A case of laryngeal diphtheria, necessitating intubation, complicating cerebrospinal meningitis in an adult / by W.K. Simpson.

  • Simpson, William K.
Date:
1905
Catalogue details

Licence: In copyright

Credit: A case of laryngeal diphtheria, necessitating intubation, complicating cerebrospinal meningitis in an adult / by W.K. Simpson. 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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    successfully performed and gave marked relief to the difficult breathing. The following day and again subsequently large pieces of membrane were expelled through the tube, from which pure cultures of the Klebs-Loeffler bac- illi were procured—thus confirming beyond question the diagnosis of laryngeal diphtheria. The tube was removed at the end of the fifth day, and during the time it was in situ there was complete relief from the dyspnea. Examination of the larynx after extuba- tion showed some redness and swelling about the superior portions of the larynx. Hoarseness, cough, and some spasmodic breathing occurred during some days following extubation, but at no time was it con- sidered at all necessary to reintubate, nor was there any subsequent appearance of membrane. Immediately after the first laryngeal examination —January lo—antitoxin was administered by injec- tion and was continued until January 19, 30,000 units being given within that period. Inasmuch as this case occurred at the time when the treatment of cerebrospinal meningitis by the in- jection of antidiphtheria serum was being advanced, the effect of the administration of the serum on the cerebrospinal symptoms was most carefully watched and recorded, and without going into detail, which is not within the scope of this article, I may say that the opinion of those immediately in attendance was that there was no appreciable effect produced on the course of the cerebrospinal meningitis. On the con- trary, it was during the administration of the serum, and also after it was stopped, that lumbar puncture was performed, in all, three times—January 13, 22, and 26, there being drawn off respectively two ounces, one ounce, and ten drachms. In each in- stance was found the characteristic meningococcus intracellularis. It is possible to suppose that if diph-