Tracheotomy in chronic disease of the larynx / by Lennox Browne.

  • Lennox Browne
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Tracheotomy in chronic disease of the larynx / by Lennox Browne. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    likely to occur the untoward risk of what we may call collapse of the larynx—a not unfrequcnt result of tracheotomy—which was first pointed out by Liston, and has since been insisted on by Whistler. Nor can I agree that the larynx can be more effectively treated by topical measures after tracheotomy than before, for, on account of the disposition to collapse just mentioned, the larynx is almost invariably far more difficult to examine, as also to be treated internally, after a tracheotomy tube has been introduced. Tracheotomy is advocated by Moritz Schmidt on the ground that it not only betters respiration—to the lungs I presume—but also that it deviates from the larynx the passage of irritating air—to which it has only to be replied that by use of oro-nasal inhalers and suitable atmospheres, the air to the larynx can readily be made non-irritating, and even beneficial, and this to a greater extent than can be provided for in the air which goes to the lungs through a tracheotomy tube. But the operation is also performed by Schmidt, by Heryng, and by Gouguenheim and Tissier, not only where the laryngeal disease is marked and advancing, but in cases in which the lungs are admittedly affected. The last named joint authors in their recently published classical treatise hold that even extensive disease of the lungs does not contra- indicate the operation, if the temperature be not high, and digestion be good—to which condition I cannot assent, for a comparatively low temperature in laryngeal phthisis is by no means a favourable indica- tion, while a good digestion is a circumstance hardly ever likely to be afforded us as a factor for consideration in this disease, and certainly not in advanced cases. I must, therefore, with all respect to the many able laryngologists who advocate tracheotomy in tuberculous laryngitis, offer my un- compromising opposition thereto, hardly excepting cases of urgent dyspnoea, in which it is considered as permissible by Solis-Cohen, Morell Mackenzie, and Krishaber. I certainly would not perform it, except at the request of the patient or his friends, and not even then without very plainly stating that, although death by actual suffocation might be thereby averted, life would hardly be prolonged, and that only at some considerable expense of suffering and lingering distress. I think also that we ought to bear in mind that performance of tracheotomy in a case of advanced tuberculous disease is likely to bring both the operation and the surgeon who performs it into disrepute ; for, as to the operation, an unfavourable result in one case may militate against consent being
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