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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    Case II.—A line little girl, four years of age, the daughter of a medical man in the country, was eating damson jam, when one of the stones, which she had been sucking, suddenly slipped into the larynx. A violent paroxysm of cough and dyspnoea, threatening suffocation, immediately ensued; but the foreign body passing downwards, temporary relief was obtained. As similar paroxysms recurred, the father telegraphed to town for Professor Goodsir and myself to come out immediately. When we arrived, we found that she had had some severe paroxysms, and that the means used by her father, and Dr Baird of Linlithgow, who had also seen her, had failed to cause ejection of the foreign body. Under these circumstances, and as the movement of the body in the trachea during respiration could be distinctly heard, we at once proposed tracheotomy, which indeed was the object of our being sent for, and therefore there was no delay. The use of chloroform was tried at the request of the friends; but it excited such a tendency to suffocation that it was given up, and I proceeded to operate at once. Owing to the bulk of the thymus gland, the numerous dilated veins, and the presence of the middle thyroid artery, the operation required some care, but the parts were so distinctly seen that it was not prolonged. I made a long incision in the trachea, and inserted the points of my dissect¬ ing forceps at the upper part, expanding their blades to keep the orifice patent; on doing this, and raising the head, a quantity of mucus was ejected,—then the plum-stone was seen to be forced towards the opening ; but, unfortunately, at this moment inspiration took place, and the rush of entering air carried it back. We attempted to cause its expulsion by inducing coughing, and by shaking, and altering the position, of the little patient, but in vain. On examining the chest, it at once became evident that the stone had become impacted ; for while the right side expanded on inspiration, the left was flattened and immoveable, the lower ribs being drawn forcibly inwards, and the respiratory murmur entirely absent. By means of flattened probes passed along the left bronchus, we attempted to reach the stone for the purpose of dislodging it; and we tried to procure its expulsion by moving the thoracic parietes, and by every means we could think of, but without success. In consultation, it was determined to take the child to town with us next morning, and try if any plan could be devised to loosen it by instruments or by suction. Having-brought the patient to Edinburgh, a great variety of means were tried, but with no better result; and, after a few days’ illness, the child died. On examination after death, the damson-stone was found impacted in the left bronchus, fairly filling it up like a cork, and preventing all entrance of air into the left lung, which was flaccid and collapsed (See Plate, Fig. 1) ; the thoracic parietes of the left side, as seen during life, were contracted and flattened. The child, at the time of the accident, was just convalescing from a severe attack of pneumonia of the right lung, the lower part of which had suffered so as to be hepatised, while the upper part was engorged with bloody serum, and the bronchi loaded with mucus ; so that the child died more rapidly than would have been the case had the right lung been healthy. The foregoing case presents several points of interest. The direction in which the foreign body was carried; 2d, Remarks. Its impaction at the termination of the left bronchus, and the complete occlusion of the tube and collapse of the lung thereby occasioned; and 3The question as to what means can be suggested for the treatment of similar cases. In regard to the first of these points, it is very generally stated that foreign bodies entering the air-passages pass into the right