Diptheria [sic] / by David Wooster.

  • Wooster, David, 1825-1894.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: Diptheria [sic] / by David Wooster. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    into the trachea of infants and of fetuses, would not cause rupture as in adults. These facts were moreover, known to Halle and Bichat, and the experiments of M. Leroy proved only that pulmonary insufflation should be moderate. M. Divergie re- gards its employment as extremely advantageous. It will De perceived that though recognized and favorably considered by Chaussier, Magendie, Dumeril and Devergie, as a valuable means of resuscitation, the laryngien tube has fallen into disuse, which can clearly be traced to the memoir of Leroy d'Etiolles, on its employment causing rupture of the vesicle in sheep. And although Mageudie and Dumeril denied the facility of rupturiDg the vt sides of foetuses and infants, still the profession have steadily ignored comments, and adhered to the first suggestions of danger, and we find in all later authors who speak of artificial L.fla- ti m, the most careful warnings against this danger. Even Marshall Hall recommends covering the child's mouth with a fold ot linen to prevent the t^-o violent inflation of its lungs, and at the same time appreciating the liability of the air to enter the siomach instead of the lungs, he tells the physician to press the child's trachea against the oesophagus, to prevent the air taking that course. Inflation by the bel- lows must be objectionable, because of the inconvenience of having a bellows always at hand, the time lost in adapting it to the tube, aad the inability to appreciate quan- tity and force, as when blowing from the mouth. The principal objection to blowing from one's own mouth is, that the air blown out has already been once employed, and must consequently be vitiated. This is readily remedied by the physician making a few forcible and rapid respirations, for it has already been shown by the experiments of Faraday, that the expired air contains much more oxygen and less carbonic acid after a tew such respirations, than during the usua1 respirations. This scarcely needed any experiments, for it is evident with- out reflection. Having examined the modes of exciting respiration in congenital asphyxia, and there being the utmost harmony among authors as to the first aad imperative indica- tion, namely, to excite respiration as soon as possible, I submit that the means which will most certainly and speedily accomplish this is the best means, if it is not attended wiih a paramount danger. The danger of the direct insufflation we have examined and found comparatively small. Indeed, I apprehend it would be impossible to rup- ture the vesicles, if a tube is employed with a diameter considerably less than that uf the trachea; for evidently as soon as there is any resistance to the further intro- duction ot air by the distension of the lungs, it would find its way out by the sides of the tube, and through the mouth, which remains wide open, or even through the nares. One can inflate a bladder of the most delicate texture by means ot a tube inserted into its neck, even though the tube does not fill the aperture of the bladder; but we cannot cause any appreciable disteusive force on the bladder, because, from the mobility of the air and the patent orifice, it of course would escape into the umbient atmosphere, belore it ruptured a vesicle of cobweb delicacy. For this rea- son I have recommended a small tube two or three lines in diameter. In the Oaz. des Hopit-aux, 1857, No. 136, will be found a concise, and not satisfac- tory case of tubing the larynx in congenital aaphyxia. Tne case is by Delfraysse, aud was suggested to him by hearing of Bouchut's tubing the larynx in croup. But this is another thing from the mode I propose. Delfraysse did not inflate the lungs through the tube, but excited the act of respiration by pressing on the child's thorax- this latter act, not the insertion of the tube, was followed by respiration ; from which we would infer that the tube mereiy removed a mechanical obstacle, (mucous spasm of the larynx, or something of the sort.) After respiration began, he withdrew the tube by the thread which retained it, one end of which hung out of the month. With this exception, I have not read of any case in Europe or America, in which the tube aud insufflation have been employed or recommended. Yet it precisely fulfills the ind.cation on which all agree—the prompt establishment of respiration. With the concise report of a single case, I close this paper. Case. A woman had been in labor more than 2i hours. The head of the foetus wuuld not engage in superior strait; presentation was occipito-posterior. Forceps applied above the superior strait. After one hour's traction without removing for- ceps the child was extracted. Asphyxia was complete. The cord was pale and pulseless, the foetal heart was absolutely still. The child and cord were placed in hot water, but the cord not pulsating, it was divided before tying, when it emptied itself of the blood contained in the foetal portion, perhaps half an ounce; it was im- mediately grasped and tied. The child was then removed, and subjected to all the usual means of resuscitation, for at least ten minutes, without any result. The skin was cold, the under jaw relaxed, the whole body perfectly hmpsy.' All present said it was dead. It did seem a hopeless case. Inflation mouth to mouth was tried, by which the stomach was inflated but not the lungs, as was easily perceived by the absence of mucous rattle on pressing out the air. I his sound is ot course well marked when the air is pressed out of the foetal lungs. Ine foetus was thus repeatedly blown up without result A small gum-elastic catheter was now substituted. Two or three attempts at get-