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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    the child becoming at once cheerful and pkyful. 3lst October 1891.—9 a.m. —The night's report was that the cliihl had swallowed easily ; the breathing had continued unobstructed ; marked collapse with high temperatures (1(14°- 107° F.) had, however, ensued from about 6 a.m. The patient sank and died fourteen hours after the operation, without the re-establishment of the difficulty in breathing. A more satisfactory immediate result after operation than was obtained here could not have been desired. The same fatal collapse with high temperatures which characterized cases VI. and VII. developed in this instance. Case X.—Girl, aged 2 years, under the care of Dr Henry Hay, 3rd Febru- ary 1891. Diphtheria of the pharynx and larynx. At 11.30 p.m. the pulse could not be counted, and great inspiratory dyspnoea was present. Intubation was at once performed, with immediate ami marked relief to the breathing and strengthening and slowing of the pulse. 4th February.—The child has breathed freely all day, and is apparently going on well. She had sleptt well during the night. Brandy is being freely administered, a moderate degree of difficulty in swallowing is present. 5fh Fehraary.—The child continues to do well. At 4 P.M. T considered it advisable to remove the tube, which had been forty hours in the larynx, and this I tried to do with the assistance of the child's father. The process of gagging and the insertion of the extractor, along with some struggling on the part of the little patient, and some difficulty in locating the blades of the extractor inside the very small tube, appeared to completely exhaust the patient, and induced a condition of death-like collapse. Artihcial re.^piration was immediately resorted to, and produced a partial reviv^al only, for the child never returned to her former condition. She died a few hours afterwards, without a recurrence of the symptoms of obstructed respiration. This case illustrates the difficulty and results that may follow, or be induced by, the manipulations necessary to remove the tube in very young children. The difficulty of a withdrawal in such cases frequently surpasses that encountered during the act of insertion, and some modification of O'Dwyer's method and instru- ments in this respect is urgently, demanded. In this case, until tlie removal of the tube was set about, progress had been most satisfactory, and its rapid termination under the circumstances now described was a great disappointment. Case XI.—Boy, aged 5 years (nearly), under the care of Dr H. Wylie. Diphtheria, complicated Avith jmeumonia of the lelt lung. The breathing was exceedingly difficult, the child, in fact, being apparentl}' almost dead. The first tube inserted appeared rather small, for it was inunediately expelled by coughing; the next larger .size of tube was accordingly used. During the interval between the insertion of the two tubes, it was oViserved that the breathing was easier, with an abundant purulent expectoration. The breathing- continued to improve alter the insertion of the second tube, and the little jmtient went off in sleep, of which he had had very little for two nights previously. He was stimulateil freely by brandy. 22wZ Februarij.—At 11.30 a.m., Resp, 56, T. 102° 5. Pulse quick but regular. Abundance of mucous rales were present in the throat (and tube ]) He was reported to have swallowed verv easily. The pneumonic lung was acting very imperfectly. 8 p.m.—Died without having evinced indications of marked respiratory obstruction. This is another instance of death from other causes than respira- tory obstruction.