Intubation of Larynx 
PAPERS 
READ BEFORE THE NEWYORK ACADEMY OF 
MEDICINE, IN THE STATED MEETING 
OF JUNE 2, 1887. 
A. JACOBI, M.D., President, in the Chair 
BY 
A. JACOBI, JOSEPH O’DWYER, FRANCIS HUBER, 
DILLON BROWN, W. P. NORTHROP, 
I. H. HANCE, and A. CAILLE 
Reprinted from The Medical Record, June 18, 25, arid July 
23, 1887 
« X- 
TROW’S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
NEW YORK 
1887 Intubation of Larynx 
PAPERS 
READ BEFORE THE NEWYORK ACADEMY OF 
MEDICINE, IN THE STATED MEETING 
OF JUNE 2, 1887. 
A. JACOBI, M.D., President, in the Chair 
BY 
A. JACOBI, JOSEPH O’DWYER, FRANCIS HUBER, 
DILLON BROWN, W. P. NORTHROP, 
I. H. HANCE, and A. CAILLE 
Reprinted frotn The Medical Record, June 18, 25, and July 
23, 1887 
NEW YORK 
TROW’S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
1887 INTUBATION.1 
FRANCIS HUBER, M.D., 
CLINICAL ASSISTANT OF DISEASES OF CHILDREN AT THE COLLEGE OF PHYSICIANS 
In the treatment of laryngeal stenoses depending upon 
the presence of pseudo-membrane (the symptoms being 
sufficiently well marked to warrant operative interfer- 
ence), the laryngeal brush, sponge, probang, and forceps; 
catheterization of larynx, tubage, intubation, and tra- 
cheotomy have been employed to relieve the urgent 
dyspnoea. The brush,, probang, and forceps are but 
temporary expedients intended to remove loose mem- 
brane, and afford relief for the time being. Catheteriza- 
tion, tubage, and intubation, while facilitating the ex- 
pectoration of membrane, are resorted to primarily for 
the purpose of relieving the dyspnoea, the immediate 
source of danger in the severer forms of pseudo-mem- 
branous or diphtheritic laryngitis. Tracheotomy, it is 
true, relieves the dyspnoea, but, for reasons apparent later 
on, I would advise the operation in those instances only 
in which intubation fails. In view of the results re- 
ported thus far such cases, I venture to predict, will be 
exceptional. 
The brush, probang, and forceps are not often used at 
present. Catheterization is an infrequent procedure, 
and has not served its purpose as well as was antici- 
pated. Tubage, injudiciously advocated by Bouchut and 
condemned by Trousseau, soon fell into disuse. In a 
number of text-books it is referred to in a contemptuous 
way and dismissed in a few words. 
AND SURGEONS, NEW YORK. 
1 Read before the New York Academy of Medicine, June 2, 1887. 4 
To quote from Pepper’s “System of Medicine” (vol. 
iii., page 107) : “ Tubage was rendered ridiculous at once 
by the assertion of Bouchut (1858), that children suffer- 
ing from croup, who were supplied by the laryngeal 
tube, were not only relieved at once, but expressed their 
gratitude in audible oratory. Still there are some cases 
of more recent date in which tubage is reported to have 
been attended with success. It is not very probable, 
however, that a larynx which admits of no air, because 
of its being clogged with firm pseudo-membrane, should 
be willing to admit and endure the presence of a tube.” 
Such was the almost universal teaching up to within a 
short time. Physiology, theory, and practice were 
against the new method. To-day, however, the author 
of the quotation referred to above, whose name is fa- 
miliar over the two continents, a strong advocate ot 
tracheotomy, and who has performed more tracheoto- 
mies than any six American surgeons, and with the aver- 
age success, proclaims himself a convert to intubation, 
and teaches its advantages in his clinical lectures. Re- 
cently, before the State Medical Society, he has publicly 
discarded the opinion expressed above, and states that a 
large number of children have been relieved immediately, 
not only temporarily, but permanently, by intubation. 
Unphysiological, ridiculous, improbable, impracticable, 
and dangerous as the procedure may appear to those not 
practically familiar with the measure, hundreds of cases 
in the practice of various independent observers have 
demonstrated the practicability, utility, and advantages 
of intubation as originated and practised by Dr. Joseph 
O’Dwyer, of New York. The dyspnoea is as effect- 
ually removed in intubation as after a tracheotomy, and 
though the children may not thank you, the ability to 
speak is maintained, and the little one can express his 
or her wants in “audible oratory.” The marked and 
almost instantaneous change in the appearance and con- 
dition, the quiet sleep and quiet respiration, the absence 
of any external wound, shock, and other evidences of 5 
an operation more or less prolonged and difficult, im- 
press one more forcibly than thanks. The whisper of a 
patient with an O’Dwyer tube in his larynx, rescued, in 
an incredibly short time from impending suffocation, by 
intubation, is more agreeable to the parents and physi- 
cian than the loud tracheal breathing of a child wearing 
a tracheotomy tube, unable to express its wants or sen- 
sations by the least sound. I have frequently seen little 
patients, upon whom a tracheotomy had been performed, 
not able to make their attendants understand their wants, 
become restless, excited, and miserable, until, perhaps 
after the lapse of a few moments, after considerable 
guessing, first showing one article, then another, asking 
question after question of the speechless little sufferers 
and watching the face for an answer—finally, more by 
chance than otherwise, quiet down at last, when they 
had made themselves understood by a nod or motion, as 
the desired object was brought or want was gratified. 
That the larynx will tolerate a tube has been demon- 
strated repeatedly and beyond question. The sensitive 
organ which rebels when a crumb of bread or a few drops 
of water go the “wrong way” in swallowing tolerates the 
tube, not for a few seconds or minutes, but for days and 
even weeks. The intubation-tube does not act the part 
of a foreign body, the presence of which excites and irri- 
tates the laryngeal orifice ; the passage, so to speak, has 
been forced, and the tube rests within the box of the lar- 
ynx and trachea and is covered by the epiglottis—rests 
there quietly, without exciting any reflex action or spasm. 
We are aware of its presence objectively by the unob- 
structed respiration and the full, explosive, metallic, char- 
acteristic cough induced by swallowing liquids. 
Bichat reports that Dessault, in 1801, accidentally 
demonstrated the fact that the larynx and trachea would 
tolerate a tube. This knowledge he put to good use, 
and, in a case of oedema of the glottis, he allowed a cath- 
eter to remain for one and a half day, the patient recov- 
ering. In 1854 Horace Green announced that he could 6 
swab out the trachea and pass a flexible tube into either 
bronchus, and thus inject strong solutions of nitrate of 
silver into tuberculous cavities. Trousseau, in his article 
on the “Treatment of Diphtheria and Croup,” discusses 
catheterism of the larynx, states that Dieffenbach had 
practised it in 1839, speaks disparagingly of Green’s 
method, and lauds the plan proposed by Loiseau. The 
latter “ arms the first two phalanges of the index-finger 
with a bent metallic finger-stall, which leaves free the 
last joint and the distal phalanx. The finger thus pro- 
tected is carried down into the throat as deep as possi- 
ble, and with the extremity of the finger the epiglottis is 
raised. This being accomplished, nothing is easier than 
to introduce an instrument into the larynx.” 
In a case of oedma of the glottis Hack employed one 
of Schroeter’s bougies. The tube was removed and the 
patient sent to the hospital. On the way, being attacked 
with severe dyspnoea, the man introduced the tube into 
his own larynx. 
McEwen (.British Medical Journal, July 24, 31, 1880) 
has shown that a catheter or tube, introduced through the 
mouth, may be employed as a substitute for tracheotomy 
or laryngotomy in case of disease or operation. Monti, 
of Vienna, has for years made use of hard-rubber tubes, 
introducing them into the larynx and allowing them to 
remain in situ twenty-four hours or more. One end pro- 
trudes from the mouth; they are resorted to as temporary 
expedients, made use of only until tracheotomy can be 
performed. 
