4th.?Which is the its
performance 5 th.?Which
easily managed
more
after
? the
larger proportion
of
Which is less prone to be followed complications ?
by
gives
recoveries ? 6th.
?
regards the first point the purpose of the two procedures is of course similar, namely, to relieve dyspnoea caused by occlusion of the ls?.? As
larynx.
Tracheotomy aims by establishing an
fulfilling this opening
at
artificial
purpose fo r entrance and exit of air behind the stricture as in perineal section, and, if possible, beyond the disease. INTUBATION The
vs.
TRACHEOTOMY.
of
Intubation, which was introduced some years ago by Dr. Joseph O'Dwyer, of New York, has now been subjected to trial on a sufficiently extensive scale to permit of a judgment being formed regarding its merits as compared with the operation of tracheotomy. This has recently been ably and impartially atoperation
tempted by
paper read Association at the
Dr. George W. Gay in
before the American
Surgical
a
Congress of American Phvsicians and Surgeons Dr. held at Washington in September last. JO
o
Gay limits his observations
to the treatment of
croup or membranous laryngitis. Intubation has also been employed in other conditions of the
larynx causing dyspnoea, but it is in diphtheria larynx that it has been most largely employed. Plere the conditions are sufficiently
of the
and the induction
simple afford
a
basis of
comparison.
arise with
naturally
methods of relieving 1 st.?Are
operation objects to
a
sufficiently large The
reference
dyspnoea
questions to
in croup
they really comparable
substitute for the other ? be
these
gained identical,
i?>
that two
are :?
;
is
one
Are the
and the circum-
calling for them similar, or, on the other hand, do they stand on a different footing as regards the purpose and conditions demanding
stances
them ?
2nd.?Which of the
catheter is
a
in.
two is the easier of per-
formance ? most
complete
and
The in
same
to restore
passed
into the bladder and tied
operations principle, and as two
are
thus
quite the points out,
not
Dr. Gay
they rather, as in the analogous urethral procedures, snpplemeut than supplant each other. An exact comparison as between, say, the flap and circular methods of amputation is not possible. They are not even rivals, for should intubation fail to relieve the symptoms, tracheotomy is still available. a
In
most
choice lies between them, in
cheotomy
is
tracheotomy
to
be
can
cases
probably
some cases
tra-
preferred ab initio, and, in all, be held in reserve in case of
need. 2nd.? As
regards comparative facility
formance the truth
is,
that
"
of per-
both
operations are occasionally require special ap-
often attended with difficulties and
danger." They both pliances, but the appliances with
bation
necessary for intuthan for tracheotomy.
special require practice,but intubation being out of sight and depending more on touch than sight, special practice on the dead and living is more needed than in tracheotomy. They both require skilled assistance, but the experiare more
They
both
ence
of intubation indicates that the
the "
3rd.?Which gives the permanent relief?
Intubation endeavours
the patency of the air tube by introducing and retaining a tube, just as, in retention of urine,
"
operation depends
more
on
success
of
the skill and
handinesa" of the assistants than the other. Tracheotomy can be done with the aid of one
good assistant, intubation requires, at least, two." The tracheotomy instruments must always be at hand, in case of failure to introduce the tube
THE INDIAN MEDICAL GAZETTE.
116
that the removal of
obvious much
be
easily
more
It
membrane.
thereof with
blocking
ol*
membrane
is can
in tracheo-
accomplished
tomy than in intubation. relief
3rd.?As
regards especially seem early, performed
operations when
more
of
dyspnoea,
cases, and
in mild to
the
be about,
equal.
Intubation possesses the great merit that it is a bloodless procedure, and therefore more likely to be consented to
earlier
by parents
and others
at
an
tion appear to be more favourable in the case of very young children than of tracheotomy. 6th.?The complications which generally prove fatal in these
get loaded and the lungs congested and the strength spent ; and inter-
source
ference is too late and
to
apt
discredited. there is
to
the
In very young children natural hesitation to cnt
a
which does not
cutting
operation
so
becomes
especially or permit
oppose inpermanency of relief
strongly
extension of disease
are
ensue
after
on
cutting is
operation
The effect very material risk. the voice in cases that recover does not appear be a serious matter in either operation. not a
On the whole, Dr. Gay shows that the operation of intubation has established itself in
practice
as a
means
of
relieving suffering
doubt,"
it relieves
that it
choose between the two
is
procedures.
