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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    examined both the larynx and bronchi with a probe, but most particularly the larynx, for all the symptoms tended to impress us with the belief that the foreign body was there. Mr Syme also examined the parts, but could not detect it. It was agreed in consultation that it was best to enlarge the open¬ ing ; I therefore divided the cricoid cartilage so as to allow a more ready exa¬ mination of the larynx, and a more easy escape of the foreign body; but we were still unsuccessful. Under these circumstances, we deemed it best to re¬ place the tube until the following day. Nothing particular occurred during the remainder of the day ; the child was carefully attended to, he continued to breathe freely through the tube, and both sides of the chest seemed to ex¬ pand equally, and at the same moment. He was ordered a little milk with warm water and sugar, for food, which he partook of readily, and slept at in¬ tervals. On Friday Professor Syme again saw him with me; the tube wras withdrawn, but the difficult respiration again returned when the opening was closed; whilst, on the contrary, the breathing was free, and perfectly easy when it was left open. We again carefully examined the larynx and bronchi, but in vain. We could not detect any foreign body; and we concluded that it had probably been pushed up by the probe passed into the |>harynx and swal¬ lowed, and that the difficulty in breathing might be owing to swelling of the mucous membrane lining the larynx. The tube was once more replaced, and the same treatment adopted as before ; a gentle laxative was prescribed, and I desired the stools to be carefully examined. I again saw him at 3 P.M., when I found his breathing was hurried, together with a considerable degree of gene¬ ral fever ; the face was flushed, and the pulse rather quick and hard; I therefore ordered some leeches to be applied over the region of the chest, the laxative medi¬ cine to be repeated, and an injection to be given in case it did not soon operate. I again saw him at 8 p.m. ; he now seemed considerably easier, there wras less fever and restlessness, and the breathing was less hurried ; the bowels had been freely opened, and the leeches had bled well. At 10 o’clock I was informed he was rather worse; and, on visiting him, I found him very restless, his breath¬ ing had become hurried, and he was thirsty and hot. Having cleaned the tube, it relieved his breathing; and I left him, and sent a person to remain with him during the night, with strict instructions to call me if he became worse. At half¬ past 11 o’clock, I was again sent for, as the child had become suddenly much worse. I now found him fast sinking. I introduced a clean tube, and ordered him some wine and water, under which he rallied in a measure ; but it was only for a short period, as about midnight he expired. Having obtained permission from the friends to examine the body, I did so on the morning of the 26tli September, and the following were the appearances found on dissection :— I carefully examined the larynx and trachea, but could find Post-mortem no foreign body. There was a slight degree of vascularity of Examination of the mucous membrane of the larynx, together with some the Body. thick mucus in its cavity, but there was very little swelling of the parts. I laid open the right bronchial tube, -which presented nearly its natural ap¬ pearance, with but slight degree of vascularity of its mucous coating, but there was no foreign body in it. The right lung, with the exception of a little con¬ gestion at its posterior part, was of a healthy appearance, and crepitated natu¬ rally on being pressed between the fingers. The left bronchus was next exa¬ mined ; and as I saw no foreign body, I was about to give up all further in¬ vestigation of the thoracic viscera, concluding that it had been pushed upwards during our examination of the larynx, as I previously conjectured, and that it passed into the stomach, when my attention was arrested by the peculiarly dark appearance of the lower portion of the upper lobe of the left lung ; and on cutting into this portion, I found the foreign body, a small damson stone, impacted into one of the large subdivisions of the left bronchus, the larger end of the stone projecting upwards. No other parts were therefore examined.