Stockton, of Chicago (Jour. Am. Med. Assoc,, May 2, 
1885), employed silver tubes of various shapes, with and 
without flanges, but soon discontinued his experiments. 
Weinlechner, Monti (referred to above), and Schroetter 
have employed catheters to provide an artificial aper- 
ture in croup. Recently, catheterization of the trachea 
and bronchi has been revived by Reichert and others, and 
various applications made directly to the sub-laryngeal 
air-passages, the parts being anaesthetized by cocaine. 7 
Dr. Landgraf (assistant at Professor Gerhardt’s clinic) 
catbeterized the left bronchus (man, aged fifty-two years) 
several times weekly, cocaine being applied to the 
trachea and larynx, and succeeded in passing an obstruc- 
tion eleven inches down, caused by the presence of an 
aortic aneurism. The relief to the dyspnoea and dis- 
tressing cough was enormous. To enter the domain of 
laryngeal surgery proper, and quote instances which ex- 
emplify the tolerance of the larynx to instrumental inter- 
ference would lead me too far. 
In September, 1858, Bouchut read a paper before the 
Academy of Medicine (Paris), entitled “ A new Method 
of Treatment of Croup by Tubage of the Larynx.” His 
conclusions were, briefly : 
1. Tubage is easily accomplished by means of a can- 
nula fastened upon the inferior vocal cords, without inter- 
fering with the functions of the epiglottis. 
2. The tolerance of the cannula by the larynx. 
3. The possibility of relieving the dyspnoea of croup 
and other laryngeal affections without tracheotomy. 
4. The facility with which the membrane is expelled 
through the tube. 
5. The advantages of tubage to the country practi- 
tioner far from assistance, etc. 
Trousseau, as chairman of the commission appointed 
to investigate the subject, reported as follows : 
Tubage of the larynx in certain cases of acute laryn- 
gitis can, by retarding asphyxia, prove of curative value. 
in certain chronic diseases of the larynx it will allow 
one to delay tracheotomy, and sometimes relieve and 
cure the patient. 
In the treatment of croup it delays asphyxia and al- 
lows a more easy introduction of air and agents capable 
of modifying the diphtheritic inflammation. 
It can only very rarely supplant tracheotomy, which 
is the principal means of opposing croup when medical 
measures fail. 
Ridiculed and condemned as unphysiological and im- 8 
practicable by Trousseau, it fell into disuse and was soon 
forgotten. 
Without any prior knowledge of what had been done, 
Dr, Joseph O’Dwyer, after a great many experiments, 
rediscovered intubation, and has since completely vindi- 
cated the position taken by Bouchut. The instruments 
devised and perfected by O’Dwyer are in no respects 
like those employed by the French physician. The tubes 
of Bouchut were hollow cylinders, narrower at one end and 
less than an inch long; they rested upon the vocal cords 
and did not reach into the trachea. A thread was left 
attached and was brought out at the angle of the mouth, 
to facilitate removal and prevent them being swallowed. 
The instruments of O’Dwyer have passed through suc- 
cessive stages of evolution, and are too well known to 
require any extended description. 
The number on the scale (Fig. 3) indicates the years 
for which the corresponding tubes are suitable. For in- 
stance : The smallest tube, when applied to the scale, will 
reach to the first line, marked 1, and is intended to be 
used up to the age of twelve or fifteen months ; the size 
marked 2 is suitable for the next year ; 3 and 4 for 
these years, and so on. When the proper tube is 
selected for the case to be operated on, a fine thread is 
passed through the small hole near its anterior angle, 
and left long enough to hang out of the mouth ; its object 
being to remove the tube, should it be found to have 
passed into the oesophagus instead of the larynx. 
The obturator is then screwed tightly to the introduc- 
tor, to prevent the possibility of its rotating while being in- 
serted and passing into the tube ; the groove in the upper 
extremity of the obturator being made to correspond to 
the small hole in the tube intended for the string. 
The following is the method of introducing the tube, 
which is done without the use of an anaesthetic : The 
child is held upright in the arms of a nurse, and the 
gag (Fig. 1) inserted in the left angle of the mouth, well 
back between the teeth, and opened widely ; an assistant Fig. 1. 
Fig. 4. 
Fig. 2. 
Fig. 3. 10 
holds, the head, thrown somewhat backward, while the 
operator inserts the index-finger of the left hand, to ele- 
vate the epiglottis and direct the tube into the larynx. 
The handle of the introductor (Fig. 2) is held close to 
the patient’s chest in the beginning of the operation, and 
rapidly elevated as the cannula approaches the glottis. 
The tube is then pushed downward, without using much 
force. It is then detached. The joint in the shank of the 
obturator is for the purpose of facilitating this part of the 
operation. As soon as the obturator is removed, and it 
is ascertained that the tube is in the larynx, the thread 
is withdrawn, but at the same time the finger is kept in 
contact with the tube, to prevent its being also withdrawn. 
It is important that the attempt at introduction be 
made quickly, as respiration is practically suspended from 
the time that the finger enters the larynx until the obtu- 
rator is removed. It is, therefore, under the circumstances, 
much safer to make several abortive attempts than one 
prolonged effort, even if successful. 
For the purpose of removal, the patient is held in a 
similar position, except that the head is not inclined 
backward, or very slighly so, and the extractor is passed 
into the tube, guided by the index-finger of the left hand, 
which also fixes the epiglottis, and is brought in contact 
with the head of the cannula. Firm pressure with the 
thumb is then made on the lever above the handle, while 
the tube is being withdrawn. If secondary dyspnoea su- 
pervenes at any time the tube should be removed and a 
larger one substituted. If the case progresses favorably, 
the tube should be removed on or about the fifth day. 
To avoid accidents, it is very essential to have some 
preliminary practice on the cadaver, particularly in ex- 
tracting, which is the more difficult operation, owing to 
the aperture of the tube being so much smaller than that 
of the larynx. 
In very young children particularly, extraction is facil- 
itated by pushing the larynx upward and backward with 
the thumb of the left hand externally, the index-finger being in contact with the head of the tube. In the ab- 
sence of a cadaver, it has been suggested to practise 
intubation upon dogs anaesthetized.1 
In introducing or extracting* the instruments should 
be worked in the median line, the operator facing the 
patient squarely. 
Waxham advises that in introducing or extracting, the 
point of the instrument should be placed under the finger, 
not over or alongside. 
Dr. Cheatham, of Louisville, suggests that inversion 
of patient, or inversion with sharp blow on the back or 
irritating the soft palate or pharynx, may be tried in 
in order to remove the tube. We recognize that the 
tube has been successfully introduced ; x, By the occur- 
rence of a paroxysm of coughing ; 2, by the relief of 
the dyspnoea. The cough is full, explosive, characteristic, 
and accompanied by the expectoration of large quantities 
of mucus and shreds of membrane. 
Intubation has passed the experimental stage. It has 
been performed hundreds of times by O’Dwyer, Dillon 
Brown, and Waxham. 
Northrup and Denhard have also done it in quite a 
large number of cases. The procedure is extensively 
employed in New York, Chicago, and Philadelphia, and 
though not as yet an established method, it has a good 
record and a great future. 
My own cases up to the present, numbering 47, are 
presented in a tabulated form for convenience and ready 
reference. 
