A practical treatise on the diseases of children / by J. Forsyth Meigs and William Pepper.

  • Meigs, J. Forsyth (John Forsyth), 1818-1882.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of children / by J. Forsyth Meigs and William Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    with which this withdrawal is required varies in different cases, but it may be stated as a general rule, that it should be performed from four to twelve times in twenty-four hours. Wiien the tube is clear, the respiration is almost noiseless, and hence the supervention of noisy breathing is usually the indication of some obstruction in the inner tube, which should immediately be withdrawn and cleaned. The drying of the mucus in its interior maybe partially prevented by dropping, every half hour, a few minims of tepid water into the mouth of the canula, and by smearing the inner surface of the tube with pure gl3'cerin, every two or three hours. Some years ago,' Bar- thez recommended instillations of tepid solutions of chlorate of soda through the canula after tracheotomy, in the hope of effecting the soften- ing of the false membranes, and their more rapid and complete expul- sion. Although he was inclined to attribute a beneficial effect to the practice at the time, it appears to have since fallen into disfavor even with its originator. We have ourselves employed lime-water in several cases, and always with obvious relief We were induced to use it from its well-known solvent action upon pseudo-membranous exudation, and have generally employed it by atomizing warm lime-water through the canula every few hours, or so often as the breathing becomes noisy and labored, de- spite the removal and cleaning of the inner tube, from the collection of viscid mucus or pseudo-membrane below the end of the canula. The atomization has been continued for a moment or two, and has usually excited cough, while at the same time it softened the viscid mucus and enabled the child to reject it through the tube. So great, indeed, is the relief at times thus afforded, that in one ease the little patient asked frequently that the use of the atomizer should bo repeated. In all prob- ability it does good, partly by its mechanical action in exciting cough, partly by the softening effect of the watery spray, but parth* also, we are inclined to believe, by the action of the lime upon the mucus and pseudo-membranes. We are also in the habit of directing that the child shall breathe, for a few minutes in every hour, the steam from slaking lime, though in all probability this does not contain an appreciable amount of the lime itself It occasionally happens, however, that the breathing becomes noisy and obstructed and remains so even after the withdrawal of the inner tube, and the use of the atomizer. The cause of the obstruction then probably consists in the presence near the end of the canula, either of a collection of dried mucus or of a piece of false membrane too large to escape through the canula. If, under these circumstances, an access of dyspnoea should ensue, the strings securing the canula should be in- stantly cut and the outer tube withdrawn. If this be followed by the rejection of false membrane and a return of quiet respiration, the can- ula may be returned; but if there is reason to fear that the trachea ■ Bull. G^n. do Th^r., May 30, 1858.