Diphtheria : its nature and treatment with special reference to the operation, after-treatment, and complications of tracheotomy / by Robert William Parker.

  • Parker, Robert William.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Diphtheria : its nature and treatment with special reference to the operation, after-treatment, and complications of tracheotomy / by Robert William Parker. Source: Wellcome Collection.

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    and had been tracheotomised eighteen and seven months respectively previous to the intubation. In neither of the cases had it been possible to remove the cannula for more than a few minutes ; in one of the cases every sort of treatment had previously failed. In the third case the boy had been tracheotomised for scald of the glottis eleven and a half years previously. After wearing his tube for five or six years and after great difficulties, it was removed. But in the course of a few days after leaving the hospital, and about a month after the tube was finally removed, his dyspnoea became urgent, and tracheotomy had to be done for the second time. All our further trials during the next five years proved unavailing. The chief facts of these 3 cases are as follows :— Case 1.—Boy, aged 4| years, suffered from diphtheria (super- vening on scarlet fever) of a severe and sloughy type. He was tracheotomised on the ninth day, and recovered, but was much debilitated by the disease. There was considerable loss of sub- stance with subsequent cicatrisation in the pharynx and upper part of the larynx, which led to some tension of the palate, of the adjoining arches, and of the ary-epiglottic folds. Efforts to remove the tube were commenced early and persisted in but without success. The boy was unable to breathe for more than five to eight minutes without his tracheotomy tube. Bougies were passed up without difficulty, but the larynx seemed to close after their withdrawal much as a urethral stricture does after catheterisation. All our efforts having failed, eighteen months after the operation, it was decided to try intubation. Mr. Symonds was invited to give us the benefit of his larger experi- ence and to undertake the operation, which he kindly did. Owing apparently to the altered relation of the parts, consider- able difficulties were experienced in introducing an intubation tube; but it was finally accomplished. The tube was worn for seventy-two hours, and was then coughed up. He had appeared to breathe comfortably while the tube was in situ, but he breathed still more easily without it: there was no need to re-introduce it. The boy now rapidly improved. I saw him on March 5th, 1891. The breathing is rather louder than normal, but there is