The above list does not represent all the cases of croup 
treated, but only those in which operative interference was 
indicated. In my own practice I have not found it neces- 
sary to resort to intubation in a larger proportion than 
one out of three or four cases of laryngeal stenosis treated 
from the onset. I will say, and would emphasize the as- 
1 The finger ought to he educated and digital examinations made of epiglottcs 
and adjoining parts in children suffering from throat-disorders. 12 
sertion, that intubation should not be resorted to until 
the stenosis assumes a dangerous character and the case, 
if seen sufficiently early, has not been benefited by proper 
medicinal means. I am well aware of the truth of the 
statement made by Thomas : “ There is nothing easier 
than the rejection of the testimony of others and the dis- 
crediting of the deductions which we ourselves have 
not drawn” (“Diseases of Women,” p. 458). The in- 
stances of recovery which I report above were cases 
which, in the opinion of the various gentlemen present 
at the time, would have terminated fatally if the obstruc- 
tion to respiration had not been removed. The cases 
were similar in severity to those in which, up to a year 
ago, I advocated, and would have performed, trache- 
otomy. 
Before entering upon a consideration of the accidents, 
mishaps, and objections to the process, I shall devote a 
few words to the diagnosis of croup and the indications 
for operative interference. When called to a case, as- 
sure yourself that the dyspnoea is of laryngeal origin. 
Examine the neck and chest carefully. Inattention to 
this point has occasioned some grave errors. In one 
case the removal of a mass of poultices and bandages 
from the neck revealed a large abscess in front of the 
larynx, incision of which, with the insertion of a drainage- 
tube, caused the disappearance of the laryngeal symp- 
toms. In a second case a child, sixteen months old, 
with hoarseness and difficulty of breathing, was referred 
to me with the diagnosis of croup. A careful examina- 
tion of the chest revealed a large empyema. Several 
cases are known to me in which retro-pharyngeal ab- 
scesses have been mistaken for croup. 
The diagnostic symptoms of membranous obstruction 
are croupy cough, aphonia, croupy inspiration and ex- 
piration, with progressive, unremitting dyspnoea, marked 
supra-sternal and epigastric retraction, and continued 
restlessness. Auscultating the chest posteriorly, we find 
the normal vesicular murmur feeble or absent. Finally, 13 
cyanosis occurs, with feeble and irregular pulse. The 
temperature, unless there be septic absorption from diph- 
theritic deposits in the nose or pharynx, or some inflam- 
matory complication in the chest, will not exceed ioo° or 
xoi°. “One of the pathognomonic symptoms of diph- 
theritic laryngitis, ‘ membranous croup,’ is the relative ab- 
sence of fever.” “ Catarrhal laryngitis, pseudo-croup, is 
a feverish disease. A sudden attack of ‘croup,’ with 
high temperature, provided there is no pharyngeal or 
other diphtheria present, yields a good prognosis ; with- 
out much fever a very doubtful one.” “In oedema of 
the ary-epiglottic folds and post-attachments of the vocal 
cords, with or without membranous deposits elsewhere, 
we have the symptoms of true croup with its dangers. 
Inspiration is impeded, owing to the partial paralysis of 
the vocal cords ; expiration, however, is free, and the 
voice is more or less intact. Diagnosis may be made by 
palpation. Aphonia, with difficulty of breathing in both 
inspiration and expiration, points positively to membran- 
ous occlusion” (Jacobi). 
True croup, as it progresses, presents a picture “the 
likes of which the most hardened man, the most experi- 
enced medical attendant, prays never to behold again.” 
To relieve the sufferings and struggle of the little patient 
for air intubation has been proposed. And now, whe?i 
shall we resort to operative interference ? As soon as 
the supra-sternal and epigastric retraction is marked, 
when there is great and continued restlessness owing to 
the progressive severe dyspnoea, and the normal vesicu- 
lar murmur is feeble or absent at the posterior inferior 
portion of the lung, we ought to intubate. Cyanosis, 
with a feeble and irregular pulse, pulmonary complica- 
tions, or septic manifestations, ought not to deter one 
from intubating, even in instances apparently hopeless. 
It is well, however, to give a hypodermic of brandy, 
caffein, etc., before operating in these desperate cases. 
Accidents, Mishaps, and Objections. Gag.— 
O’Dwyer’s gag may be displaced by struggles of child. 14 
Denhard’s modification of above, not liable to this ac- 
cident, should be employed (The Medical Record, 
April 27, 1887). If heart’s action weak or general con- 
dition poor, separation of jaws by gag may cause alarm- 
ing symptoms of asphyxia due to falling back of tongue. 
In this condition give hypodermic of brandy, or caffein, 
or other cardiac stimulant before inserting gag—pull 
tongue forward. 
Thread ought to be eighteen to twenty inches long, 
and if not removed at once, looped over the ear to pre- 
vent its being swallowed. In a case reported by Dr. 
Hance, traction upon the string by the muscles of deglu- 
tition caused the tube to be pulled into the oesophagus 
and swallowed. In one of Dr. Agan’s cases, the thread 
being swallowed, a bent probe was used to fish it up. In 
Dr. Schottky’s case, the thread being too short, the tube, 
having slipped into the oesophagus, entered the stomach 
and was passed per anum two days later. (A second 
tube, after considerable difficulty, owing to the swollen 
condition of the parts, being placed in the larynx, child 
recovered.) Tipton (The Medical Record, May 28, 
1887) reports that in wiping away some saliva the silken 
cord was caught, tube dragged out of larynx and swal- 
lowed, before the cord could be grasped. A second tube 
now introduced. First tube passed per rectum ten days 
later. 
Accidents which may occur in intro due i7ig tube.— 
Tube.—(a) May enter the oesophagus, recognized by 
breathing not being improved and cough still croupy. 
(b) Danger of delicate parts being lacerated ; the 
rounded end of the obturator closes the lower portion 
of tube completely and prevents injury, unless force be 
employed. 
(c) Membrane may be crowded down in front of tube. 
This is a possible and serious accident. When it occurs 
and the membrane is not expelled when the tube is re- 
moved, tracheotomy may be necessary. Dr. Ferguson 
reports a case in which he was compelled to perform tracheotomy [N. Y. Med. Journal, March 5, 1887). In 
other instances this resulted in death of patient. 
Dr. Waxham has devised a trachea-forceps to remove 
the membrane through the mouth when this unfortunate 
accident has taken place. He reports a case in which the 
accident occurred and in which a cast of the trachea and 
main bronchi were removed by passing the long trachea- 
forceps through the mouth into the larynx and trachea, in 
a child seven years of age (Medical News, January 1, 
1887). “The intubation-tube was now introduced; res- 
piration so quiet as to be scarcely observed.” 
In an instance in which the accident occurred to me, 
I gave some pure brandy (hoping that some would enter 
trachea through tube and cause expulsion), thus inducing 
a severe paroxysm of coughing which expelled tube and 
a large piece of membrane. The tube was reintroduced ; 
breathing unobstructed; child recovered. In Dr. CailH’s 
case removal of tube was followed by expulsion of mem- 
brane. 
Accidents which may occur while tide is i?i situ.— 
The lateral bulging weight of tube, together with the 
anatomical fit and length, tend to keep it from being 
coughed out. 
1. The tube may be coughed out (a) by a severe paroxysm 
of coughing, (b) if too small, or (c) if a plug of mucus or 
membrane is below it. Not serious, as breathing is gener- 
ally improved and dyspnoea will not return for several 
hours. This has been my experience. When dyspnoea 
returns tube can be reintroduced. 
