A treatise on the diseases and injuries of the larynx and trachea : founded on the essay to which was adjudged the Jacksonian prize for 1835 / by Frederick Ryland.

  • Ryland, Frederick (Surgeon)
Date:
1837
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases and injuries of the larynx and trachea : founded on the essay to which was adjudged the Jacksonian prize for 1835 / by Frederick Ryland. Source: Wellcome Collection.

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

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    Unless in cases where animation is suspended, and where, conse- quently, the irritability of the glottis has ceased, there is reason to believe that a convulsive cough and inconceivable distress are pro- duced by the attempt to introduce a tube into the larynx, and that these are renewed every time that the instrument comes in contact with the glottis. These occurrences must be very perplexing to an inexperienced practitioner, and, if the operation be attempted « during the existence of chronic inflammation or ulceration of the larynx, seriously hurtful to the patient. The difficulty of direct- ing the tube is considerable : it may pass either into the larynx or the pharynx. In the latter case it must again be withdrawn, and a curved stilet passed down it with the concavity forwards. The determined shape and the solidity which this addition gives to the tube, will greatly increase the facility of its introduction. The safety of the practice is undeniable; but its efficiency is certainly open to controversy. If the tube be of large size, the difficulty of passing it through the rima glottidis will be very great; and if it be small, it will soon be clogged with the mucous secretions of the air passages, when, of course, it must be removed to be again replaced. The vei'y presence of the tube will create an increased secretion, and if any inflammatory disposition be pre- sent in the air-passages, it will be fostered by the irritation of an extraneous body. An avoidance of the dangers of bronchotomy, and of the trou- ble of the wound which this operation leaves behind it, is unques- tionably an advantage, if reliance can be placed upon the means offered as a substitute. Most of the modern improvements in sur- gery have for their object the simplifying or the abolition of the necessity for operations; but it would be the height of weakness and of negligence to be deterred from the execution of a tolerably certain mode of relief by the unfortunate result of two or three cases, and to place our trust, when life is at stake, upon means of doubtful character, and that offer very equivocal prospects of suc- cess. The fear of an aerial fistula a])pears to be almost groundless.