CASES OF LARYNGOTOMY AND TRACHEOTOMY. Treated by Dr. G. C. Roy, m.d., f.r.c s. Lond., &c., In the
Soory
Charitable
(Reported by Assistant-Surgeon
Dispensary.
Apurba Kkisna
Chaudhuki, l.m.s.)
Shaik Busseruddi, a Mahomedan male, aged aDout 45, was admitted in the Soory Charitable Dispensary on the morning of the 12th February, 18S3, for pain in the throat and extreme difficulty of deglutition and respiration. On admission his friends stated that since last 4 or 5 days Voice had he was complaining of pain all over his throat. become husky, and he could take even liquid food with great difficulty. Since last evening his respiration had become hurried and stridulous, and he could not speak but in whispers. He complained of a peculiar pain in the throat, especially over He was in a cold sweat, and was restless the Pomum Adami. and anxious for relief. Present condition.?He is a man of broken down constitution, of short stature, and off and on has suffered from malarial complaints. On examination the fauces were seen reddened, dusky The patient said that he exposed himself to cold and swollen. the night previous to the attack, and that two of his co-villagers have died of the same disease within a month. At 9-3 A. M. laryngotomy was at once performed by A gush Dr. Roy under chloroform, and the tube inserted. of air and frothy mucus, surcharged with blood, came out with the first and subsequent efforts of expiration through the tube. The patient felt immediate relief after operation, and fell into a
quiet sleep.
Ordered?fomentation to the part with hot sponge ; tube be cleansed as soon as it becomes blocked. Milk and broth to be given as diet, ?Has got slight fever now ; complains of pain at the 5
to
site of operation ; respiration natural. Ordered? a dose of morphia. ijth.?Has no fever now, pain much less ; appetite sharpened. Bowels did not move : sleep disturbed. Ordered?Quinine Sulph. Gr. iv t. d. nit. silver lotion to the Broth and milk. inflamed glottis. Fomentation to the part. Enema. 14th.?Pain much less. Bowels moved twice after the enema. Wound dressed Feels still difficulty to drink broth or milk. with Carbolic oil and lint. Ordered?Continue all. 5 P.M.?Feels better; still feels difficulty to swallow both liquids and solids ; feels hungry but cannot take milk or broth, which mostly comes out of the nostril. ijth.?Feels better. Pain at the seat of operation much less. Is hungry. Bowels moved once. Sleep was disturbed by hunger at the latter part of the night.
Ordered?Mist. Pot. Iod. ?i t. d., nit. silver to the fauces. Food, consisting of milk and rice, was introduced into the
stomach by stomach pump morning and evening. 16th to igtii.?Was well in other respects except the pain on deglutition. Food was continued, to be introduced through the tube of the stomach pump. 20th.?The laryngeal tube was taken out this morning and the wound dressed with carbolic oil and lint. 21st to 28th.?Doing well. Can take milk diet without difficulty. Wound contracted. He was discharged cured on the 2nd of March. He is doing well. Janokee Nath Roy, a Brahmin male, aged about 47, of robust constitution, came on the morning of the 22nd May 1882, at about 9 A.M., to the Soory Charitable Dispensary and applied for treatment for pain in the throat and difficulty of respiration. Previous history.?About 8 years ago he suffered from an attack of primary syphilis, and had secondary symptoms off and on every year since then. About 6 or 7 days ago he exposed himself to the vicissitudes of the weather. He slept the whole night outside his room in the verandah?the night being very cold. Next morning he perceived soreness of the throat, his voice became husky, and there was slight pain on trying to swallow anything. The symptoms, in spite of all native On examination, the tonsils treatment, gradually increased. were seen highly inflamed, the larynx and the pharynx had partaken of the same condition. Nothing more could be detected with the naked eye. Had no bowels
?ever;
constipated.
Ordered?Nit. silver application
jalap ; 6 leeches to inhalation, mist. Pot.
the
throat, the throat, fomentation, hot Iod. t. d.
to
calomel and water
vapour
A MIRROR OF HOSPITAL PRACTICE.
October, i883.]