2. May become occluded by mucus or membrane. As 
the air is warm and moist and the inner surface of tube 
is smooth, mucus passes through tube readily. When 
tube becomes occluded with membrane the tube is coughed 
out in many instances. One case, however, is reported 
by Dr. Wheeler (W. Y. Med. Journal, February 26, 1887) 
in which plugging of tube caused death of child.1 
1 The doctor states that “during the evening the child breathed noisily, as 
though there were a good deal of mucus in the tube, but apparently without any 16 
3. Tube may be coughed up arid then swallowed. Dr. 
Parkes refers to a case in a young lady, seventeen years 
of age, who passed tube per rectum twenty-four houis 
after intubation. In Dr. Montgomery’s case it was feared 
that as a smaller tube than suited to age was inserted, 
the tube might have passed into trachea. A tracheot- 
omy was done and child recovered. Intubation-tube 
passed per anum two days later (Med. News, March 5, 
1887). It seems to me that the proper plan would have 
been to have inserted a second tube. Dr. S. Hemingway 
kindly gave me the details of a case in which, after a vio- 
lent fit of coughing, hoarseness was again noticed (four 
days after tube had been inserted by Dr. O’Dwyer). 
A week later the tube was passed per rectum. 
4. Tube may descend into the trachea. This accident 
has occurred several times. It must not be forgotten, 
however, that the tubes were of an earlier pattern (Wax- 
ham, Chicago Medical Journal and Examiner, November 
25th; Eichberg, Cincinnati Lancet and Clinic). 
The shape of the head, the resistant nature of the 
vocal cords, and length of tube prevent a repetition of 
the accident when the latest style of tubes are used. 
Dr. Brothers, at my suggestion, has kindly made the 
following experiment in the dead-house : “ The smallest- 
sized tube was introduced into the larynx of a child five 
years of age and an incision made in the trachea. Mak- 
ing traction below it was found that considerable force 
was required to pull the head of the tube below the 
vocal cords ; it was impossible, however, to force it be- 
low the cricoid cartilage.” 
5. Entrance of food into bronchi and thus cause 
“ schluck pneumonic.” Discussed further on. 
6. Cause ulcerations and possible hemorrhage. “ The 
head or shoulder of tube does not rest upon the vocal 
impediment to respiration. At 10 p.m. she hart a severe fit of coughing, and, ac- 
cording to her moiher’s account, choked up and died in about two minutes.” 
The noisy breathing in the case is to me an indication to remove the tube tem- 
porarily. If this had been done the membrane no doubt would have followed re- 
moval of the tube, and the untoward result might have been avoided. Table of Cases. 
oi 
c; 
U 
Age. 
Diphtheritic 
patches on 
Complications. 
Degree of 
stenosis. 
Tube 
removed. 
Relief to 
dyspnoea. 
Recovery. 
Cause of death. 
Operator, 
Dr. F. Huber. 
Remarks. 
1 year. 
2 years. 
2 yrs. 8 mos. 
6 years 
3 yrs. 8 mos. 
3 years. 
2 yrs. 2 mos. 
3 years. 
2 yrs. 6 mos. 
Tonsils and pharynx. 
Advanced. 
Complete. 
Heart-failure 18 
Emergency 
Tube coughed up; reintro* 
hours later. 
Sepsis 6 hours 
call. 
Dr. Denhard 
duced. 
Nares and pharynx. 
Nares and tonsils. 
Nares and tonsils. 
Tonsils and pharynx ; 
membraneg ganre- 
nous. 
Tonsils and pharynx. 
Nares and pharynx. 
Tonsils and pharynx. 
u 
Complete. 
Recovery, 
later. 
assisting. 
3 
4 
Measles. 
“ 
6th day. 
2% days later 
pneumonia and 
nephritis. 
Uraemic convul- 
and Mauson. 
Dr. Neufield. 
Dr. Denhard 
Tonsils very large ; intubation 
assisting. 
Dr. Neufield. 
difficult in consequence. 
7 
Old mitral en 
docarditis. 
Measles. 
6th day. 
Complete. 
Recovery. 
sions 6 hours 
later. 
Dr. Neufield. 
Drs. Neufield 
Child had eaten a hearty meal, 
and each attempt at removal 
of tube induced vomiting; 
fearing that food might enter 
larynx, I waited until stomach 
was empty and then removed 
tube without much trouble. 
Brandy and caffein injected. 
Brandy and caffein were in- 
jected on account of weak 
and irregular pulse. As the 
patches had disappeared, tube 
- removed on sixth day. Child 
comfortable. Two days later 
was called again (Dr. Den- 
hard kindly seeing case with 
me), and found recurrence of 
stenosis; the ary-epiglottic 
folds felt swollen and round- 
er than normal. Again in- 
tubated, with immediate re- 
lief, and 3 days later tube 
removed, a pneumonia having 
developed in the meanwhile. 
Upon close questioning found 
that patient was allowed to 
sleep in a crib near the door, 
thus accounting for the laryn- 
geal complication and the 
pneumonia. Two months later 
was presented at Dr. Jacobi’s 
clinic. 
Comfortable until morning of 
fifth day, then rise of temper- 
ature, dulness at left apex, 
suppression of urine, and pul- 
monary oedema. 
9 
5th day. 
Complete. 
6 days afterward 
pulmonary 
oedema, sec- 
ondary to 
Bright’s dis- 
and Mauson. 
Dr. Berlinger. 
IO 
1 year. 
2 yrs. 6 mos. 
11 months. 
15 months. 
Tonsils. 
Tube cough- 
ed up on 
4 th day. 
Fair. 
Complete. 
Recovery. 
4 hours later 
Dr. Horn as- 
sisting. 
Dr.Schlessing- 
Case seen by Dr. Schlessiriger, 
who confirmed diagnosis and 
regarded case as hopeless if 
operative measures were not 
resorted to. 
Child moribund when seen. 
J 2 
13 
Tonsils. 
Nares. 
Measles two 
weeks before. 
Recovery. 
sepsis. 
er. 
Dr. Denhard 
u 
Exhaustion 12 
assisting. 
Dr. Wilson. 
gastro-enteri- 
hours later. 
14 
15 
Nares and pharynx. 
No patches visible ; 
membrane coughed 
tis. 
Pneumonia 2% 
Dr. V. Rotten- 
3 years. 
Measles a short 
time ago. 
“ 
5th day. 
“ 
Recovery. 
days later. 
burg.. 
Dr. Lilienthal. 
16 
4 years. 
up. 
Tonsils and soft pal- 
ate. 
Nares and pharynx. 
Nares and pharynx. 
Nares and pharynx. 
Nares and pharynx. 
No patches visible ; 
pieces of membrane 
coughed up later. 
Nares and pharynx. 
Membrane coughed 
up. 
.< 
Dr. Brugman. 
Tube coughed up; saw case 3 
hours later with Dr. Den- 
hard. Symptoms of stenosis 
extreme. A larger tube (5-7 
years) was then introduced 
and retained. 
2% days later 
Emergency. 
18 3 years. 
i 
Hemiplegia. 
“ 
“ 
pneumonia. 
3 days later sep- 
sis. 
2 days later 
Dr, Naughton. 
Child had had some brain 
trouble during the summer, 
resulting in left hemiplegia. 
General condition poor. 
20 
2 £ 
pneumonia. 
2 days later sep- 
sis. 
18 hours later 
2 yrs. 8 mos. 
Measles one 
week ago ; 
pneum 0 n i a 
present. 
nth day. 
Recovery. 
Dr. Denhard 
assisting. 
Dr. V. Rotten- 
Seen 3 days before intubated 
by Dr. Jacobi, and diagnosis 
of membranous laryngitis 
confirmed. Tube removed on 
sixth day, but necessary to re- 
introduce it 15 minutes later. 
Great difficulty in nourishing 
the patient: resorted to 
stomach-pump. 
23 4 yrs. 6 mos. 
Measles short 
time ago. 
Measles. 
7th day. 
Coughed out 
on 4th day. 
Coughed out 
on 6th day. 
4th day. 
“ 
Recovery. 
heart-failure. 
Died 36 hours 
after tube was 
coughed out; 
pneumonia. 
burg. 
Dr. Denhard 
assisting. 
