Intubation of the larynx in laryngeal diphtheria : with notes of fifteen cases / by G. Hunter Mackenzie.

Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Intubation of the larynx in laryngeal diphtheria : with notes of fifteen cases / by G. Hunter Mackenzie. 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.

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    escaped. The child died a few days afterwards, apparently of ex- haustion. An inspection was not permitted. In the absence of a post-mortem examination it is, of course, impossible to say with precision how the abscess had_ arisen. ]ts situation, the expectoration of bloody pus by the patient, and the septic condition of its contents, indicated that it communicated with the larynx. A diphtheritic ulcerative process of the laryn- geal mucous membrane had probably extended to and implicated the cartilage, and thus led to perichondritis and suppuration in the overlying soft tissues. Case XV.—Bov, aged 6h years, under the care of Dr Henry Hay. 24th Jubj 1891.—This child was exti-eiuely ill with diphtheritic croup, the dyspna-a, in fact, being so intense as to make death appear a matter of but a few minutes. Intubation was rapidly performed, witli innuediate and complete relief to the respiration. It is no exaggeration to say that the child breathed immediately al'ter the operation as freely as if nothing were amiss with his throat. 2bth Juhj (twenty-four liours after intubation).—The child continues well, breathes freely, and swallows without difficulty. (Thirty-two hours al'ter operation)— The dyspnoea has recommenced, tlie child is not so well, and is restless. (Thirty-six hours after operation)—The dyspnoea having increased, the tube was renioved for ])urposes of examination, but it was found that the increasing difficulty in breathing was not due to its blockage. Improvement followed the removal of the tube, but only for a few minutes. The tube was accordingly reinserted, but no improvement in the respiration followed, and the child died of asphyxia shortly afterwards. A second obstruction to the respiration, most probably due to fresh formation and extension of membrane to the trachea and bronchi, was the main and direct cause of death in this instance. It is highly problematical whether, under these circumstances, the performance of tracheotomy would have been of service; and as from the first the parents objected to this operation, it was not recommended in the latter staiie of the case. In commenting on the preceding cases, and in criticising in a general way the operation of intubation of the larynx, it is neces- sary to bear in mind that it is tlie application or performance of the operation in diphtheria with which we are now dealing. In non-diphtheritic affections in children, such as acute inflammation from scalds, etc., it is, as I have had occasion to note, a most excellent operation, yielding highly satisfactory results. Further consideration of these cases does not fall within the scope of the present paper. Nor am I concerned to discuss the question of the identity or non-identity of croup and diphtheria, excei)t to say that I am of those who believe what is sometimes called membranous croup to be diphtheria. No distinction, clinical or pathological, can be drawn between these two diseases (if two there be), and their mortality is, unfortunately, also equally great. Both are, in the words of Morell Mackenzie,' diseases characterised by more or less inflanunation of the mucous membrane of the pharynx, larynx, ^ Diseases of the Throat and Nose, vol. i. p. 120.