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

Date:
1892
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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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    a fatal result O'Dwyer^ acknowledges that it may occur, and says it is more likely to happen in secondar}-- dyspntea wlien tlie tul)e is introduceil ibr the second time. In one case where this happened the tuhe was immediately withdrawn, when a mem- branous cast of the trachea was coughed up. In all such cases it is necessary to remove the tube and afford the patient an opportunity of expelling the detached membrane. Failing this, tracheotomy or a rapid laryngotomy may be indicated. The Retention of the Tube.—In two of the cases reported in this paper death was due to asphyxia Irom blockage of the tube—in the one case by blood, and in the other by inspissated mucus. Such occurrences do not appear to be common. Deming^ has recorded a similar case, and O'Dwyer,^ out of sixty-five cases, found that in two the tube was stopped witli membranous masses, but apparently without fatal results. Wheeler'^ mentions the case of a child who, twelve hours after intubation, had a severe fit of coughing and died suddenly. The tube was found completely obstructed with a large piece of false membrane, which had appar- ently been driven into it by the act of coughing. Mount Bleyer^ found that, in two out of 322 cases of intubation which terminated fatally, the cause of death was asphyxia due to closure of the tube by membrane. It is curious to note the divergence of opinion which exists regarding this very important point—the lia- bility of the tube to blockage. Eamon de la Sota ^ speaks of it as being a common accident; whilst Fletcher Ingals says that the incidents of the clogging of the tube and choking are so rare as not to trouble him. The writer seems to have been somewhat unfortunate in having met with it twice in fifteen cases. To obviate the risk of blockage, it is advisable to remove the tube every twenty-four hours, inspect, and, if necessary, clean it. Pinkham^ recommends to clear the tube in position by means of an aspirator—a most impracticable suggestion. It is stated by some authorities (Fletcher Ingals^J that when the tube becomes clogged it is almost certain to be coughed up, but this has Jiot been my experience. This occurrence ought not to be depended upon as at all likely to happen. Coughing up of the tube is a much more common, and for- tunately a much less serious event than blockage. It re])eatedly occurred in several of my cases, without having any bad result. The tube is either forced into the oro-pharynx or mouth, whence it can easily be removed by the finger. It may be swallowetl 1 Nexo York Medical Record, 22nd October 1887. 2 Ibid., ISth Febniavy 1888. 3 ^^^^^^ 28th Mav 1887. * Ibid., 2(5tli February 1887. ^ Transdctions of the Tenth International Medical Congress, 1890 (reuriiit.') « Siylo Medico, 12tli October 1890. ' Transaciions of the Ninth Annual Congress of the American Larnnqoloqical Association, May 1887. New York Medical Record, l7tli INfarch 188S. 9 Op. cit. s
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