Dr. Lyttle. 
This patient is a sister of Case 
21. 
Dr. Lyttle writes that intuba- 
tion was a success as far as 
the relief of the stenosis was 
concerned. 
Child not seen by Dr. Neufield 
until patient was nearly mori- 
bund. Injected brandy and 
caffein, and then intubated. 
Pneumonia developed after 48 
hours; temperature at high- 
est, 105° ; ran usual course, 
and patient recovered. 
3 yrs. 6 mos. 
roX months. 
2 yrs. 10 mos. 
3 years. 
Tonsils and pharynx. 
Tonsils, soft palate, 
and pharynx. 
Tonsils, pharynx, and 
soft palate. 
Membranes gangre- 
Advanced. 
Recovery. 
26 
27 
28 
<( 
2 days later sec- 
ondary croup. 
Sepsis. 
assisting. 
Dr. Brothers 
Septic case. 
u 
Partial. 
assisting. 
Dr. J. Horn. 
nous. Table of Cases.—Continued. 
1 -3^3 
Age. 
Diphtheritic 
patches on 
Complications. 
Degree of 
stenosis. 
Tube 
removed. 
Relief to 
dyspnoea. 
Recovery. 
Cause of Death. 
Operator, 
Dr. F. Huber. 
Remarks. 
2 9 
3° 
4 yrs. 6 mos. 
2 years. 
Tonsils and pharynx. 
Membrane coughed 
up. 
Membrane coughed 
Pneumonia. 
Advanced. 
6th day. 
Complete. 
Recovery. 
Dr. F. Norde- 
man, Dr. 
Brothers as- 
sisting. 
Dr. J. Horn. 
Prognosis extremely unfavor- 
able in this case. Intubated, 
with a view to enthanasia. 
u 
8th day. 
Recovery. 
An older child sick with laryn- 
geal stenosis at same time, 
but symptoms were not suf- 
ficiently urgent to require in- 
tubation. 
32 
33 
34 
35 
36 
37 
38 
39 
up. 
Tonsils and palate. 
Pneumonia. 
Measles. 
Measles a 
week ago. 
Exhaustion 2% 
days after. 
Dr. Neufield. 
9 months. 
2 yrs. 6 mos. 
7 years. 
3 yrs. 6 mos. 
18 months. 
Nares. 
Tonsils and pharynx. 
Coughed up 
after 64 
hours. 
Recovery. 
hours after. 
Dr. Brothers. 
Dr. H. F. 
Tube removed on $th day; 1 
hour later Dr. Brothers re- 
intubated because of recur- 
rence of stenosis, using small 
tube ; 36 hours later it was 
coughed up and not neces- 
sary to insert again. 
Intubation easily accomplished. 
Shreds of membrane, etc., 
coughed up ; still respiration 
is somewhat obstructed, and 
it was evident that membrane 
had been forced down. Tra- 
cheotomy not allowed, and no 
forceps accessible. Gave pure 
brandy { 3 j.), causing severe 
paroxysm of cough, with ex- 
pulsion of tube and large 
piece of membrane. Intu- 
bated again; relief complete. 
Nares and pharynx. 
Secondary croup 
2 days later. 
Nordeman. 
Membrane coughed 
t< 
up. 
Nares and fauces. 
,t 
Coughed up 
on 6th day. 
u 
hours later. 
assisting. 
months. 
2 yrs. 6 mos. 
5 yrs. 6 mos. 
2 yrs. 9 mos. 
No membrane visible; 
Recovery. 
hours later. 
pieces coughed up. 
Tonsils. 
7 th day. 
Neufield, 
Dr.Denhard 
present. 
41 
42 
Tonsils and pharynx. 
Died 6 days 
later. 
Died 2 days 
later of second- 
and Neu- 
field. 
Dr. Rotten- 
burg. 
Tonsils and nose. 
u 
7th day. 
43 
22 months. 
Tonsils ; membrane 
6th day. 
u 
Recovery. 
4 years. 
3 years. 
coughed up. 
u 
ent. 
Referred to me for intubation 
by Dr. F. Nordeman. 
Referred to me by Dr. Lyttle. 
45 
sils. 
Tonsils and palate. 
Pneumonia. 
4< 
2 days later sec- 
ondary croup 
and pneumo- 
nia. 
ent. 
46 
11 months. 
Membrane coughed 
up. 
present. 
Dr. H. G. Lyt- 
tle. 
secondary 
47 
4 yrs. 6 mos. 
Pharynx, etc. 
.. 
croup 2j£ days 
later. 
Died 3 days later 
of secondary 
croup. 19 
Resume 
of Cases 
Age. 
Under three years of age. 
Age. 
Three years of age and over. 
No. 
Recov- 
ery. 
Death. 
No. 
Recov- 
ery. 
Death. 
8 months.... 
I 
0 
I 
3 years .... 
6 
2 
4 
g months.... 
I 
0 
I 
si vears • • • 
2 
1 
I 
gh months... 
1 
1 
O 
3% years .. 
I 
0 
I 
105 months.. 
I 
1 
O 
4 years .... 
3 
2 
I 
11 months... 
4 
2 
2 
years .. . 
3 
2 
I 
i year 
2 
1 
I 
5i years . 
I 
0 
1 
13 months... 
I 
0 
I 
6 years .... 
I 
1 
O 
ii year 
I 
0 
I 
7 years .... 
I 
1 
O 
i£ year 
4 
0 
4 
2 years 
s 
2 
3 
2$ years .... 
4 
2 
2 
2% years ... 
4 
2 
2 
Total 
29 
11 
18 
Total 
x8 
9 
9 
Twenty-nine were under three years of age, 11 recoveries ; 18 were three years 
old or over, 9 recoveries. Other points of interest will be developed later on. 
cords, but just above them on the ventricular bands. 
There is not any ulceration of the cords, but slight ulcera- 
tion may be produced by the head and lower end of the 
tube, when retained for a long time.” This does no 
harm. 
7. May give rise to difficulty in swallowing. Dis- 
cussed further on. 
8. Dr. Hance reports two cases in which there was 
sudden and complete cessation of respiration, due to ex- 
cessive secretion of mucus and falling back of tongue, 
forcing epiglottis over the fenestra of the tube. Relief 
was afforded by depressing tongue and forcing it forward, 
in order to remove mucus from throat. 
Accidents possible in extraction.—i. May be forced 
down into trachea. This occurred in Dr. Eichberg’s case, 
the tube being of the old pattern, and necessitated trache- 
otomy for its removal. No danger of this accident with 
the latest style of tube. 
2. Tube may be firmly fixed by swollen fold of mucous 
membrane of epiglottis or ary-epiglottic folds (oedematous); 20 
pushing it aside by finger made removal possible (Cable). 
Similar condition found at autopsy in one of Dillon- 
Brown’s cases (The Medical Record, April 10, 
1886). 
3. Possible aspiration of food into bronchi during 
vomiting while extraction is attempted. Occurred in 
one of my cases, the little patient having eaten a very 
hearty meal shortly before. Did no harm in this case. 
Would advise, however, that but little nourishment be 
allowed for several hours prior to extracting tube. 
In extracting, try to sink the forceps deeply into the 
tube and thus secure a firm hold, otherwise they may 
slip as the handle of the extractor is carried downward. 
It is well, therefore, to keep the left index-finger in con- 
tact with the shoulder of the tube, so that its removal 
may be accomplished by the finger if the forceps slip 
after the tube has been raised out of the larynx (the 
child being inclined forward at same time). 
Removal of tube.—1. The tube may be removed as 
early as the fourth, fifth, or sixth day ; exceptionally it 
may be necessary to allow it to remain ten or eleven 
days. O’Dwyer’s tube can be dispensed with much 
more readily and earlier than the tracheotomy-tube. 
