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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    non-traumatic, ulcerative cause. Blocking of the tube by blood was doubtless the immediate cause of death in this case. If, as iu this case, sudden accession of dyspnoea occur when the tube is in the larynx, it ouL;ht at once to l3e removed, examined, cleared of any obstruction that may be present, and reinserted, if necessary. Case III.—Boy, a'^ed ?> year^;, lltli i\rarcli 1889, under the care of Dr liainiltoii Wylie. The chihl had been suirerin^^ fnim dij^htheria of tlie pharynx for about a week. The disease had now extended to the hirynx, as indicated by the signs of marked hn-yngeal f)bstrnction ; great restlessness was ])resent. Iiitubation was followed Ijv imiuediate and complete relief to the breathing. lAth March—Morning.—The patient has breathed continuously well since the oiieration (three days) ; there is, however, a good deal of difficulty in swallow- ing, and the temperature keeps high (E. 105°, M. l()4°-r)). The pulse is (piick, regular, and weak. Evenmg.—The patient died at 8.30, after the supervention of great and sudden difficulty in breathing. An inspection was not ])erniitted. The tube was found almost completely i)locked with thick, glutinous, almost membranous material, which was removed with dithculty, even after macera- tion in hot water. There can be little doubt tliat, in this case, the tube was per- mitted to remain too long in tlie larynx without removal for examination and cleansing purposes. It was my intention to have removed it in about twenty-four hours after the operation, but the breathing continued so satisfactory as to induce me to refrain from disturbing it, and let well alone. As in the preceding case, we have the child suffocated from blockage of the tube, an occu'rience which I now think ought to happen very rarely, or not at all. The result was rendered all the more disappointing by the fact of the breathing having continued so good from immediately after the operation until just before death. The high temperatures were partly due to a pulmonary complica- tion (catarrhal pneumonia) which was present prior to the perform- ance of the operation. Case IV.—Boy, aged 10 years, 31st March 188f), under the care of Drs M'Leod and M'Kwan, Dundee. There was the usual history of progressive laryngeal stenosis, but the cause of this was at lirst somewhat obscure. Intuba- tion was performed at 8 p.m., the tube being properly inserted on the tirst attempt. The breathing was immediately relieved, but did not become (piite free until several hours ai'ter the openitiou. Is/. April.—P. 120, T. 103° ; the patient had passed a good night, and had swallowed very fairly indeed. He received some antipyrin, and was stinuilated freely. 2nd A2:)ril.—The patient continued to progress satisfactorily ; the pulse was better, and the temperature liad fallen two degrees. He had nutrient enemata, and was still stimulated freely. At 7 p.m. the tube was removed. 3rd April.—Temperature normal ; breathing easy, and patient (piite comfortable. He had passed a quiet night, and had slept well. 5th April.-—I was recalled to Dundee this afternoon, and found a relapse had occurred. The breathing was again obstructed, expiration being particularly prolonged and lal)oured. I again inserted the tube, which was twice expelled by severe attacks of coughing ; very little relief to the breathing followed. The patient gradually sank, and died on the 7th, one week after the first intubation, -witii all the signs of obstructed respiration. On inspection of the larynx, etc., after death, firm diphtheritic membrane was f(jund extending from the glottis tlu'ough tlie trachea into the bronchi.