Cases of tracheotomy in croup and for the removal of foreign bodies / by James Spence.
- James Spence
- Date:
- 1858
Licence: Public Domain Mark
Credit: Cases of tracheotomy in croup and for the removal of foreign bodies / by James Spence. Source: Wellcome Collection.
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![Next morning, when Dr Glen saw him, he desired the mother to ask me to visit the child. On going to the house, I found the patient in great agony from dyspnoea. As there was no great amount of bronchitis present, and evidently no time to be lost, I caused the child to be brought to the hospital, which was in the imme¬ diate neighbourhood, and at once performed tracheotomy. Some mucus and shreds of lymph were expelled on introducing the tube ; the breathing then be¬ came easy, the lividity of the face passed away, and the little patient seemed quite relieved. He continued to progress favourably, and on the evening of the third day the tube was removed, but had soon to be replaced on account of threatened asphyxia. It was finally removed on the sixth day, after which the wound gradually healed, and the child was dismissed cured on the 28th of May. He has continued to enjoy excellent health ever since, with the exception of show¬ ing a susceptibility to hoarseness during damp weather. For the notes of the following case, I am indebted to my friend Dr Wilson, and I give the report in his own words :— Case II.—C. W., aged 3|, was first seen by me on the 19th of September, on the second or third day of an attack of scarlatina. From my first seeing him, the case presented a very bad aspect ; the throat was considerably affected, and then a troublesome diarrhoea set in, accompanied by typhoid symptoms, for which he had very large quantities of wine, gradually increasing to 10 or 12 ounces a-day, chlorate of potash, astringents, etc., which were evidently bene¬ ficial ; and I was in hopes he was going to struggle through, when, at the end of the third week of the disease, he was seized with symptoms of laryngitis. “ These increased, and the case seemed hopeless if left to itself; but the disease being apparently confined'to the upper part of the larynx, the propriety of operative interference suggested itself to me, and I determined to ask you to see him. This you most kindly did, accompanied by Dr Watson, on the 10th of October. “ The child was much emaciated, and the pulse feeble; still, as the disease ap¬ peared to be confined to the upper part of the larynx, you resolved to give him the chance, though small, of the operation. Immediately after the operation the breathing became quite easy, and continued so till death, except on two occasions when attempts were made to dispense with the tube, and the nurse was unable to introduce it on a paroxysm of dyspnoea ensuing, although the patient had been breathing easily during the time your assistant remained. He continued to take both wine and beef-tea in large quantities, and by injection ; but the stomach began to fail, the pulse became feeble, emaciation progressed, and he died on October 15th, five days after the operation. “ On reviewing the case at this distance of time, I have no hesitation in saying that the operation, though unsuccessful, was most beneficial, even allowing that it did not prolong life, which, however, I am inclined to think it did ; still the relief afforded was so great, that I would be inclined (however reluctant we must be to advise operations not likely to be successful), were a precisely similar case occurring to me, to recommend the performance of tracheotomy.” Case III.—William Lindsay, aged 4 years, was seized with hoarse cough, sore throat, and occasional difficulty of breathing, on the loth of October 1856. No treatment was resorted to till the 16th, when the symptoms became more severe, and Dr Menzies was called to see him. He was then labouring under symptoms of croup ; the stridulous breathing and paroxysms of dyspnoea occur¬ ring, however, at lengthened intervals. His pulse was very rapid and small. Leeches were applied over the neck, followed by a blister, and antimonial solu¬ tion was ordered to be given at stated intervals. On Sunday the ] 7th Dr M. found the little patient so much worse that he](https://iiif.wellcomecollection.org/image/b30563690_0004.jp2/full/800%2C/0/default.jpg)