This is due to the fact that more or less membrane is 
detached from the larynx when the tube is introduced. 
2. The frequent forcible and explosive cough assists 
in dislodging and expelling mucus and shreds of mem- 
brane. 
3. The presence of the tube must of necessity cause 
more or less disintegration of the false membrane with 
which it is in contact. 
4. When an intubation-tube is in position reflex spasm 
can no longer take place—the diseased structures are 
kept apart and at rest. 
I do not forget that after a tracheotomy the membrane 
below the opening, even though recent, is apt to be ex- 
pelled as soon as the trachea is opened or the tube in- 
serted ; that upon the vocal cords and in the larynx—and 21 
here is the point—is not thrown off for from six to sixteen 
days or more in a patient upon whom tracheotomy has 
been done. Though the greater amount of air enters the 
lung through the tracheal cannula, some air passes through 
the larynx and alongside the tracheotomy-tube ; the la- 
ryngeal structures are more or less active, and are not 
as quiet as when separated by the intubation-tube. 
5. Granulations are of frequent occurrence after trache- 
otomy, and require to be removed before the cannula 
can be dispensed with. They do not form after intuba- 
tion ; if ulceration be produced, the ulcers are superficial 
and soon heal. 
As long as the respiration is obstructed and expecto- 
ration free, there is no occasion for the removal of the 
tube until five or six days have elapsed. If, during this 
period, the breathing becomes noisy and does not be- 
come quiet after the subsidence of a paroxysm of cough 
purposely induced by the ingestion of lime-water, etc., 
or if it be suspected that membrane be loose, and there 
is danger of obstruction, the tube ought to be taken out, 
to permit removal of the obstacle, and then reintro- 
duced, if necessary. 
I do not favor its frequent removal, nor is it necessary 
for the purpose of allowing the patient to take nourish- 
ment. It is safer and easier to insert the stomach tube, 
through the mouth or nares, and thus nourish the child. 
We must not forget the danger of crowding membrane 
down in the reintroduction of tube. 
When diphtheritic patches are visible upon the tonsils, 
pharynx, or in the nose, I generally wait until they dis- 
appear before the intubation-tube is permanently re- 
moved. No membranes being present in the fauces, it is 
well to remove the tube at the end of five or six days ; if 
the dyspnoea return, the tube can be reintroduced at 
once or after the lapse of a few hours. The hoarseness 
and aphonia which persist when tube is removed yield 
to general treatment in from one to three weeks. 
The prognosis in intubation (and this applies to tra- 22 
cheotomy as well) is belter when the evidences of general 
infection are mild or wanting ; when the operation is 
done in cases in which the symptoms of asphyxia pre- 
dominate, and the local lesion—the membranous de- 
posits in the larynx—constitute the main danger to the 
patient. It is unfortunately true that in many instances 
it is not always possible, amid an aggregate of symptoms, 
often very complex, to distinguish perfectly the symp- 
toms due to the local trouble in the larynx and those 
due to the sepsis or other complication. In view of the 
simplicity of the procedure and the comparative ease 
and rapidity with which it can be done, I have often in- 
tubated (the stenosis being sufficiently well marked to 
warrant it) regardless of the tender age and no matter how 
hopeless the cases from septic or other complication, the 
object being to allow the child to breathe more easily 
and to render its condition more comfortable, to prevent 
asphyxia with its struggles and suffering. 
No positive prognosis can be given until forty-eight 
hours at least have elapsed. Though the dyspnoea be 
relieved, the membrane may extend downward, pneu- 
monia set in, cardiac failure occur, systemic infection 
take place, and paralysis, nephritis, or heart-clot render 
the prognosis bad. If no marked elevation of tempera- 
ture occurs and the respirations do not become acceler- 
ated during the first two or three days, the case will 
probably pursue a favorable course. Exceptionally a 
nephritis or late pneumonia will cause a fatal termination 
after the fifth or sixth day. 
Treattnent.—lntubation relieves the stenosis and keeps 
the larynx patent, so that air can gain free access to the 
lungs. It is thus a symptomatic expedient, so to say, re- 
sorted to, not with a view to cure the disease itself, but 
rather to overcome the obstruction to respiration. This 
should not be forgotten. We still have to deal with a seri- 
ous disease and must meet other indications as they arise. 
What medicines are to be given ? Dr. Northrup an- 
swers, “ Milk and whiskey.” He further adds : “ I have 23 
occasionally found my tubes well corroded when enthu- 
siasts in bichloride treatment and advocates of iron have 
been hard to manage.” At the risk of corroding my 
tubes and being included among the “enthusiasts,” I 
would state that I continue the use of the “bichloride” 
throughout the disease.1 
If there be extensive diphtheria of the fauces, iron and 
chlorate of potash are indicated. If the nares be in- 
volved, nasal injections are resorted to. If other symp- 
toms arise, the appropriate remedies are prescribed. In 
cases of threatened heart-failure, hypodermics of brandy, 
ether, camphor, caffein, etc., may be employed. High 
temperature is treated by antipyretics either by mouth 
or suppositories. 
By means of Spencer’s steam atomizer, steam is kept 
up continuously. Alcoholic and other stimulants are not 
to be neglected. 
Alimentation is of primary importance in this as in 
any other severe affection. Disgust for every article of 
diet is a very unfavorable symptom. As a rule the little 
patients will not take food well from parents or friends, and 
whenever possible it is advisable to insist upon the pres- 
ence of a good nurse. Even then personal supervision 
should be exercised, and precise directions left ; too 
much latitude should not be given, or much left to the 
discretion of the attendant not familiar with the require- 
ments of the case. The proper preparation of the food 
ought to be looked into by the physician. I have fre- 
quently been told that it was impossible to administer 
1 The deductions ofThallon (New York Medical Journal, April 12 and 19, 1884) 
prove not only that the bichloride is a proper antifermentative, but also that the 
doses must be larger than usually recommended. Following the teachings of Ja- 
cobi (The Medical Record, May, 1884), I have kept these patients under the in- 
fluence of mercury. From one-sixth to one-half and even a grain (according to the 
urgency of the symptoms and age of child) may be given in divided doses in 
twenty-four hours, and continued for a number of days without producing any un- 
toward results. The medicine is continued even after intubation ; and when the 
difficulty in swallowing is great, tablet triturates of bichloride, one-fortieth of a 
grain, are powdered and mixed with a small amount of sugar and placed dry upon 
the tongue, ice being given at the same time to facilitate solution and prevent the 
drug reaching the stomach in too concentrated form. 24 
anything to the child. Sitting down by the bedside and 
personally attending to the feeding, I have been able to 
make the child take a reasonable amount of nourish- 
ment, either by threats of punishment, insertion of gag, 
force, or bribery. Trousseau very truly says : “ There are 
no rigid rules in respect to the choice of food. We are 
often obliged, in some individuals, to satisfy the strangest 
possible caprices of taste.” Some five years ago I per- 
formed a tracheotomy in a case of whooping-cough com- 
plicated with membranous laryngitis. Cyanosis was so 
far advanced that the operation was practically done 
without an anaesthetic. The boy, of Russian-Polish par- 
entage, absolutely refused milk, stimulants, and usual 
articles of diet. Any attempt to force him would pro- 
voke him to such an extent that he would tear his hair, 
toss about wildly, and have a severe paroxysm of cough, 
often bringing up considerable quantities of blood. I 
was finally compelled to allow him to have his own way 
and to permit him to select his own dietary, his favorite 
dish being a compound composed of dried pears, carrots, 
potatoes, and meat stewed together. Of this he would 
eat two or three heaping soup-platefuls daily. The 
boy recovered. I mention this case, which is excep- 
tional, merely to show that rigid rules cannot always be 
carried out, and in rare instances a departure from well- 
established precepts may not be attended by any un- 
toward consequences. If after repeated attempts to gi/e 
proper food 1 fail, I do not hesitate to allow the little 
fellow full latitude as regards his diet, provided rectal 
feeding be not possible and a resort to the use of the 
stomach-tube (through nose or mouth) be attended by 
marked prostration. 
