The loud stridor, sometimes heard all over the house, the projecting eyeballs, the livid features, the cyanosis, the clutching at the throat, the piteous begging in a whispering voice for help, cease as if by magic. The patient lies pale and quiet. The loud stridor is re placed by almost noiseless respiration, and death is held at bay. The patient falls into quiet refreshing slumber.
After-treatment of Intubated Cases.— Rest and nutrition are now important. In former days the question of feeding was beset with many difficulties, but now happily these obstacles have been largely overcome. It was found by Drs. Frank Carey and William E. Casselberry, of Chicago, while jointly treating a case, that if the patient were placed in the recumbent position, with the head slightly lower than the shoulders, swal lowing could be effected with little diffi culty. This discovery marked a great advance in the successful management of these cases, and has added not a little to the success of the operation and to the comfort of the little sufferers.
In order to obviate the difficulties of administering liquids to patients who have undergone intubation, the child should be placed head downward on an inclined plane; an angle of from 45 to 90 degrees seems necessary to obtain the best results. The child is held on its back in the arms of the nurse, the feet elevated, and the head left to hang over the arm, then it may take the mouth of the feeding-bottle, suck through a tube from a glass, or feed from a spoon. The only difficulty is encountered when the child is again placed in the upright posi tion, which posture it must not be per mitted to regain until it has been made to swallow three or four times after the vessel of liquid has been taken from its mouth, in order to swallow all the fluid which has gravitated into the pharynx and naso-pharynx. Casselberry (Chicago Med. Jour. and Examiner, Oct., 'SS).
The mechanism is simple enough: the tube being on an incline, the fluid cannot drop into it. The patient should be placed on a pillow with the head extend ing slightly over it, either on the back or the side, preferably the side; the pillow is moved over the side of the bed and the head is slightly depressed. If the head is lowered too much the fluid will pass into the post-nasal space and nasal cavities, while if it is raised too much it will pass through the tube and into the lungs and cause violent coughing.
A few trials will demonstrate the re quired position in each individual case. With a little patience and firmness a child should take abundance of liquid nourishment without difficulty. The physician should himself attend person ally to this matter until the attendants are so trained that they are fully capable.
]n feeding children, while the tube is in the larynx, the writer prefers to have the patient lie on the stomach, face clown, as this gives greater command over the constrictors. Thomas J. Hillis (N. Y. Med. Jou•., Dec. 5, '96).
It is best to give water and food from a spoon, although some children will pre fer to draw it through a glass or rubber tube. The nourishment should be milk, beef-juice, or the various soups, although semisolids—as custards, ice-cream, and the like—may be allowed in case there is repugnance for the more fluid foods. Milk is the most convenient, and usually the best food that can be given in these cases.
Regarding the after-treatment, ,little need be said. Antitoxin should have been given at the very onset of the dis ease and should have been repeated. If not, it should now be given in large dosage and again repeated in twelve or sixteen hours. If there is a tendency of the membrane to extend downward, indi cated by quickened respiration and some times by rales or roughened or harsh respiratory sounds, then the antitoxin should be crowded to the limit.
Report of twenty-nine eases of intnba Hon with the combined use of antitoxin. All the eases were seen in consultation, and in all of them the operation was urgently required. Three were under two years of age, with two recoveries, or per cent.; eight were two years old, with eight recoveries, or 100 per cent.; six were three years old, with six recoveries, or 100 per cent.; six were four years old, with five recoveries, or 83 V, per cent.; two were five years old, with two recoveries, or 100 per cent.; and four were six years old, with four re coveries, or 100 per cent. Total, twenty nine cases with twenty-seven recoveries, or 93.1 per cent., a mortality of only 6.9 per cent. This great reduction in the mortality is attributed to the full and free use of antitoxin in all the cases.