Cases of tracheotomy in croup and for the removal of foreign bodies / by James Spence.

  • Spence, James, 1812-1882.
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: Cases of tracheotomy in croup and for the removal of foreign bodies / by James Spence. Source: Wellcome Collection.

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    much swollen. A blister was ordered to be applied over the upper part of the chest, but not to extend to the throat. March 7.—A consultation was held to-day as to the propriety of trache¬ otomy. All were in favour of immediate operation, and it was accordingly done without delay. 8. —Pulse small and irregular, but not very frequent; breathing quiet. The tube is cleared of mucus by a feather; the quantity of mucus is small. 9. —Breathing quite steady and regular; the engorgement of the face and neck is quite gone. Pulse rising in strength. 11.—The tube was removed to-day for the first time, cleaned, and replaced. Doing well. 14.—Breathing very easy; pulse weak, but slowly rising in strength. The tube moves apparently synchronously with the pulsations of the innominate artery. 18.—Patient looking very much better; no lividity of the countenance ; breathing quite easy. The pulse is still small; but this seems to be its natural condition, for the pulse in the brachial and posterior tibial arteries is also very small. 22.—A new double tube, having an opening in its convexity to enable the patient to use the voice, was introduced to-day. Doing well. April 1.—Patient’s appearance and general health much improved. The pulse still continues small ; as nothing abnormal can be found in the chest to explain it, this must be its natural condition. 16.—Patient going on well. The pulse still unnaturally small. The voice is loud and distinct when she closes the opening of the tube with her finger. 20.—Dismissed cured. The case of Mr R. is remarkable for the intensity of the suffo- Remarks cative paroxysms, life being all but extinct at the time I opened the trachea ; and the immediate effect of the operation was highly satisfactory. But the peculiarity in this case most deserving of notice, is the attack of hemiplegia of the right side, occurring whilst the tube was out of the trachea for a few minutes. Was this dependent on ob¬ structed respiration affecting the cerebral circulation, or did it arise from some temporary cerebral excitement ? The coincidence of the withdrawal of the tube and the accession of the hemiplegia, together with the fact that no organic lesion of the brain, beyond a little effu¬ sion, was found, would lead us to suppose it was the former cause which produced it; but then the opening of the trachea was free, its edges were rounded off and adherent to the surrounding parts, and the patient had expelled some mucus on the withdrawal of the tube. There was, therefore, no apparent cause of obstruction to respiration; and, moreover, there was no noisy breathing nor struggle on the part of the patient, for I was standing close to his bed, and must have heard and noticed it; so that, except for the re¬ lief afforded by the replacement of the tube, I would rather incline to the belief, that the seizure was referable to some temporary condition of the cerebral circulation in a man of great nervous susceptibility. The case of Ann Cuthbert was a well-marked case of progressive chronic laryngitis, with stridor on inspiration, great aphonia, lividity of the surface, and paroxysms of dyspnoea, which were becoming both more severe and more frequent, especially at night. It exem