The introduction and removal of the tube

are

said to be easy operations, which can be accomplished without assistance in less than a minute, and the number of cases in which the INTUBATION OF THE LARYNX. The subject of relieving laryngeal obstruc-

operation

performed for the relief of croup is stated to be " quite large:" The New York has been

contributes twenty-five with especially those of inflammatory Foundling Asylum six recoveries. Dr. Hance, of New York, and membranous causation, by the introduction number of the New York of tubes, is at present exercising the miuds of contributes to a rcceut

tions,

more

American surgeons. An interesting article

on

the

subject

has been

contributed to the October number of the American Journal of the Medical Sciences, by Dr. J. Lewis Smith of New York, in which he expreshis belief that intubation is destined to be

ses

cases

Four of these

the

more

"

maintains that

iu all

cases

struction is limited to the intubation relieves

in which

larynx

and

the

the ob-

resorted to.

was

were cases

of croup, one of which recovered. The relief afforded by the introduction of the tube in the other

cases

according

marked?quite as great, author, as from tracheotomy.

was

very

to the

The introduction of tubes into the

generally than tracheotomy in treatment of pseudo-membranous croup. He by

employed

in which "intuba-

Medical Journal five

tion"

no

means

in

Glasgow,

novelty.

a

is

Du. MacEwen of

interesting

an

larynx

contributed

paper

to the British Medical Journal

(24th and trachea, 1880, pp. 122 and 163), gives a quickly, July of the attempts which have been tracheo- history

31st

short

dyspnoea as made and effectually, permanently as does to time time insert tubes to from into the tomy. It gives, iu most instances, complete at the Desault, beginning of the relief for a time. If the respiration subsequent- larynx. into the larynx tubes 19th century, passed ly become embarrassed, and no benefit occurs He appears and trachea through the nose. from cleaning the tube, tracheotomy may be to have succeeded thus in giving marked and required. Intubation may properly precede trapermauent relief to a patient suffering from cheotomy in most cases. The method of operating was Not a few parents, in the middle and lower oedema glottidis. "

classes,

allow their children to die rather than

consent to this

operation. On the other hand, few parents will object to intubation, and when they see the relief which it produces they will

probably if the

consent more

dyspnoea

should return. be

performed,

these

operations

show

nearly as good tracheotomy.

from

readily

a

to

If

tracheotomy only

one

of

statistics thus far

result from intubation

as

trypsin inhalations, properly constantly used, and intubation performed early, when the patient begins to suffer from dyspnoea, would probably prevent the necessity of tracheotomy in a large proportion of instances. But if such treatment do not fully relieve the dyspnoea, it will, in most instances, so retard the progress of croup that the physician, remote from help and unfavorably situated for the performance of tracheotomy, will have ample time to prepare for the operation." "

Alkaline and

and almost

difficult, and

the

mend itself to the invented

tube for

little

a

procedure did not recomfaculty. In 1858 Bouchut insertion

which he described

larynx,

tion to the

Academy

in

of Medicine.

into the

communica-

a

He met with

very hostile reception, and dropped the The next incident in the history of

a

subject.

laryngeal

catheterism is the

proposal of Trendelenburg bougies into the larynx of stenosis with a view to gradual dilatain cases tion. These were improved upon by Schrotter who used triangular- or three-cornered tubes of to introduce solid metal

also for purposes of dilatation. employed by Dr. Hack in 1878 in of cedema glottidis with success. The

graduated sizes, These a

case

tubes

were

were

hour.

than

an

ject

in 1878.

dead subject, that tubes up

retained

for

short

periods?less

Dr. MacEwen took up the subHe made experiments on the

using to

rounded

Nos. 18 and

tubes,

and

20 of the

found

English

INTUBATION OF THE LARYNX.

Nov., 1886.]

335

larynx geal catheterism aud employed it repeatedly in without difficulty by introducing the finger into cases of croup with satisfactory results. the mouth, depressing the epiglottis on the The evidence which we have thus briefly glancthe tube so and back ed over the at certainly justifies perseverance iu the tongue, guiding of the finger into the larynx." The larger direction of using tubes for the relief?temposized tubes could be introduced more easily than rary or permanent?of laryngeal obstruction. in the the smaller. He gives The operation of tracheotomy is often a diffipaper in question cult aud always an ugly one; and if the use of details of four cases in which he used laryngeal catheter scale could be

into the

passed

"

tubes with decided benefit.

experience "

up his

tubes is competent to avert or postpone resort to it (and this would seem to be fact) the case

passed through the mouth only in chronic but iu as ajdema glottidis.

employment is very strong. It would, however, be prudent, as Dit. MacEwen recommends, always to ascertain the state of the larynx by the use of the finger and laryngoscope as accurately as possible before proceeding to iusert

in these words

:

He

sums

?

Tubes may be into the trachea not 1.

acute

affections,

sucli

They can be introduced without placing the patient under an auoesthetic. 3. The respirations can be perfectly carried on through them. The expectoration cau be expelled "4. through them. "5. Deglutition can be carried on during "2.

"

the time the tube is in the trachea.

Though the patieut at painful sensation, yet this

first suffers from

sleep

with the tube in

"

6.

a passes off, aud the parts soon become tolerant of the presence of the tube. ?

The

7.

patient

can

situ. "

The tubes iu these

8.

least

were

rapid,

com-

cases at

harmless. "

plete, "

The ultimate results

9.

satisfactory.

and

Such

10.

were

operations

on

tubes may be introduced iu the face aud mouth in order to

prevent blood from

gaining

access to

the

trachea,

and for the purpose of administering the autesthetic, aud they answer the purpose admirably." The

practice

thus

strongly

recoinmeuded

by

Dr. Ma.cEwen does not appear to have been followed to auy great extent in Britain. A few

cases

have been contributed to the Medical

Journals, but a

opeuing

the air-tube aud

iuserting

cauula for permauent retention contiuues

be the due to

to

resort iu

approved respiratory exigencies laryngeal atresia, whether acute or

chronic. The

present revival

of the

practice

of intu-

bation in America is due to the efforts of Dr. O'Dwyer, of the New York Fouudling

Asylum, who iuveuted

a

special tube for laryn-

for their

either tubes

or

bougies into it.