The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].
- Duncum, Barbara M.
- Date:
- 1947
Licence: In copyright
Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.
622/664 page 602
![of the size of 8 to 10 catheters—the latter being more liable to catch on the various irregularities on the internal laryngeal surface. ' While it was easy to introduce instruments by the mouth into the trachea, it was difficult to pass them through the nose into the air-passages. ... A catheter, having a strong properly curved stilette, after considerable labour and many efforts, might find its way into the larynx ; but even this could not be depended on. The first occasion on which MacEwen passed a tube through the mouth into the larynx clinically was in order to pack off the throat and anaesthetize the patient. He described the case in detail : ' Case i.—Removal of Epithelioma from Pharynx and Base of Tongue : Introduction of Tube into Trachea through Mouth to occlude Haemorrhage from Larynx and for administration of Anaesthetic.— ' As it was an operation which would cause considerable bleeding, precautions had to be taken to secure the air-passages from occlusion. Hitherto this had been effected by opening the windpipe, by laryngotomy, and the introduction of Trendelen- burg's tampon-cannula. Instead of this, I had determined, should an opportunity present, to introduce into the trachea, by way of the mouth a tube, which would extend beyond the vocal cords, and through which the patient would respire. The upper laryngeal opening could then be plugged outside this tube, so as to prevent the entrance of blood into the larynx. The plug could then be effected in various ways, by causing the tracheal tube to perforate a close sponge of suitable size, which, after the tracheal tube had been introduced, could then be fixed in the laryngeal orifice ; by fixing to the tube, at a convenient part, a piece of fine muslin or other material, which would act as the canule a chemise used after lithotomy ; by inflation of a closely fitting bag, etc. ' Preparatory to the operation, a tube was several times inserted through the mouth into the trachea, beyond the vocal cords ; and it was found that, with the exception of the cough which ensued immediately on its insertion, he [the patient] bore the tube sufficiently well to warrant the success of the procedure. . . . ' The operation was performed on July 5, 1878. The usual cough followed the introduction of the tube ; but it ceased as soon as he received a few whiffs of chloroform, and long before](https://iiif.wellcomecollection.org/image/b20457200_0634.jp2/full/800%2C/0/default.jpg)