4th.?The after treatment in both mands skill
have
de-
tracheotomy tube perhaps changed. intubation tube may get gummed up and to be removed, cleaned and replaced, or it
requires The
cases
to
and
be
The
care.
kept
clean and
may be coughed up or even swallowed. On this point Dr. GrAY observes :?" In situated at such
cases
distances,
under cir-
or
cumstances, in which only ordinary and not skilled assistance can be obtained in an emergency, tracheotomy is the safer method." In other words, if the services of a skilled phy-
sician as
in
a
cannot be obtained at
hospital, tracheotomy
intubation. the
Any
contingencies
doctor
or
a
moment's
is to be
notice, preferred to
cope with but it requires
nurse can
of
tracheotomy, replace an intubaspecial is tube. tion Feeding evidently less easily managintubation than after tracheotomy. ed after 5th.?Dr. Gay has gone very carefully into skill
to remove and
the question of the proportion of recoveries which take place after both operations. The
experience
is
larger
in the
case
of
tracheotomy,
but careful consideration of available statistics " leads him to the conclusion that the mortality
he states,
of intubation have
record,
and the results
now
are
The immediate relief to the
for all with
is
more
easily
Hundreds of
been put upon
fairly satisfactory.
dyspnoea
may not,
complete, as it is after it is usually sufficient operation, yet
severe cases
the old
that
life ; that it to do; and that,
dyspnoea; reasonably safe operation in the majority of instances, it performed than tracheotomy. cases
"
and
saves
a
in the severe
the other.
is,
With respect to depends on the extent and progress of the disease, and there does not seem to be much to
tubation.
as
of course, a special risk of operation, but danger from this
Wound infection the
one
having life in croup. " There can be no
that
to
lungs, pulmonary congestion and pneumonia, blood-poisoning, asthenia, syncope ; and the evidence goes to show that these results are as
tubes
are
cases
the
liable to
than the
disease
namely,
in round numbers 75 per cent, of deaths and 25 per cent, of recoveries. The results of intuba-
stage cutting operation. This is a very great point in its favour ; for if operative relief is delayed, the
of the
each is about the same,"
attending
1889
[April,
practical opposition,
be
as
Intubation has met purposes. but in spite of its dangers and
inconveniences, from which no method of treating these affections is free, its advantages are gradually forcing themselves upon the profession, as experience becomes more extensive."
performance 5 th.?Which
easily managed
more
after
? the
larger proportion
of
Which is less prone to be followed complications ?
by
gives
recoveries ? 6th.
?
regards the first point the purpose of the two procedures is of course similar, namely, to relieve dyspnoea caused by occlusion of the ls?.? As
larynx.
Tracheotomy aims by establishing an
fulfilling this opening
at
artificial
purpose fo r entrance and exit of air behind the stricture as in perineal section, and, if possible, beyond the disease. INTUBATION The
vs.
TRACHEOTOMY.
of
Intubation, which was introduced some years ago by Dr. Joseph O'Dwyer, of New York, has now been subjected to trial on a sufficiently extensive scale to permit of a judgment being formed regarding its merits as compared with the operation of tracheotomy. This has recently been ably and impartially atoperation
tempted by
paper read Association at the
Dr. George W. Gay in
before the American
Surgical
a
Congress of American Phvsicians and Surgeons Dr. held at Washington in September last. JO
o
Gay limits his observations
to the treatment of
croup or membranous laryngitis. Intubation has also been employed in other conditions of the
larynx causing dyspnoea, but it is in diphtheria larynx that it has been most largely employed. Plere the conditions are sufficiently
of the
and the induction
simple afford
a
basis of
comparison.
arise with
naturally
methods of relieving 1 st.?Are
operation objects to
a
sufficiently large The
reference
dyspnoea
questions to
in croup
they really comparable
substitute for the other ? be
these
gained identical,
i?>
that two
are :?
;
is
one
Are the
and the circum-
calling for them similar, or, on the other hand, do they stand on a different footing as regards the purpose and conditions demanding
stances
them ?
