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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    requested me to see him, in case I might think it advisable to perform tracheotomy. I found him suffering from very urgent dyspnoea, with prolonged stridulous inspiration and very short expiration. The expansion of the thorax was defi¬ cient, the ribs being drawn inwards during respiration. The pulse was small, and the face livid. There was some slight bronchitis, but not to such an extent as to forbid the operation, which was accordingly performed, and a double tube introduced. A quantity of mucus was expelled on opening the trachea, and then the breathing became easy. A piece of muslin was placed over the orifice of the tube, and the attendants were shown how to clear it from time to time. In the afternoon, when I saw him, I found him much relieved. The colour of the face was natural; the pulse, though still quick, was softer, fuller, and less rapid than in the morning; the breathing was quite easy. I removed the inner tube, cleaned it, oiled it slightly, showed the attendant how to remove and clean it, and made her take it out and replace it, to make sure that she understood me. Next morning I found him still improving, and breathing so easily, that, after cleaning the tube, I did not think it necessary to visit him again that day. On Tuesday the 19th, when I called on Dr Menzies to accompany me to see the patient, I learned, to my great surprise, that he had died at 3 a.m. Dr M. informed me that he had seen him after my visit, and found him still doing well, and breathing quite easily. About 1 p.m., however, owing to some mucus obstructing the tube, a fit of dyspnoea came on. The nurse, instead of with¬ drawing the inner tube, although she had been taught how to do it, became alarmed, and it was only when the child was nearly suffocated that his father, in desperation, took it out. This at once relieved the breathing ; but the effects of long-obstructed respiration soon showed themselves in pain in the head, dilated pupils, and other symptoms of cerebral effusion. The poor child soon became comatose, and died thirty-nine hours after the operation. Case IV.—George Stark, aged 5 years, admitted to the Infirmary on the 18th of March 1857. The patient has been subject to cough for the last two years, and is liable to occasional acute aggravations of it. He was seized with one of these attacks about a fortnight ago, and was considerably worse than usual. His symptoms became gradually more urgent, and he was brought to the hospital on the 18th of March, suffering from a severe attack of true croup. The usual treatment, including repeated counter-irritation, was used in vain, and on the 19th he was so ill that tracheotomy seemed to afford the only chance for life. The breathing was noisy and laborious, the respirations being 30 per minute; the expansion of the chest on inspiration was very imperfect, and there was marked depression of the lower ribs in expiration, The operation was accordingly performed in the usual way, and a double tube introduced. Great relief to the breathing immediately followed the operation. 20th.—Pulse 140 ; skin hot: but patient breathing much more easily. The tube is carefully kept clear. Since the operation, considerable pain and tender¬ ness have been felt below the left jaw. 22d.—Pulse 120, and skin cooler. The tenderness below the jaw has disap¬ peared. Breathing very easy. The tube was taken out to-day, and did not require to be replaced. 25th.—Pulse 120, rather small ; ordered gij wine. The tube required to be replaced, as the breathing was becoming impeded from the closing of the wound. 26^.—Tube finally removed to-day ; doing well. 30th.—Pulse 100; breathing easy ; general health very much improved. April 6th.—Pulse 100, full and soft; general appearance much improved ; and the tracheotomy wound is closing rapidly. The raw surface left after the repeated blistering is still sloughy and irritable.