Diseases of the nose and throat, comprising affections of the trachea and oesophagus / by Sir St. Clair Thomson.
- Thomson, St. Clair, 1859-1943
- Date:
- 1912
Licence: In copyright
Credit: Diseases of the nose and throat, comprising affections of the trachea and oesophagus / by Sir St. Clair Thomson. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![copious, ma3^ produce immediate asphyxia ; or, if less abundant, may cause septic pneumonia. When it occurs, the anfesthesia should be stopped, and the patient rolled well over on to his lace or inverted, until the breathing in the trachea is cleared. At the conclusion of all nose and throat operations if is a wise pre- caution to keep the patient on his side, the head on a low pillow, and the face downwards, while the body is arranged in the gynae- cological position. He should occasionally change from one side to the other, so that gravity may assist the exit of blood and mucus from each bronchus. Shock, particularly in operations on the nose, is apt to be marked in young children and in elderly persons. It is for this reason that we try to avoid the removal of adenoids in patients under three years of age, or of polypi in those over sixt}?^; and that in all cases we endeavour to operate as rapidly as possible. Removal of part or all of the larynx sometimes causes marked shock.* This possibility of shock is guarded against and treated in the usual way. The use of cocaine and adrenalin, even in patients under a general anaesthetic, helps to avoid it.f and .anaesthesia should never be too deep or prolonged. When operating under local anaesthesia it is sometimes wiser not to attempt too much at one sitting, e.g. to treat only one side of the nose at a time. In other conditions, and when a general anaesthetic is employed, it may be safer to try to complete treatment at one operation. Sepsis and other complications.—Some of these possibilities have been mentioned when describing the use of the galvano- cautery, and others will be referred to subsequently. Deaths have been recorded after the simple use of the galvano-cautery or the removal of nasal polypi, and of course are more to be feared after major operations, such as the radical cure of sinus suppura- tions or extensive proceedings in the pharynx or larjmx. These accidents may be due to direct septic infection, or to thrombosis.^ The orbit may be invaded in operations on the ethmoid, the external muscles of the eye may be injured in the frontal sinus * Chevalier Jackson, Journ. of Laryngol., xxi., 1906, p. 632. t G. W. Crile, Joum. Aincr. Med. Assoc, June 17, 1905. X ]• Merckx, Ann. des Mai. dc VOrcille, 1906. ii., p. 199. (Meningitis simply from removal of a polvpus from the middle turbinal ; but the patient had double ethmoid and frontal suppuration of many vears' standing.) Broeckaert, Ann. des Mai. de VOrcille, D6c.. 1894. (Death after removal of polypus with the galvano-cautery : but the autopsy showed multisinusitis.) H. P. Mosher, Journ. of Larynpo'l.. 1907, p. 363. (Fatal meningitis after re- moval of anterior end of middle turbinal; but foul pus was present in many of the accessory cavities.) G. L. Tobcy, jun., Journ. of Larvnpol., Julv, 1907, p. 363. (An analogous case.) Griinwald, Centralbl. f. Ohrenhcilk., Aug.,'1908.](https://iiif.wellcomecollection.org/image/b23984478_0102.jp2/full/800%2C/0/default.jpg)
