TRACHEOTOMY IN A CASE OF LARYNGITIS RECOVERY. By Ashutosii Laha, L.M.S., Surgeon in medical charge of Srinagur, Govermnent Charitable Sudder Dispensary, Ourwhal. Patu, a Hindoo pahari, male, aged 44 years, was admitted on the 5th. of January 1877. Stated that he had been suffering from occasional fits of dyspnoea for the last 3 or 4 months, and that lately his voice also has become hoarse ; has led a very irregular and dissipated life since his boyhood, and had syphilis and bubo about 20 Is years ago. Used sundry native drugs and was salivated. father of 3 children, two of whom died at an early age, one from cholera, the other from measles, and the third (first born, now 18 years old) is quite healthy. None of his children or his wife ever manifested any symptoms of syphilitic affection. On examination the following symptoms were observed :? Slight pyrexia ; moist but furred tongue ; congestion of the fauces and the tonsils ; pain on pressure over the larynx ; occasional hard, dry, spasmodic cough ; moderate difficulty inbreathing, attended with a wheezing noise in each act of inspiration; Assistant
hoarseness of voice ; confined bowels. Treatment.?The bowels were moved by a mild dose of castor oil, a strong sinapism was applied over the larynx, followed by very hot atta poultices every 2 hours, and he was directed to inhale the steam of boiling water as often as he could. As there was no apparent improvement, Liquor Lyttae was applied over the larynx, and Iodine inhalation substituted for the hot water ; drinks of hot tea and milk were given at intervals, and the following mixture administered internally every 3 hours :? Yini Ipecac m xx ...
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xxx Spt. Chloroformi Tinct. Hyos. xv ? Mucilaginis jii =i Aquas Campborse After taking this the patient expressed himself as much relieved, and remained pretty well for nearly 72 hours. The pain in the larynx and the spasmodic cough diminished considerably, and the breathing became much easier. This short period of quiescence was soon succeeded by a sudden aggravation of the dyspnoea, which threatened suffocation. On the 11th of January, 6 days after his admission into the hospital, I was informed at 11 I'M. that the patient had been suddenly seized with a violent fit of suffocation, and was dying. In ...
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about a minute and half I was with him, and found him to all appearances dead ; his breathing had stopped, and he lay on the floor near the charpoy from which he got out in the struggle I hastily performed tracheotomy, and at once comto breathe. menced artificial respiration. After full ten minutes I saw a movement of the upper eyelids, and accordingly we persevered with artificial respiration till the functions of respiration and circulation were thoroughly established, and the patient became conscious. This took half an quite hour. altogether The tube was then tied in the trachea and fastened round his neck with a piece of tape. Hot sponges were held close to the mouth of the tube for the purpose of imparting warmth to the air inspired, and this was kept up for 3 to 4 days. There was scarcely any blood lost during the operation. 12th January.?Had a good night's rest; took some brandy, chloric ether, and warm milk at intervals; breathed freely the tube. through Morning.?Pulse, 108 ; temp., 1000,2F. Evening.?Pulse, 108; temp., 100o,8F. 13th January.?Slept well last night; had one scanty stool; complained of pain during the act of deglutition ; there is a good deal of tracheal irritation and spasmodic cough, and a profuse quantity of mucus is discharged through the tube. Ordered some tincture of hyoscyamus, spirits of chloroform, mucilage, and honey with camphor julep every 4 hours. Morning.?Pulse, 96; temp. 100?'2. Evening.?Pulse, 120 ; temp. 102o-5. 15th January.?Canula taken out, cleansed, and re-introduced with case; appearance of the wound healthy. Morning.?Pulse, 108 ; temp. 101o,6F. Evening.?Pulse, 102 ; temp. 99?F. 18^/t January.?Continues to improve ; temperature normal; the former medicine discontinued, and the following mixture was ordered to be given thrice daily.
i
/
THE INDIAN MEDICAL GAZETTE.
210 P> Quiriiae Sulph.
grs.
ii,
Tinct.
Hyos. mvii, Mucilaginis 5i)
Mollis 51, Aquae Camph. ?i?misce. 11th to 24iJanuary.?Doing well. Pulse and temperature normal.
30thJunuary.?Improving fast; can leave his bed and walk about; and from this date the patient made steady progress. On one occasion, on the night of the 18th February at 10 p.m., he was troubled with threatening suffocation, owing to the tube becoming clogged up with a pellet of inspissated mucus. The removal of the tube at once eased him, and it was then cleaned and put back in the trachea. Subsequently attempts were made to close the artificial opening, but they could not be carried out owing to the patient's On utter inability to breathe through the natural passages. several occasions temporary closure of the mouth of the canula caused great distress in breathing, and therefore
by the finger
all endeavours to permanently close the opening were entirely given up. The patient is now as comfortable with the tube as he would have been in health without it. He goes about without the least apprehension of suffocation, and converses freely by putting his finger on the mouth of the silver tube. He is yet in the hospital, undergoing a course of tonic and antisyphilitic treatment. Remarks?Without an examination of the interior of the larynx with the laryngoscope it is impossible to give here a description of the nature and extent of the destruction or alteration which it has undergone, but the mere fact of the patient's utter inability to breathe through the natural passages, and the temporary closure of the mouth of the tube giving rise to dyspnoea and impending suffocation, tend to shew that the extent of disorganization in the interior of the larynx is not slight, and may be of a permanent nature.