2nd.?Which of the
catheter is
a
in.
two is the easier of per-
formance ? most
complete
and
The in
same
to restore
passed
into the bladder and tied
operations principle, and as two
are
thus
quite the points out,
not
Dr. Gay
they rather, as in the analogous urethral procedures, snpplemeut than supplant each other. An exact comparison as between, say, the flap and circular methods of amputation is not possible. They are not even rivals, for should intubation fail to relieve the symptoms, tracheotomy is still available. a
In
most
choice lies between them, in
cheotomy
is
tracheotomy
to
be
can
cases
probably
some cases
tra-
preferred ab initio, and, in all, be held in reserve in case of
need. 2nd.? As
regards comparative facility
formance the truth
is,
that
"
of per-
both
operations are occasionally require special ap-
often attended with difficulties and
danger." They both pliances, but the appliances with
bation
necessary for intuthan for tracheotomy.
special require practice,but intubation being out of sight and depending more on touch than sight, special practice on the dead and living is more needed than in tracheotomy. They both require skilled assistance, but the experiare more
They
both
ence
of intubation indicates that the
the "
3rd.?Which gives the permanent relief?
Intubation endeavours
the patency of the air tube by introducing and retaining a tube, just as, in retention of urine,
"
operation depends
more
on
success
of
the skill and
handinesa" of the assistants than the other. Tracheotomy can be done with the aid of one
good assistant, intubation requires, at least, two." The tracheotomy instruments must always be at hand, in case of failure to introduce the tube
THE INDIAN MEDICAL GAZETTE.
116
that the removal of
obvious much
be
easily
more
It
membrane.
thereof with
blocking
ol*
membrane
is can
in tracheo-
accomplished
tomy than in intubation. relief
3rd.?As
regards especially seem early, performed
operations when
more
of
dyspnoea,
cases, and
in mild to
the
be about,
equal.
Intubation possesses the great merit that it is a bloodless procedure, and therefore more likely to be consented to
earlier
by parents
and others
at
an
tion appear to be more favourable in the case of very young children than of tracheotomy. 6th.?The complications which generally prove fatal in these
get loaded and the lungs congested and the strength spent ; and inter-
source
ference is too late and
to
apt
discredited. there is
to
the
In very young children natural hesitation to cnt
a
which does not
cutting
operation
so
becomes
especially or permit
oppose inpermanency of relief
strongly
extension of disease
are
ensue
after
on
cutting is
operation
The effect very material risk. the voice in cases that recover does not appear be a serious matter in either operation. not a
On the whole, Dr. Gay shows that the operation of intubation has established itself in
practice
as a
means
of
relieving suffering
doubt,"
it relieves
that it
choose between the two
is
procedures.
4th.?The after treatment in both mands skill
have
de-
tracheotomy tube perhaps changed. intubation tube may get gummed up and to be removed, cleaned and replaced, or it
requires The
cases
to
and
be
The
care.
kept
clean and
may be coughed up or even swallowed. On this point Dr. GrAY observes :?" In situated at such
cases
distances,
under cir-
or
cumstances, in which only ordinary and not skilled assistance can be obtained in an emergency, tracheotomy is the safer method." In other words, if the services of a skilled phy-
sician as
in
a
cannot be obtained at
hospital, tracheotomy
intubation. the
Any
contingencies
doctor
or
a
moment's
is to be
notice, preferred to
cope with but it requires
nurse can
of
tracheotomy, replace an intubaspecial is tube. tion Feeding evidently less easily managintubation than after tracheotomy. ed after 5th.?Dr. Gay has gone very carefully into skill
to remove and
the question of the proportion of recoveries which take place after both operations. The
experience
is
larger
in the
case
of
tracheotomy,
but careful consideration of available statistics " leads him to the conclusion that the mortality
he states,
of intubation have
record,
and the results
now
are
The immediate relief to the
for all with
is
more
easily
Hundreds of
been put upon
fairly satisfactory.
dyspnoea
may not,
complete, as it is after it is usually sufficient operation, yet
severe cases
the old
that
life ; that it to do; and that,
dyspnoea; reasonably safe operation in the majority of instances, it performed than tracheotomy. cases
"
and
saves
a
in the severe
the other.
is,
With respect to depends on the extent and progress of the disease, and there does not seem to be much to
tubation.
as
of course, a special risk of operation, but danger from this
Wound infection the
one
having life in croup. " There can be no
that
to
lungs, pulmonary congestion and pneumonia, blood-poisoning, asthenia, syncope ; and the evidence goes to show that these results are as
tubes
are
cases
the
liable to
than the
disease
namely,
in round numbers 75 per cent, of deaths and 25 per cent, of recoveries. The results of intuba-
stage cutting operation. This is a very great point in its favour ; for if operative relief is delayed, the
of the
each is about the same,"
attending
1889
[April,
practical opposition,
be
as
Intubation has met purposes. but in spite of its dangers and
inconveniences, from which no method of treating these affections is free, its advantages are gradually forcing themselves upon the profession, as experience becomes more extensive."