For several hours after the tube has been introduced 
nothing should be allowed but small pieces of ice dipped 
in brandy or wine. These will be readily taken and will 
not induce coughing to any extent. At the next visit 
(three to four hours later) the physician should make it a 
rule to endeavor to discover how much fluid can safely 25 
be allowed at a time. Solids and semi-solids will be 
swallowed without much difficulty. Fluids, however, 
provoke considerable coughing. We must remember 
that the epiglottis is only an accessory to the closure of 
the larynx, and that the other more important factor, the 
action of its constrictor muscles, is prevented by the 
presence of the cannula; it is therefore evident that 
the deglutition of fluids can never be perfect with any 
form of tube in the glottis. If the head of the tube be 
too large, or ride too high in the larynx, the difficulty is 
greater. 
It is my practice to sit by the bedside and endeavor 
to discover the idiosyncrasy of the little patient as re- 
gards the ability to swallow fluids. I begin with a tea- 
spoonful of brandy and milk; if this be swallowed well, 
the nourishment is continued in teaspoonful doses, or 
larger amounts if well tolerated. If much cough follow, 
the quantity is diminished; in some instances but ten to 
twenty drops can be taken, and are then to be given by 
means of a medicine-dropper. This frequently happens 
in very young children, in such under eighteen months. 
In the case of older children we may allow them to sit 
up and take their food slowly from a cup or spoon—in 
fact, permit them to feed themselves as much as possible. 
Medicines may be administered in the same manner. 
It is far preferable to gauge the patient’s ability to swal- 
low than to allow him to take indefinite amounts, which 
are coughed up as soon as taken, and only tend to add 
to the discouragement and torment of the little one. 
Solids and semi-solids are better taken than liquid when 
there is pain and difficulty in deglutition, as they do not 
provoke coughing to the same extent. Thick soups, 
farinaceous food with milk, chocolate, cream, soft-boiled 
or scrambled eggs, frozen or condensed milk undiluted, 
may be allowed. Ice-cream, water-ice, and jellies of 
various kinds, with or without wine or brandy, may be 
tried. To children a year or so of age I have given rice, 
barley, or oatmeal water, cooked thick and strained, with 26 
white of egg and milk, a little salt and sugar being added 
to make it more palatable. 
Rectal nutrient injections I have used in one or two 
cases; 'in only one case was I compelled to use the 
stomach tube (Davidson syringe and Jacque’s catheter). 
Dr. Caille and others, in order to lessen the dangers 
of pneumonia or pulmonary complications from the 
possible entrance of food into the trachea, advise rectal 
alimentation or feeding by the stomach-tube (The Med- 
ical Record, March 19, 1887). 
This, in my opinion, is going too far. If the hints 
thrown out above are followed, I do not think that feed- 
ing by mouth will add materially to the danger of pneu- 
monia in this class of cases. Furthermore, we must 
remember that pneumonia complicating diphtheritic lar- 
yngitis is a rather frequent occurrence and is usually a 
broncho-pneumonia and results from rarefaction of the 
air in the respiratory passages during the period of im- 
peded respiration, with consequent collapse of pulmo- 
nary tissue and dilatation of blood-vessels, and hence a 
disturbance of the circulation. . . . Lobular pneu- 
monia will result from the aspiration of pieces of mem- 
brane into the smallest bronchi. . . . Second form 
of pneumonia is from the beginning of a fibrinous charac- 
ter (Jacobi). The danger exists, I admit, but is greatly 
exaggerated, and I have not been able to find the rec- 
ords of a single case in which, at the autopsy, the pul- 
monary inflammation was found to be due to the aspira- 
tion of particles of food into the bronchi after intubation. 
In the first few cases Dr. Denhard, misinterpreting the 
directions, inserted the tubes so that the bevel of the 
flange looked upward and forward, and in these instances 
the curious fact was observed that the patients could 
swallow very well. A number of gentlemen in Chicago 
have had a similar experience, and the reversed position 
is preferred by many, among them Professor Hoadley. 
The latter maintains that the flange of the tube, as placed 
by him deeply in the vestibule of the larynx, in no wise interferes with the functions of the epiglottis or the ary- 
epiglottic fold. Its removal, however, is attended with 
considerable difficulty. In order to test this further Dr. 
Denhard has lately introduced the tube in the reversed 
position and the patient was able to swallow with facility 
and comfort. 
In this connection it may be well to refer to Dr. Wax- 
ham’s modification of O’Dwyer’s tubes, devised to over- 
come the difficulty of nourishing the patient. They are 
made with smaller heads and are provided with a rubber 
collar with an artificial epiglottis attached. The collar 
projects sufficiently to prevent the tube slipping into the 
trachea, and being more elastic, fits more perfectly into 
the larynx than the large metalic heads. When the child 
swallows, the epiglottis presses the artificial epiglottis 
down, so as to completely cover the aperture of the tube. 
As deglutition ceases the larynx falls and the elasticity 
of the rubber throws the artificial epiglottis upward. 
Even with this addition the deglutition of liquids is not 
perfect; some enters the larynx. 
The pertinent question has been asked, Does intuba- 
tion leave the patient without any of the advantages 
offered by tracheotomy ? 
In my experience and that of others who have given 
the new plan a faithful trial, intubation secures to the 
patient evq§y advantage afforded by incision of the 
trachea. The insertion of an O’Dwyer’s tube relieves 
the stenosis as promptly, thoroughly, and efficiently as 
tracheotomy. Expectoration is more readily accom- 
plished after intubation, for the ability to close the glottis 
is preserved, the cough consequently is explosive and 
full, and the mucus and shreds of membrane are readily 
brought up. 
Furthermore, intubation will save many lives in cases 
in which tracheotomy would not be permitted; it will 
save many a patient from the need of tracheotomy; and 
“ finally, it will save many that could not be saved by 
tracheotomy.” The last applies particularly to children 28 
under three years of age. Fifty-two of Waxham’s cases 
(up to December 14, 1886) were three years or under, a 
great many nursing infants, with 13 recoveries (twenty- 
five per cent.). Among the recoveries were 1 nine 
months old, others respectively, fourteen months, eigh- 
teen months, and twenty-two months of age {Med. News, 
January 1, 1887). 
My own cases comprise 29 under three years of age 
with 11 recoveries, including one nine and one-half months 
old, one ten and one-half months, two eleven months, and 
one one year old. 
I have endeavored, to the best of my ability, to bring 
before you a faithful view of the subject under considera- 
tion, to give the dark as well as the light sides, to pre- 
sent the advantages as well as the imperfections of the 
measure. The picture may be rose-colored, but my 
experience warrants the favorable and even enthusiastic 
view I have taken. I have seen child after child die of 
laryngeal obstruction in instances where tracheotomy was 
objected to, and of twelve cases in which I have oper- 
ated, ten have died. I have furthermore assisted at the 
operation and more or less closely followed the after 
treatment of at least a score of cases in the practice of 
various friends. The results have not been brilliant or 
encouraging. It is thus evident that Ido not reject the 
cutting operation upon theoretical grounds 
experience. I appreciate the relief afforded by trache- 
otomy and have urged its performance in spite of dis- 
couraging results. Intubation affords relief as effectually 
and as thoroughly as tracheotomy. Moreover, it is a sim- 
pler and safer method. “ The child is swathed, the gag is 
in, the tube is in, the thread is out, the gag is out, and the 
relieved and bewildered child is looking about, coughing, 
quite unable to comprehend the surroundings.” Those 
who have witnessed the operation of intubation recognize 
the truth of the above and appreciate the benefits and 
advantages as well as the simplicity of the procedure. 