2"xrd.?He came with nil the symptoms aggravated. There was spasm of the larynx, recurring every 10 or 15 minutes. There was pain and tenderness on pressing the windpipe. Voice had become suppressed almost to a whisper. Breathing hurried and take stridulous. Could nothing since last evening, as the effort of deglutition produced spasm and a sensation of suffocation ? became urgent, lips and face became livid, Dyspnoea gradually feature pale and bedewed with cold and clammy perspiration, Respiration laboured and difficult; pulse became small, weak and quick. He was put under chloroform and laryngotomy at once performed by Dr. Roy and a silver tube inserted. There was no haemorrhage during or after the operation. Ordered?fomentation to the part with hot sponge. Inner tube to be cleansed. Broth and milk as food ; morphia draught in the evening. 5 P. M.?Had slight fever ; complained of pain at the site of
operation.. 24th.?Slept
well last night, no fever in the morning ; pain Felt exhausted. Breathing easy. 25th to 29th.?Feels well in all respects, and could inspire and expire through the naiural passages on closing the opening of the tube with the finger. The tube was taken out and the patient kept under observation. He passed the whole day without any discomfort, but at 5-30 p. m. the opening contracted, spasm of the glottis supervened and dyspnoea became urgent. The tube was necessarily again inserted. On the 4th June the tube was again taken out, which produced a little haemorrhage, but with the same result. jth.?The throat examined after taking out the inner tube. A small white fungating lump was seen protruding through This was cut and the the posterior slit of the outer tube. part touched with a probe mounted with solid nitrate of silver tube inserted. inner the and then less.
?i
t. d. Ordered?Mist. Pot. Iod. On the 8th the patient was discharged at his own request. He came again on the 29th June, when he could respire through He usually kept the mouth of the tube the natural passages. ciosed with a piece of cork without feeling any difficulty, and in that' condition could even blow a conch-shell by the mouth. The tube was again taken out on the 30th June, bat at 6 P. M. he was attacked with spasm, which threatened suffocation, and necessitated its reintroduction. The patient wears the tube even now, with but little inconvenience to himself or to his profession. Case No. 3.?On the 16th of April 1882,tat about 8-30 a.m., Jadub Chunder Gone, a Hindoo male, aged about 40, was registered as en out-door patient for pain in the throat and huskiness of vioce. Previous history.?About 11 years ago he had an attack of chancre, which was followed by constitutional symptoms. He never suffered from any inflammatory disease of the throat. Lately he suffered oft and on from malarial complaints which weak. greatly reduced his health, his constitution being naturally Present condition.?He is a sparely-built mah, of' short stature ; complains of pain in the throat and huskines's of voice, which have gradually become aggravated within the last 6 days. Has no Feels difficulty to swallow anything but liquid food. fever now. No abnormality could be detected on exploring the chest. Bowels did not move regularly since'last 3 days. On examination, the upper part of the air-passage was seen congested and the uvula enlarged. Ordered?Nit. silver to the throat. Pot. chloras and Tr. steel mixt. steam inhalation. Milk diet. Calomel and Rhub. at bed time. 17th.?Pain a little less, but no decided: improvement otherwise. Bowels moved twice this morning. Ordered.?Nit. silver to the throat and Mist. Pot. Iod. 18th to 21st.?Attended the dispensary regularly. Symptoms ,
......
,
are
gradually subsiding.
He was not seen for a week after this date, but* on the 28th he again applied to the dispensary for treatment with all the previous symptoms aggravated. Body more emaciated. There was great difficulty both in respiration and deglutition, so much so that he was kept under observation. At 4 P. M. dyspnoea threatened death from suffocation. Voice became whispering. Nails, lips and conjunctivae livid. The whole body bathed in cold perspiration, and the patient Pulse became flickering, small and quick. was restless. Tracheotomy was performed by Assistant-Surgeon A. K. Chaudhuri, and the tube inserted. Patient fell into a deep sleep,
287
Respiration stopped 4 times after the operation, but was kept i.p by Howard's method. The inner tube was cleaned several times in the night. The part fomented with hot sponge, and broth and milk given as nourishment. 29th.?Feels very weak; complains of pain at the site of operation. Coughs a little. Has slight fever now. Ordered?Mist. Pot. Chloras, Tr. steel and Vin. Gallici. Fomentation to the part. The inner tube to be cleaned regularly. Nit- silver to the throat. Quinine, Sulph. during intermission. Milk and broth to be given as diet. Wound to be dressed with Carbolic oil. Tpth.?Feels better. Has no fever. Ordered to continue all. \st lo \th May.?Doing well. Can take milk and rice. Ordered.?Mist. Pot. Iod. and nit. silver to throat. On the 5th May he was discharged and treated as an outdoor patient. On the 10th the tube was taken out, but at 2 r. M. there was difficulty of respiration, and consequently the tube was reapplied.
On the 16th the tube was again taken out, but in the evening there was difficulty in respiration and it had to be re-introduced. Since then the tube is taken out occasionally for cleansing and re-applied the same day. He can speak in an audible voice when The tube has now been the opening is closed with the finger. kept permanently in without any discomfort tothe patient. He is doing his duties as a court-peon, and has picked up flesh and
strength.
