CASE

OP ASPHYXIA CAUSED BY

PHARYNGEAL

ABSCESS ;

POST

RESUSCITA-

AND HOWARD'S

TION BY

EVACUATION,

DIRECT

METHOD OF ARTIFICIAL RES-

PIRATION. By Scrgeon-Major H.

Cayley,

Superintendent, Mayo Hospital, fyc. The following case presents some points of interest which I think renders it worth recording. I was recently called in hurriedly by a native medical practitioner for the purpose of performing tracheotomy on a child suffering from an inflammatory affection of the throat, which was causing alarming symptoms of difficulty of breathing. The child was about 1J years old, and had shown symptoms of inflammation in the throat for nearly 3 weeks, and for 2 days the obstruction to the breathing had been getting severe. I found the child suffering from most urgent dyspnoea, and with each inspiratory effort the

intercostal spaces and hollows above the sternum and clavicle was forcibly drawn in. The child's face was livid, and it was evidently almost at the point of death unless something could be done at once to relieve the breathing. 1 noticed that there was considerable, swelling on the left side of the neck just below the angle of the jaw, and observed too that when the child cried its voice was louder than one usually finds in obstruction within the larynx, and on forcing my finger into the mouth behind the bicuspid teeth, which was done with great difficulty on account of spasmodic closure of the jaws, I could feel a prominent fluctuating swelling at the back of the fauces which pressed forwards against the epiglottis and base of the tongue and so closed the opening of the glottis. I therefore decided, before having recourse to tracheotomy, to open this tumour, which was evidently The great difficulty was to force open the an abscess. child's mouth so as to be able to get at the swelling, as we were afraid to give chloroform in the condition the child then was. I had the assistance of two medical practitioners, and whilst we were endeavouring to open the jaws and put in a gag the child suddenly ceased to breathe, and in fact died. It was quite evident to all who were present that life was extinct, and at once the female relatives set up the usual loud howls and wailings which whole house. were repeated and echoed through the They at once seized the child's body and endeavoured to carry it off, find we had a regular struggle to prevent their doing so. I may say literally that we had forcibly to hold the body whilst the friends were trying to drag it out of our hands. This scene, which was painfully exciting, lasted of course only a few seconds, and when quiet was _

somewhat

restored, though

the

loud

wailings

of the

still reverberated through the house, I determined to open the abscess as quickly as possible, and try artificial respiration. As the muscles were perfectly relaxed in death, the child's mouth was easily opened and I plunged a bistoury into the swelling at the back of the throat, when an immense quantity of pus gushed out and nose. I then proceeded to emthrough the mouth " ploy Howard's direct method of artificial respiration The child was laid on its back with its head hanging over the edge of the bed, so that the pus might run freely out of its mouth and nostrils and not back into the windwomen

August 1,

1879.]

NOTICES TO CORRESPONDENTS.

a small hard round pillow was placed under the middle of its back. I then pressed firmly with my hands on the lower ribs and upper part of the belly for 2 or 3 seconds so as to squeeze the air out of the chest, and then removing the pressure the chest expanded and air After this process had been contiwas again drawn in nued for about a minute, to our intense satisfaction a faint inspiratory gasp was apparent, and the process being steadily kept up, in the course of another minute or so respiratory efforts returned, at first fitfully and then steadily, until breathing was re-established and the child restored to life. I need not add further details of after treatment, but in the course of a few days the child was convalescent. It is difficult to realize the excitement, astonishment and thankfulness of the mother and other relatives on seeing their son alive again after they themselves had seen and felr. it lying lifeless. It is, I think, very unusual for an abscess at the back of the pharynx to cause a fatal obstruction to the breathing, but it was so in this case, as the child was fast saw it. dying asphyxiated when I first " With regard to Howard's direct method" of artificial respiration, the process was fully described in the Lancet of 25th May 1878, and there is no need to repeat the details, but it is briefly as follows : The patient is laid on his back with a thick hard round pillow or bundle placed under the spine just opposite the lower ribs. The head and shoulder hang as it were over the pillow and the arms are drawn up from the si

Case of Asphyxia Caused by Post Pharyngeal Abscess; Resusctation by Evacuation, and Howard's Direct Method of Artificial Respiration.

Case of Asphyxia Caused by Post Pharyngeal Abscess; Resusctation by Evacuation, and Howard's Direct Method of Artificial Respiration. - PDF Download Free
4MB Sizes 0 Downloads 7 Views