Excision of Larynx and Part of the OEsophagus
Authors: T. Wallace
Journal: BMJ (1898)

THE cases of suppurative pericarditis treated by incision alnd drainage-are still, according to our medical records, very few and far between.This is no doubt due to the misfortune of only successful cases generally being published, and partly explains the favourable statistics to be drawn from tlhem, as shown in my paper in the Clinical Society 's Transactions, vol.xxx.The following case, although unsuccessful, is another contribution towards this very limited list: J. W., aged 4, was admitted into the East London hlospital for Childreni, Shadwell, on January I3th, I898, under the care of my colleague, Dr. Coutts.He had been well up to three weeks before, when lie took cold and complained of pain in his chest, particularly on the right side.He had a very bad cough, and there was con- siderable difficulty in expectorating.One week before ad- mission he became much worse, his breathing being very rapid, with profuse sweating at night.On admission, he was very aniemic and cyanotic at times; there was no vomiting, but constipation.The cardiac area was a little increased on percussion, and the heart sounds ratherfeeble.Pulse 124; temperature, 8 P.M., I01.60.Lungs were normal on percussion anteriorly, but there was some dulness at the right base, over whicil there was a patch of tubular breathing; over both lungs mucous rdles were heard.Respirations 44 per minute.Abdomen normal.January I4th, 8 A.M.-Pulse 120; respirations 4o.Local conditions about the same.8 P.ms.-Temperature 100.60; pulse i8o; respirations I6o.Breathing more difficult, and heart sounds not so distinct.January I5th, 8 A.m.-Temperature, 96.80; pulse, 120; respirations, 48.Sick once.Heart sounds distant and feebly heard at apex; cardiac dulness increased.There is some extension of dulness at base of right lung, and tubular breathing especially hleard about the angle of the right scapula.At 8 P.mr. the temperature was 990; pulse, 120; respirations, 52.January i6th.-Temperature at midnight 970, and at 2 A.M. 99.40; at 8 A.M. 97.40, with pulse 120, and respirations 48.Vomited once.At 8 P.M. the temperature was 98.80.January I7th.-Midnight temperature, 970; at 2 A.M\. 99.60; at 8 A.M. 97.40.Vromited twice.At 8 P.M. the temperature was 980; pulse, 136; and respirations, c6 January i8th.--Temperature at midnight 970; at 8 A.Al. 97.6; pulse, I I2; respirations, 48.The cardiac dulness is now considerabiy increased, reaching lower border of first rib above, extending to the right three-quarters of an inch to January 4th, I898.She was chloroformed, and the swelling at the angle of the jaw was cut down on and removed, two glands from the sheath of the vessels being taken away.The glands were adherent to the carotid sheath.The wound was sewn up and sealed.January 5th.She was quite comfortable and free from pain.January 12th.For a few days previous to this she had great difficulty in getting the tube passed through the fauces, and she was at this time wearing the smaller Symonds tube per- manently.January 22nd.A larger-sized tube was put in; the sinus between the mouth and the cesophagus was now a deep groove almost covering the tube.January 3oth.She had a fainting attack and some abdominal pain.February ist.The temperature ranup to IO30, and she got an attack of erysipelas on the right side of face, which subse- quently spread to the left, Februaryi4th.The erysipelas had entirely disappeared.From this date on there was great difficulty in changing the tracheotomy tube.She could only breathe comfortably when a very long tube was in or the trachea was held open by a dilating forceps.FebruaryIsth.The dilating forceps had to be held in the wound nearly all night because of dyspncea.In the morn- ing a large Symonds cesophageal tube was passed down the trachea, after which she went to sleep.March ist.The large tube was worn out and a smaller one substituted.This was not large enough, and she had oxygen to inhale, as she had on previous occasions well-marked benefit from it.March 2nd.A large rubber drainage tube was passed.March 4th.The tube was taken out to be washed when she had a bad attack of dyspncea.The tube could not be got in again.A No. I4 elastic catheter was passed, through which she breathed comfortably.There appeared to be some swell- ing on the left side of the neck.There had also been some bleeding from the trachea.March 8th.After she had had a bad attack of dyspncea on [NOV. 26,i 89FO TM Earn= I