The laryngoscope : illustrations of its practical application, and description of its mechanism / by George Duncan Gibb.

  • George Duncan Gibb
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: The laryngoscope : illustrations of its practical application, and description of its mechanism / by George Duncan Gibb. Source: Wellcome Collection.

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    some serous fluid, but as the relief was not sufficiently decided, I intro- duced a large bougie into the glottis tliree times, and ft-eely dilated it, yntix marvellous relief to the breathing. On the 16t]i of March, he expectorated another portion of the cricoid cartilage the size of a six- pence, in coughing. He eats, drinks, and sleeps well, and lias some colour. A third piece of cartilage was coughed up subsequently, and, I believe, still another piece has to come. His voice is now loud but hoarse, not painful; the larynx is clearer, but still with some swelling in the old situation, the natural appearance of the true vocal cords has not been quite restored, but will be in a few more weeks. This case was an illustration of the efforts of nature to expel a dead cartilage, and the means she took to accomphsh this were exposed by the aid of the laryngoscope; in all probabihty, it might have had an mitoward result had not the treatment been greatly aided by one's \-ision, which permitted of the daily use of topical means, admirably seconded by Mr. 0. A. Atldns, house-surgeon to the Hospital. It is the first in- stance on record where the condition of necrosis of the cartilages was seen with a mirror, and also the first where the scarification of osdema was practised aided by vision, as well as the introduction of tracheal sounds, which were seen to enter the proper channel. I have used the scarificator with success in some cases of acute oedema of the glottis since the occurrence of the foregoing. The remains of subglottic cedema, originating in acute laryngitis; disease of the nose. In January, 1863, I examined a little girl, set. 14 (Temperance P ), in University College Hospital (for Mr. Erichsen), who had been admitted, with a severe attack of acute laryngitis, three days before. The symptoms were very urgent, but under general treatment the dys- pncEa became less, and she escaped tracheotomy. In my examination with the laryngoscope, the interior of the larynx was seen to be much inflamed, the inflammation extending to the vocal cords, the fiee mar- gins only of which were of a greyish-white colour, thus giving them a narrow outline. They were widely separated, but approximated during the examination—the left cord, however, not very fi-eely. In the sub- glottic region, below the posterior two-thirds of the left vocal cord, was a red, fleshy swelling, pressing, inwards, much encroaching upon the aperture of the glottis, and extending to the posterior part of the sub- glottic space, thus explaining the pecuhar noise in breathing. The mucous membrane around was somewhat tumid, and of a vi^^d redness, which latter pervaded the trachea as far as could be seen. The case was clearly one of acute laryngitis, vrith considerable oedematous swelling of the subglottic region, now no doubt somewhat diminished from the treatment pm-sued. The uvula and central part of the soft palate were destroyed by ulceration, and rhinoscopy was very easy, showing extension of this process to the left nostril. Tliis general examination was made with great ease in the presence of Dr. Ringer, Mr. Rickards (the house