Transactions of the international Medical Congress : seventh session held in London, August 2d to 9th, 1881. Diseases of children / prepared for publication under the direction of the Executive Committee by Sir William Mac Cormac ; assisted by George Henry Makins and H. B. Donkin, R. W. Parker.

  • International Medical Congress 1881 : London)
Date:
1881
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Licence: Public Domain Mark

Credit: Transactions of the international Medical Congress : seventh session held in London, August 2d to 9th, 1881. Diseases of children / prepared for publication under the direction of the Executive Committee by Sir William Mac Cormac ; assisted by George Henry Makins and H. B. Donkin, R. W. Parker. Source: Wellcome Collection.

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    croup with false membranes (diphtheria?), occurring in a boy of eight years, the catheter was inserted, and false membranes were expelled through it, and the patient breathed freely and easily. This patient recovered from the laryngeal affection, the tube was withdrawn, and he was pronounced convalescent. Four days later he became affected with pneumonia, from which he afterwards died. These, then, are five cases in which these tubes have been used with success, four of these having recovered and are living at the present time ; the fifth recovered from the laryngeal affection but succumbed to pneumonia contracted during convalescence. So that it may be said that the five cases hitherto tried have been successful. Besides these cases, tracheal catheters were introduced in two patients who had to undergo operations for the removal of epithelioma of the back part of the tongue and pharynx. Instead of performing tracheotomy and introducing, Trendelenburg’s tamponade canula, the catheter was introduced into the trachea, the upper portion of the glottis being occluded by an india-rubber ring placed on the outside of the catheter so as to increase its external circumference. Chloroform was administered through the tube, which projected several inches from the mouth. It was thus easy to exhibit the anaesthetic during the con- tinuance of the operation, while it in no way interfered with the operator, and it also prevented blood from entering the trachea. DISCUSSION. Dr. Alex. Robertson, Glasgow : I saw three of the patients referred to by Mr. MacEwen, who were shown by him at meetings of medical societies in Glasgow. They had all fully recovered. In one of the cases the tube had been in the larynx for thirty-six hours continuously, except for a few minutes on two or three occasions. I carefully observed in that case the state of the voice. It was perfectly normal, and the patient said it was as strong and clear as ever it was. I also saw the child aged eight years spoken of by Mr. MacEwen, after the tube had been in for three days. The little patient was quietly breathing through the tube, which projected about three inches beyond the lips. By examining with a lighted candle, I satisfied myself that the breathing was through the tube, not by the side of it. The respiratory murmur was heard by me at the base of the lungs, showing that the admission of the air was quite free. Fearing that the tube might act as a conductor to fluids in any attempt to swallow, I satisfied myself on that point by causing the nurse to give the child a spoonful of milk, which it swallowed with little difficulty, obviously none going into the larynx. Mr. President, I regard this mode of treatment, which I think is mainly Mr. MacEwen’s, though M. Bouchut pre- viously made some not very successful attempts by a somewhat similar method, as a valuable addition to the means of treating a most important class of cases. How far, however, it may supersede the operation of tracheotomy it would be premature to say.