Intubation of the larynx in laryngeal diphtheria : with notes of fifteen cases / by G. Hunter Mackenzie.

Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Intubation of the larynx in laryngeal diphtheria : with notes of fifteen cases / by G. Hunter Mackenzie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    5/22 (page 5)
    o to the left; invasion of the larynx on the 10th ; urgent dyspnoea and intubation under chloroform on the 12th. The tirst two attempts were unsuecessliil ; the third succeeded, l)Ut the thread attaclied to the tube liaving been caught l)y the insertor on its withdrawal, caused displacement of the tube. It was inimediately and finally reinserted, and the thread witlidrawn. The patient died twenty hours after intubation. The leading iealures after the operation were relief of the breathing, aggregation of mucus in the larynx or tube, and ditliculty in its expectoration ; swallowing fairly satisfactory, with the occurrence of occasional spasm during the act, and marked failure of the pulse some hours before death. This was tlie first case in which I performed intubation, and is the only one in wliicli I administered an aniestlietic. After fnrther experience I found that, with elhcient assistance, it could be done very easily without anaistlietizing the patient. The second un- successful attempt to introduce the tube was due to the patient's head being placed too low, and to the tube becoming prematurely detached from the obturator, partly owing to faulty construction of the instruments. This case indicates the necessity of keeping clear of the thread on withdrawal of the insertor, otherwise displacement of the tube is bound to ensue. The relief to the breathing afforded by the operation in this case was not complete, and death resulted, partly from respiratory obstruction, and partly from cardiac and general exluiustion. It may be added that the mother of the patient died during the following week of laryngeal diphtheria, for which tracheotomy was performed. -On comparing the results of the respective operations in these two cases, I was inclined to tliink that intubation gave the greater relief, and was productive of the less discomfort. Case II.—Child, aged 21 months, 1st March 1889. I was asked by Dr P, A. Young to see this case, and if necessary to perform intul)ation. The child was reported to have lieen croupy for a day or two ; now there were marked laryngeal dyspna'a and stridor. No. 2 tube was introduced on the third attempt; the breathing was immediately relieved, Itut inspiration was not so satisl'actorily performed as one could have wished. The thread was not detached from the tube. The child was reported to have gone on fairly well until four hours after the operation, when sudden profuse lijiomorrhage from the mouth and nose set in, and death immediately ensued. On inspection after death, the tube was found lying in the oro-pharynx, blocked with coagulated blood. Membrane was found in tlie larynx, and erosions of the left inferior (posterior) laryngeal artery and vein were found. The fact of the tube being found in the oro-pharynx was due to tlie attempts of tlie nurse to remove it after death, by pulling on the thread. Regarding the hasmorrliage, if, as seems probable, this came from the eroded vessels, it must be regarded either as an incident of the disease or as a result of the operation. If the latter, it must have been from pressure of the lower extremity of the tube upon the vessels. On experimenting with the tube I found that, when 171 situ, its lower extremity did not correspond with the locality of the erosions, and I therefore came to the conclusion that the disease itself was the cause of the bleeding. The appear- ance of the erosions also favoured the idea of their beincr due to a B