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

Date:: 1892

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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$in,^ without ditHciiltv ; luoi!^t sounds liad coiniucuced to develop in the windpiije. He died fourteen hours after the operation, after liavinjr, according to the report of the faniilv medical atten(h\nt, hn-athed and sivalloiced without difhcMty to the very end. After death, the tube was found in the lower part ot the trachea, and patches of membrane were found in the larynx. 80 far as relief of tlie breathing was concernecl, the operation in this case was successful. Death was due to one or otlier of those occult causes which are well known to affiiCt children who are, or lately have been, suffering from diphtheria. The tube was forced into the trachea by unsuccessful attempts on the part of unskilled hands to use the extractor after death. Case VII.—Boy, aged 1| years, 6th December 1889. This child was reported to be suffering from croup (diphtheiia of the larynx). He liad had several severe laryi'igeal spasms ; intubation was accordingly perl'ormed at 2 P.M., the tube being easily inserted on the first attemi»t. The breathing was immediately relieved, and became graduallv easier as tlie day advanced. Tliere was, however, c(msideraljle pyrexiii (T. at 10 p.m., 105°) ; at tlie same time the child appeared to possess a fair amount of strength, and was breathmg with great freedom. Wine was freely administered. 1th December—The child died somewhat suddenly at 1 a.m., without luiviwj again presented any symptoms of hiryngeal obstruction. An inspection was not permitted. In the treatment of this case it was decided to rely mainly upou nourishment by enemata, an opinion having been expressed in some quarters '(which I did not share), that food administered in the usual way was apt, with the tube in situ, to slip into the respiratory tract, and tiiere cause trouble. The remarks appended to the preceding case apply equally to this. Here was another case in which the breathing was completely and permanently relieved by intubation, and yet the child died. Case VIII.—Boy, aged 7^ years, under the care of Dr Wylie, 25th December 1890. An undoubted case o'f dijilitheria of the ])harynx, thence spreading to the larynx, with dry inspiratory dyspncea, and siiil'ocative spasms. Intubation was performed at l2 noon with soine difficulty, but the tube was soon expelled 1)V cou;diing. It was not re-inserted, as the patient now breatht^l with com- parative freedom, and the respiratory sounds were moister. I did not again see the patient, in whom during the late afternoon laryngeal dyspnoea again developcfb Re-insertion of the tube was not permitted by the relatives. He died at 9 p.m. The difliculty in intubating in tliis case was owing to the presence of an abscess at the tip and under the nail of the operator's left index finger, which necessarily interfered with the power of guid- ing the tube into the larynx. The tube was not re-inserted inmiediately after expulsion on account of the ease to the breath- ing which had already ensued, and owing to the experience of some operators chat a merely temporary insertion of the tube is sometimes sufficient to permanently relieve the breathing. Un- fortunately in the present instance this did not prove the case. Case IX.—Bov, aged 6 yenrs, under the care of Dr Brewis, .30th October 1890. Diphtheria of the pharynx and larynx, T. (8 p.m.) 104°. At 11 p.m. intubation was performed, with immediate and complete relief to the breathing,$

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

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