Soory
Charitable
(Reported by Assistant-Surgeon
Dispensary.
Apurba Kkisna
Chaudhuki, l.m.s.)
Shaik Busseruddi, a Mahomedan male, aged aDout 45, was admitted in the Soory Charitable Dispensary on the morning of the 12th February, 18S3, for pain in the throat and extreme difficulty of deglutition and respiration. On admission his friends stated that since last 4 or 5 days Voice had he was complaining of pain all over his throat. become husky, and he could take even liquid food with great difficulty. Since last evening his respiration had become hurried and stridulous, and he could not speak but in whispers. He complained of a peculiar pain in the throat, especially over He was in a cold sweat, and was restless the Pomum Adami. and anxious for relief. Present condition.?He is a man of broken down constitution, of short stature, and off and on has suffered from malarial complaints. On examination the fauces were seen reddened, dusky The patient said that he exposed himself to cold and swollen. the night previous to the attack, and that two of his co-villagers have died of the same disease within a month. At 9-3 A. M. laryngotomy was at once performed by A gush Dr. Roy under chloroform, and the tube inserted. of air and frothy mucus, surcharged with blood, came out with the first and subsequent efforts of expiration through the tube. The patient felt immediate relief after operation, and fell into a
quiet sleep.
Ordered?fomentation to the part with hot sponge ; tube be cleansed as soon as it becomes blocked. Milk and broth to be given as diet, ?Has got slight fever now ; complains of pain at the 5
to
site of operation ; respiration natural. Ordered? a dose of morphia. ijth.?Has no fever now, pain much less ; appetite sharpened. Bowels did not move : sleep disturbed. Ordered?Quinine Sulph. Gr. iv t. d. nit. silver lotion to the Broth and milk. inflamed glottis. Fomentation to the part. Enema. 14th.?Pain much less. Bowels moved twice after the enema. Wound dressed Feels still difficulty to drink broth or milk. with Carbolic oil and lint. Ordered?Continue all. 5 P.M.?Feels better; still feels difficulty to swallow both liquids and solids ; feels hungry but cannot take milk or broth, which mostly comes out of the nostril. ijth.?Feels better. Pain at the seat of operation much less. Is hungry. Bowels moved once. Sleep was disturbed by hunger at the latter part of the night.
Ordered?Mist. Pot. Iod. ?i t. d., nit. silver to the fauces. Food, consisting of milk and rice, was introduced into the
stomach by stomach pump morning and evening. 16th to igtii.?Was well in other respects except the pain on deglutition. Food was continued, to be introduced through the tube of the stomach pump. 20th.?The laryngeal tube was taken out this morning and the wound dressed with carbolic oil and lint. 21st to 28th.?Doing well. Can take milk diet without difficulty. Wound contracted. He was discharged cured on the 2nd of March. He is doing well. Janokee Nath Roy, a Brahmin male, aged about 47, of robust constitution, came on the morning of the 22nd May 1882, at about 9 A.M., to the Soory Charitable Dispensary and applied for treatment for pain in the throat and difficulty of respiration. Previous history.?About 8 years ago he suffered from an attack of primary syphilis, and had secondary symptoms off and on every year since then. About 6 or 7 days ago he exposed himself to the vicissitudes of the weather. He slept the whole night outside his room in the verandah?the night being very cold. Next morning he perceived soreness of the throat, his voice became husky, and there was slight pain on trying to swallow anything. The symptoms, in spite of all native On examination, the tonsils treatment, gradually increased. were seen highly inflamed, the larynx and the pharynx had partaken of the same condition. Nothing more could be detected with the naked eye. Had no bowels
?ever;
constipated.
Ordered?Nit. silver application
jalap ; 6 leeches to inhalation, mist. Pot.
the
throat, the throat, fomentation, hot Iod. t. d.
to
calomel and water
vapour
A MIRROR OF HOSPITAL PRACTICE.
October, i883.]
