page_title: Joseph O'Dwyer
section_title: Intubation
hierarchical_section_title: Joseph O'Dwyer / Intubation
context_page_description: Joseph O'Dwyer was an American physician. He developed a valuable system of intubation in diphtheria cases. O'Dwyer is often cited as the "father of laryngeal intubation in croup".
context_section_description: In the 1800s diphtheria was a devastating disease, especially lethal in children. The cause of death was usually asphyxia due to an obstructed airway.
  A tracheotomy was often a necessary procedure to save a patient suffering with diphtheria from suffocation. This was, at that time, a high-risk procedure, even post-operative. In 1858, Paris pediatrician Eugene Bouchut devised a method to bypass the diphtheria pseudomembrane obstructing the larynx without resorting to a tracheotomy. However, Bouchut's proposal was not well received, due in part to the opposition of Armand Trousseau, the known authority on tracheotomies.
  The use of tracheotomy had fallen into disrepute at the Foundling Hospital with a record 100% death rate, among children due to suffocation when diphtheria brought about closure of the larynx. O'Dwyer and his colleague at the Foundling Hospital, W.P.Northrup, experimented with various approaches to keep the laryngeal airway open. At first, O'Dwyer experimented with his device on cadavers.
    
  The use of a tube for intubation had often been attempted but unsuccessfully. After five years of study, working with surgeon George Fell, by 1885 O'Dwyer had devised a set of tubes of graduating in size to fit children from one to ten years of age. He also developed a procedure for the insertion and extraction of the tube, using specially designed instruments. After a number of refinements the final tubes, made by George Tiemann and Company of New York, were made of brass, lined with gold, and came in five different sizes. These were later supplanted by Annandale's rubber endotracheal tube. The method proved successful in relieving difficulty in breathing. In 1885, O'Dwyer presented his findings. According to Sperati and Felisanti, O'Dwyer's modifications in Bouchut's concept "were determinant". O'Dwyer's tubes of hard rubber or metal had rounded edges and were therefore, well tolerated.
  The O'Dwyer Method was first published in the N. Y. Medical Journal in 1888, as "Intubation of the Larynx". O'Dwyer's design was supported by Abraham Jacobi, the leading pediatrician at that time. O’Dwyer’s tubes and method was quickly adopted by American physicians and became the first widely used endotracheal technique. Before his death it was universally acknowledged that he had made the most important practical discovery of his generation. Use of O'Dwyer's intubation tubes required considerable practice. O'Dwyer wrote and spoke extensively to educate his fellow practitioners. His tubes and the accompanying instruments for intubation and extubation, with his methods for the care of these patients, came to be employed throughout the medical world, gradually reducing the use of tracheotomy for croup, and thereby "leading to a significant reduction in the death rate".
  Bouchut and O'Dwyer met in Berlin in 1890 at the X International Congress of Medicine which focused on laryngeal intubation, and where both acknowledged the other's contribution to the development of the procedure. Afterwards O'Dwyer devoted himself to the study of pneumonia. In 1896 he served as president of the American Pediatric Society. He was also active at Presbyterian Hospital.
  The O'Dwyer method replaced tracheotomy until around 1895 when the development of antitoxins for diphtheria became more common. When the development of antitoxins reduced the need for intubations, O'Dwyer was among the early practitioners to switch from intubation where appropriate.
caption: New York Foundling Asylum, 175 East 68th Street
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