swelling began tirst under the angles of the jaw, but afterwarils extended all round below the chin. June 22.—Poultices had been constantly applied to the dittuse swelling of the throat. Fluctuation was detected in the part under the chin ; and an incision having been made, a large tiuantity of laudable pus was discharged. She was ordered to have 3 oz. of wine daily. June 23.—The opening in the trachea Avas entirely closed. June 24.—She complained of acute pain of the left Avrist, elbow, and shoulder joints, which were tender on pressure. The wrist was red and swollen. She was ordered to take 20 drops of the solution of morphia three times in the day. June 25.—The joints of the left arm were considerably better, but the left knee was tender on pressure, and the seat of a throbbing pain. The prescription of the preceding day was continued. July 4.—The joints which had been affected with rheumatism were quite free from pain and sweUing. The pulse was 72, soft, and of moderate size. The swellings xmder the jaw were entirely removed; and there was only a very slight serous dis- charge from the incision which had been made for the evacua- tion of the matter. She had been taking for some time past, in addition to the -wine and generous diet, simple doses of the saccharine carbonate of iron three times daily, and subsequently a quinine mixture, which had effected considerable improvement in her appetite and general health. She was dismissed cured, but still rather weak, in the be- ginning of August. At the present date (November 16) her health and strength are completely re-established. Remarks.—The opinion which I entertain of the nature of this case is expressed in the title of the paper, but it is proper that I should now detail more fully what I beheve to be its true pathology. When the sand was thrown into the mouth of the patient, a few of the particles appear to have found their way into the larynx. These, although not sufficient to oppose any physical barrier to the free entrance of air, Avere the cause of irritation, which, exciting a reflex action of the laryngeal nerves, induced spasmodic closure of the glottis. The incident exciters concerned in this process are filaments of the superior laryngeal nerAes, Avhile the reflex motors are derived from the inferior laryngeal or recurrent nerves.* The patient coughed up some of the particles of sand; but apparently a few had still remained in the larynx, and these wor(^ not discharged until the opening had been made in the trachea. • .See the Eimay of Dr John Reid on the Functions of the Eighth Pair of Nervc«, in Edia .Med. and .Surg. Journal, No. J 34.