2"xrd.?He came with nil the symptoms aggravated. There was spasm of the larynx, recurring every 10 or 15 minutes. There was pain and tenderness on pressing the windpipe. Voice had become suppressed almost to a whisper. Breathing hurried and take stridulous. Could nothing since last evening, as the effort of deglutition produced spasm and a sensation of suffocation ? became urgent, lips and face became livid, Dyspnoea gradually feature pale and bedewed with cold and clammy perspiration, Respiration laboured and difficult; pulse became small, weak and quick. He was put under chloroform and laryngotomy at once performed by Dr. Roy and a silver tube inserted. There was no haemorrhage during or after the operation. Ordered?fomentation to the part with hot sponge. Inner tube to be cleansed. Broth and milk as food ; morphia draught in the evening. 5 P. M.?Had slight fever ; complained of pain at the site of
operation.. 24th.?Slept
well last night, no fever in the morning ; pain Felt exhausted. Breathing easy. 25th to 29th.?Feels well in all respects, and could inspire and expire through the naiural passages on closing the opening of the tube with the finger. The tube was taken out and the patient kept under observation. He passed the whole day without any discomfort, but at 5-30 p. m. the opening contracted, spasm of the glottis supervened and dyspnoea became urgent. The tube was necessarily again inserted. On the 4th June the tube was again taken out, which produced a little haemorrhage, but with the same result. jth.?The throat examined after taking out the inner tube. A small white fungating lump was seen protruding through This was cut and the the posterior slit of the outer tube. part touched with a probe mounted with solid nitrate of silver tube inserted. inner the and then less.
?i
t. d. Ordered?Mist. Pot. Iod. On the 8th the patient was discharged at his own request. He came again on the 29th June, when he could respire through He usually kept the mouth of the tube the natural passages. ciosed with a piece of cork without feeling any difficulty, and in that' condition could even blow a conch-shell by the mouth. The tube was again taken out on the 30th June, bat at 6 P. M. he was attacked with spasm, which threatened suffocation, and necessitated its reintroduction. The patient wears the tube even now, with but little inconvenience to himself or to his profession. Case No. 3.?On the 16th of April 1882,tat about 8-30 a.m., Jadub Chunder Gone, a Hindoo male, aged about 40, was registered as en out-door patient for pain in the throat and huskiness of vioce. Previous history.?About 11 years ago he had an attack of chancre, which was followed by constitutional symptoms. He never suffered from any inflammatory disease of the throat. Lately he suffered oft and on from malarial complaints which weak. greatly reduced his health, his constitution being naturally Present condition.?He is a sparely-built mah, of' short stature ; complains of pain in the throat and huskines's of voice, which have gradually become aggravated within the last 6 days. Has no Feels difficulty to swallow anything but liquid food. fever now. No abnormality could be detected on exploring the chest. Bowels did not move regularly since'last 3 days. On examination, the upper part of the air-passage was seen congested and the uvula enlarged. Ordered?Nit. silver to the throat. Pot. chloras and Tr. steel mixt. steam inhalation. Milk diet. Calomel and Rhub. at bed time. 17th.?Pain a little less, but no decided: improvement otherwise. Bowels moved twice this morning. Ordered.?Nit. silver to the throat and Mist. Pot. Iod. 18th to 21st.?Attended the dispensary regularly. Symptoms ,
......
,
are
gradually subsiding.
He was not seen for a week after this date, but* on the 28th he again applied to the dispensary for treatment with all the previous symptoms aggravated. Body more emaciated. There was great difficulty both in respiration and deglutition, so much so that he was kept under observation. At 4 P. M. dyspnoea threatened death from suffocation. Voice became whispering. Nails, lips and conjunctivae livid. The whole body bathed in cold perspiration, and the patient Pulse became flickering, small and quick. was restless. Tracheotomy was performed by Assistant-Surgeon A. K. Chaudhuri, and the tube inserted. Patient fell into a deep sleep,
287
Respiration stopped 4 times after the operation, but was kept i.p by Howard's method. The inner tube was cleaned several times in the night. The part fomented with hot sponge, and broth and milk given as nourishment. 29th.?Feels very weak; complains of pain at the site of operation. Coughs a little. Has slight fever now. Ordered?Mist. Pot. Chloras, Tr. steel and Vin. Gallici. Fomentation to the part. The inner tube to be cleaned regularly. Nit- silver to the throat. Quinine, Sulph. during intermission. Milk and broth to be given as diet. Wound to be dressed with Carbolic oil. Tpth.?Feels better. Has no fever. Ordered to continue all. \st lo \th May.?Doing well. Can take milk and rice. Ordered.?Mist. Pot. Iod. and nit. silver to throat. On the 5th May he was discharged and treated as an outdoor patient. On the 10th the tube was taken out, but at 2 r. M. there was difficulty of respiration, and consequently the tube was reapplied.
On the 16th the tube was again taken out, but in the evening there was difficulty in respiration and it had to be re-introduced. Since then the tube is taken out occasionally for cleansing and re-applied the same day. He can speak in an audible voice when The tube has now been the opening is closed with the finger. kept permanently in without any discomfort tothe patient. He is doing his duties as a court-peon, and has picked up flesh and
strength.
