11.1-U111111;tt 1,11.111 of usual Instruments Ili as to snake one instrument serve for introduction and extraction of tubes, extractor having much shorter curve. Egidi (I1 Policlinico, vol. i, No. 35, '95).
not screwed upon the instrument, but is a plain band of steel solidly attached to the introducer. Moreover, the instru ment, which consists of only two plain pieces of metal, can be easily separated. There are no crevices in which septic matter can be concealed. The tubes are the same as in the O'Dwyer set. The gag is constructed so as to insure unlocking of the blades for purposes of disinfec tion. The extractor (Fig. 26) is also so constructed that the three parts of which ducer. It has at its distal extremity two serrated beaks about two inches long. They are opened by a pressure with the thumb upon a lever, and are automatic ally held open by a ratchet arrangement, while pressure with the index finger it is made can easily be separated for the same purpose. These instruments are simple, uncomplicated, and efficient.
Improved intuhator for the relief of laryngeal stenosis. The tubes are corru gated and act as a self-retaining device, being much less easily ejected; they are made of vulcanized Para rubber, the best and purest obtainable. The length is the same as O'Dwyer's. They are made upon the lower end of this ratchet-bar relieves it and closes the beaks. By firm pressure the beaks hold the tube im movably. The tubes themselves are also slightly modified, the upper opening be ing funnel-shaped to facilitate the in troduction of the beaks when the tube is in the larynx, and the lower end being cut off at an angle of forty-five degrees, inclining from right to left. This facili tates the passage of the tube between large in the centre. The introducer is so constructed that the lumen of the tube is never occluded. L. Fischer (Med. Record, June 20, '97).
Instrument personally designed com bines the offices of extractor and intro the vocal cords. Max Thorner (Cincin nati Lancet-Clinic, Feb. 19, 'OS).
Comparative Value of Intubation.— The weight of evidence, nowadays, as compared to tracheotomy is in favor of intubation as a life-saving operation. Out of 543 cases in which I have per formed intubation, all in private practice, I obtained 215 recoveries, or 39.79 per cent. In my last 143 cases, there were 76 recoveries, or 53.14 per cent. In the 40 eases (fully reported at the Denver meet ing of the American Medical Association, Section of Pediatrics) in which antitoxin was employed in conjunction with in of the operation when aided by the use of antitoxin.
tubation, there were 33 recoveries, or 95 per cent. Such a record I am convinced has never been reached by a single oper ator with tracheotomy in private prac tice.
The following tables of my cases well illustrate the success that followed in creasingly the gradual development of the operation, and the wonderful results Two thousand three hundred and sixty-eight cases of intubation collected from the reports of 166 operators, with 647, or 27.3 per cent., recoveries. Dillon Brown (N. Y. Med. Jour., Mar. 9, '39).
Two thousand four hundred and seventeen tracheotomies performed for croup, with 586 recoveries, or 24.2 per cent., and 5546 intubations, with 1601 recoveries, or 30.5 per cent. George Mc Naughton and William Madden' (Brook lyn Med. Jour., Aug., '93).
_ Collective investigation on intubation in Germany gives an aggregate of 1445 cases intubated for the relief of croup, with 553 recoveries, or 38 per cent. Ranke (Miinchener med. Woch., No. 44, '93).
The results in tracheotomy are: in 15,995 cases, 4816 recoveries, or 30.18 per cent.; in intubation, 8299 cases, with 2486 recoveries, or 29.97 per cent. In 769 cases of intnbation secondary tra cheotomy has been practiced 136 times as a last resource, and has given 10 cures. Gillet (Gaz. des HOpitaux, Mar. 5, '94).
Twenty-six cases of intubation for croup in a country practice, with a mortality of 30 per cent. Abarnon (These de Paris; Ped., May 15, '98).
I fully believe that when antitoxin is given early and properly and energetic ally employed in full doses and repeated that the disease is at once cut short and that no further progress occurs. Again, I am fully convinced that if a patient dies after intubation from bronchial ob struction due to the presence of ritic exudation, that the remedy has either been used late, the extension having taken place before its administra tion, or that it has been used with a tating hand and in insufficient dosage or that the preparation has been of uncer tain strength. The normal prognosis in diphtheritic or membranous croup, is so fatal that hesitation in the use of anti toxin is almost criminal. A full dose of 2000 units should be given to a child and half the strength for infants, repeat ing or even doubling the dose in twelve or sixteen hours. It should be given in full doses and be repeated once, twice, or thrice, if necessary.
O'Dwyer has stated that acute non traumatic stenosis of the larynx in chil dren that endangers life by suffocation is, with rare exceptions, diphtheria. This disease, if unrelieved by mechanical means, proves fatal in about 90 per cent. of the cases, and, with all the aid that medicine and surgery can afford, it still continues to be, with few exceptions, the most fatal of all acute diseases. In con trast to this statement it may now be said that as a result of the early and free use of antitoxin, aided by properly per formed intubation, death from this dis ease should rarely occur.
Intralaryngeal insufflation is a most valuable auxiliary in the emergencies of surgical practice. Whenever the respir atory function is compromised and in by acute surgical atelectasis, an apparatus for artificial respiration sug gested which consists of a modified O'Dwyer tube and a new graduated air pump. The instrument is described in detail, and while the opportunity has not been afforded the author to apply this pump on a living subject, its prac tical working capacity has been fully demonstrated on the cadaver and clog. Rudolph Matas (Amer. Med., Jan. IS. 1902).