[August
1, 1877.
hoarseness of voice ; confined bowels. Treatment.?The bowels were moved by a mild dose of castor oil, a strong sinapism was applied over the larynx, followed by very hot atta poultices every 2 hours, and he was directed to inhale the steam of boiling water as often as he could. As there was no apparent improvement, Liquor Lyttae was applied over the larynx, and Iodine inhalation substituted for the hot water ; drinks of hot tea and milk were given at intervals, and the following mixture administered internally every 3 hours :? Yini Ipecac m xx ...
...
xxx Spt. Chloroformi Tinct. Hyos. xv ? Mucilaginis jii =i Aquas Campborse After taking this the patient expressed himself as much relieved, and remained pretty well for nearly 72 hours. The pain in the larynx and the spasmodic cough diminished considerably, and the breathing became much easier. This short period of quiescence was soon succeeded by a sudden aggravation of the dyspnoea, which threatened suffocation. On the 11th of January, 6 days after his admission into the hospital, I was informed at 11 I'M. that the patient had been suddenly seized with a violent fit of suffocation, and was dying. In ...
...
...
...
...
...
...
...
?
about a minute and half I was with him, and found him to all appearances dead ; his breathing had stopped, and he lay on the floor near the charpoy from which he got out in the struggle I hastily performed tracheotomy, and at once comto breathe. menced artificial respiration. After full ten minutes I saw a movement of the upper eyelids, and accordingly we persevered with artificial respiration till the functions of respiration and circulation were thoroughly established, and the patient became conscious. This took half an quite hour. altogether The tube was then tied in the trachea and fastened round his neck with a piece of tape. Hot sponges were held close to the mouth of the tube for the purpose of imparting warmth to the air inspired, and this was kept up for 3 to 4 days. There was scarcely any blood lost during the operation. 12th January.?Had a good night's rest; took some brandy, chloric ether, and warm milk at intervals; breathed freely the tube. through Morning.?Pulse, 108 ; temp., 1000,2F. Evening.?Pulse, 108; temp., 100o,8F. 13th January.?Slept well last night; had one scanty stool; complained of pain during the act of deglutition ; there is a good deal of tracheal irritation and spasmodic cough, and a profuse quantity of mucus is discharged through the tube. Ordered some tincture of hyoscyamus, spirits of chloroform, mucilage, and honey with camphor julep every 4 hours. Morning.?Pulse, 96; temp. 100?'2. Evening.?Pulse, 120 ; temp. 102o-5. 15th January.?Canula taken out, cleansed, and re-introduced with case; appearance of the wound healthy. Morning.?Pulse, 108 ; temp. 101o,6F. Evening.?Pulse, 102 ; temp. 99?F. 18^/t January.?Continues to improve ; temperature normal; the former medicine discontinued, and the following mixture was ordered to be given thrice daily.
i
/
THE INDIAN MEDICAL GAZETTE.
210 P> Quiriiae Sulph.
grs.
ii,
Tinct.
Hyos. mvii, Mucilaginis 5i)
Mollis 51, Aquae Camph. ?i?misce. 11th to 24iJanuary.?Doing well. Pulse and temperature normal.
30thJunuary.?Improving fast; can leave his bed and walk about; and from this date the patient made steady progress. On one occasion, on the night of the 18th February at 10 p.m., he was troubled with threatening suffocation, owing to the tube becoming clogged up with a pellet of inspissated mucus. The removal of the tube at once eased him, and it was then cleaned and put back in the trachea. Subsequently attempts were made to close the artificial opening, but they could not be carried out owing to the patient's On utter inability to breathe through the natural passages. several occasions temporary closure of the mouth of the canula caused great distress in breathing, and therefore
by the finger
all endeavours to permanently close the opening were entirely given up. The patient is now as comfortable with the tube as he would have been in health without it. He goes about without the least apprehension of suffocation, and converses freely by putting his finger on the mouth of the silver tube. He is yet in the hospital, undergoing a course of tonic and antisyphilitic treatment. Remarks?Without an examination of the interior of the larynx with the laryngoscope it is impossible to give here a description of the nature and extent of the destruction or alteration which it has undergone, but the mere fact of the patient's utter inability to breathe through the natural passages, and the temporary closure of the mouth of the tube giving rise to dyspnoea and impending suffocation, tend to shew that the extent of disorganization in the interior of the larynx is not slight, and may be of a permanent nature.
[August
1, 1877.
