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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    ]0 aiul others in wliicli every remedy fails. For reasons wliich need not now be discussed, the worst forms of diphtheria are those m which the hirynx is affected, i.e., precisely those in which we are called u[)on to intubate, and I a^ree with Dillon Brown^ in the conclusions he ariived at after an experience of 200 cases, tliat those in which membrane is absent from the pharynx or posterior nares are more fatal than those in which membrane is present in those localities. Tn the medicinal treatment of post-intubation cases, one of tlie most important points is that of stimulation. Should alcohol be administered, and if so, how? Different opinions have been expressed on this point. Jacobi of New York, whose experience of diphtheria in children has been very large, says,'^ Alcoliolic stimulants ought to be given early and freely. A few ounces daily may suffice, but the author has often seen ten ounces daily of brandy or whisky save children who had been doing badly with three or four. There is no danger of intoxication from them in such septic diseases as diphtheria. These views were expressed with reference to the general treatment of the disease, but I believe they are also applicable to those special cases in whom intubation has been performed. The frequent subsequent collapse of patients who have borne the operation well, and in whom respiration is effectively per- formed until the very end, indicates that active medical treatment is urgently called for. Heart failure, which may develop with or without warning, is probably the affection which most clamantly demands attention. Cardiac stimulants, says Jacobi,^ are indicated, and their administration ought not to be postponed until feebleness and collapse have set in. Digitalis, preferably in combination with iron, ought to be frequently administered in doses proportionate to the age of the child, and all depressants, such as emetics, and drugs such as antipyrin, ought to be avoided. In several of tlie cases recorded in this paper mercurial inunction was practised, but without, so far as could be seen, affecting the progress of the case.'* The amount of purely local treatment necessary after intuba- tion should, I think, be small A bi-hourly spray of peroxide of hydrogen,-'' of the strength of 10 to 15 volumes mixed with two or three times its bulk of water, from its antiseptic and 1 New York Medical Journal, 9th March 1889. 2 { British Medical Journal, 22iid Septoiiiljer 1888. \ Deutsche med. Zeitung, No. 72, 1890. 3 Op. cit. ■* It is right to record tliat O'Dwyer apcril)es Lis increasingly favonrahle results partly to the use of the suMiinate (iVeiw York Medical Journal, 14th January 1888). Peroxide of hy(h-ogeu is now kept in stock l)y most chemists. It is well preserved hy keeping in a cool place, at a temperature not exceeding G.j° F. and excluding the light. Metals should not be used in its application.