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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    uiiirrituliiig iiiiLure, and its freedom from inducing toxic symp- toms, ai)peiirs to be the local remedy which, especially in America, has met with most favour. This remedy may also be applied by irrigation, by means of a catheter, which may be passed right into the larynx. It may be here mentioned tliat sprays and inliala- tions are more efficacious when used through the nose than througli the mouth, and in this manner the ])ei'oxide ought to be more l)articidarly employed. Mercurial washes and sprays and applica- tions of lime-water may act chemically upon the tube (Boldt and IsTorthrup).^ The sliutting-up of these cases in croup-tents in an atmosphere of steam appears a very doubtful jjrocedure, and I regret that in several of the cases now recorded this was had recourse to. Acute laryngeal diphtheria in children is almost invariably characterized by a high temperature, i.e., 102° and over, and the only results 1 have witnessed of this method of treatment have been augmenta- tion of the fever and of the restlessness of the child, and an increased disinclination for food. The moistening of the throat, as already stated, can be effectually carried out by means of the peroxide of hydrogen spray or douche. I am in favour of placing such patients in cool, well-ventilated rooms, without steaming. The mortality of the two operations may be first compared. Out of 2166 cases of intubation of the larynx in croup or diphtheria, which I have collected from various sources, 32'5 per cent. I'ecovered; similarly, out of 1730 cases of tracheotomy, 22 per cent, recovered. The difference is thus about 10 per cent, in favour of intubation. Dillon Brown,2 in March 1889, published a list of 2368 cases of intubation obtained from the records of 166 operators, with 27 3 per cent, of recoveries. The mortality of intubation in the practice of any one operator tends to diminish as he acquires increased experience, and, above all, recognises the necessity of paying most careful attention to the details of after-treatment. This is well shown by Waxham^ in the following figures from his practice:— It is advanced in favour of intubation that it is l)loodless, can be performed with great rapidity, and does not preclude the subsequent performance of tracheotomy. The first two are correct Comparison with Tracheotomy. 1st 100 cases gave 27 per cent, of recoveries. 1 Neio York Medical Record, 12th November 1887. Ibid., 9th March 1889. ^ Archives of Pediatrics, July 1891.