Many authorities, without any familiarity with the meas- 29 
ure and without a proper study of the subject, condemn 
the plan and attempt to discredit the assertions of its 
advocates. The objections are theoretical. 
Edmund Owens (“Year-Book of Treatment for 1886,” 
page 164) concedes that he “neither has nor desires a 
practical acquaintance with it,” and yet condemns the 
method. Michael, of Hamburg, says the method is as 
dangerous as it is impracticable. Thus far it has not 
met with much favor in England or on the continent. 
In concluding, it is but just that we acknowledge the 
debt of gratitude we owe to our confrere, Dr. Joseph 
O’Dwyer, considered by Jacobi the most deserving and 
most modest of all men. The patient, painstaking, and 
unostentatious manner in which he has conducted his 
experiments and investigations deserve due recognition 
at our hands. The perseverance, ingenuity, and origi- 
nality shown in perfecting the method merit our admira- 
tion. The disinterestedness, candor, and modesty, so 
characteristic of the man, and which stamp his references 
to this invaluable addition to our resources in the treat- 
ment of croup, cannot be extolled too highly, and deserve 
more than mere praise or words of fulsome flattery. Fi- 
nally, I heartily indorse the sentiment expressed by Dr. 
Ingals and join “in acknowledging the nobleness of the 
profession at large which tolerates no secret method, 
but generously donates to mankind every improvement 
in the healing art.” Among the latest, but not the least, 
may be classed intubation, rightly considered as “ one of 
the great advances in this age of medical discoveries.” FEEDING AFTER INTUBATION OF THE 
LARYNX. 
With Exhibition of Tubes Modified to Overcome 
Difficulty in Feeding. 
ATTENDING PHYSICIAN TO THE NEW YORK FOUNDLING ASYLUM. 
JOSEPH O’DWYER, M.D., 
From the very beginning of my experience with intuba- 
tion I recognized the fact that the greatest objection to 
this operation, and the one most difficult to overcome, 
was that of feeding the child while the tube remained 
in the larynx. I therefore began very early to try vari- 
ous modifications in the size and shape of the heads of 
the tubes with a view to remedying this defect. I will 
show you a few of these modifications in the order in 
which they were made. 
i. I first had the tube made with a very small shoul- 
der which rested on the vocal cords, while the lateral 
portions of the flange occupied the ventricles, thus per- 
mitting some action of the constrictors, such as occurs 
under normal conditions, to aid the epiglottis in protect- 
ing the larynx during the act of deglutition. The objec- 
tion I found to these small-headed tubes was the ten- 
dency of the swollen tissues to close over the aperture 
above, and there was also the danger that the tube might 
be pushed through into the trachea during attempts at 
extraction. 
2. My next modification consisted in gradually in- 
creasing the size of the head and giving the upper por- 
tion of the tube a backward curve in order to carry it 
away from the base of the epiglottis, at which point the 
straight one frequently produced ulceration. 3. The posterior portion of the tube was made longer 
than the anterior, or oblique from before backward and 
upward, in order to allow the epiglottis to come in con- 
tact with it sooner and with greater force when pressed 
down by the base of the tongue. 
4. The next modification was to increase the size of 
the head so as to make it fill the cavity of the larynx and 
thus prevent the entrance of fluids around it, for cough 
will be excited by contact of a foreign body with any 
portion of the mucous membrane of the glottis. The 
heads of the tubes now made are much larger than is 
necessary, but as deglutition, if no better, is certainly no 
worse, I have not changed them for the reason that the 
large head renders the extraction less difficult. 
5. The head of the tube was now made concave on 
its upper surface. This shape was suggested by taking a 
wax cast of the larynx and pressing the epiglottis over it 
while the wax was still soft. The impression made on 
the wax was similar in shape to that which you see in 
this tube. I have used this modification in a few cases, 
but without witnessing any apparent improvement in 
deglutition. Should it not prove otherwise objection- 
able on a more extended trial, this form of head may be 
an advantage, as it would render the removal of the tube, 
which is now the more difficult operation, much easier 
than its introduction, for the extraction, striking any- 
where on the concave surface, would naturally and easily 
glide into the aperture. 
6. In some cases a double backward curve has been 
given to the upper portion of the tube, the first curve 
being covered by the flange and the second being a little 
lower down. This has been used in several cases, but I 
have not seen any improvement in deglutition to result 
therefrom. 
This shape is advantageous, however, in one respect. 
Autopsies were made in three cases in which these modi- 
fied tubes were used, and not the least abrasion was 
found on the anterior wall of the trachea, at the point 32 
corresponding to the lower extremity of the tube, where 
more or less ulceration is not uncommonly produced by 
the tubes ordinarily used. This ulceration is sometimes 
quite marked in cases in which the vital powers have 
been much reduced by a previous attack of scarlet fever 
or measles or both, and is produced in the following 
manner : A tube in the larynx acts as a lever, with the 
posterior commissure as a fulcrum. During every act of 
deglutition the epiglottis presses the upper short arm of 
the lever backward and tilts the lower long arm forward 
against the wall of the trachea. First, the pseudo mem- 
brane disappears for about one-fourth of an inch above 
and below the end of the tube. I have seen many cases 
in which this alone occurred, and others in which the 
lesion varied from simple loss of the epithelium to pretty 
extensive ulceration. Several years ago, when I was 
using short tubes, from one to one and one-half inch in 
length, and of larger calibre, I never found ulceration 
in the trachea, but this lesion was present in almost 
every case just below the vocal cords in the subglottic 
division ot the larynx. 
I also show you one of Dr. Waxham’s modified tubes 
with rubber epiglottis, which I have not yet tried. 
With all these modifications, and others that I have 
not mentioned, I have found about the saifie difficulty in 
the swallowing of fluids, some of which, when compressed 
by the muscles of deglutition, will be forced under the 
epiglottis, no matter how accurately it covers the aper- 
ture of the tube. 
There are still other modifications that I intend to 
try, and as other men are working in the same line, there 
•is reason to hope that some device will yet be found to 
overcome this difficulty. 
Solids and semi-solids, when there is an appetite for 
such food, and when the patients can be induced to 
take it, are swallowed much better than fluids and do 
not enter the tube, as far as lam aware. Indeed, there 
is no reason why they should do so, for a bolus of food as 33 
it passes downward tends rather to press the epiglottis 
more firmly over the mouth of the tube than to raise it, 
as happens in the case of fluids. I make an exception 
to this statement in the case of malignant diphtheria of 
the larynx, a few cases of which I have operated upon, in 
which the epiglottis is converted into a mass of an almost 
globular shape by reason of the infiltration into its 
tissues, whereby its normal functions are completely 
abolished. 
Some children swallow remarkably well after intuba- 
tion, others very imperfectly, while a few refuse abso- 
lutely to swallow anything. This difference is to be 
explained partly by the condition of the epiglottis, 
whether very much swollen or not, and partly by the 
absence or presence of a desire for food. I have often 
known children to refuse milk or any other kind of 
nourishment, when they would drink water, beer, or 
anything that they liked, with very little difficulty. On 
several occasions I have removed the tube for the pur- 
pose of giving nourishment, but found that the patients 
could not be induced to take food any better than before. 
This occurs more frequently in cases of severe complicat- 
ing nephritis which occasions nausea and a loathing of 
food. 
There is sometimes an apparent improvement in swal- 
lowing after intubation, and more nourishment is taken 
than before the operation. This is due to the relief of 
the dyspnoea, which, before the insertion of the tube, was 
so urgent that the little sufferer could not afford the loss 
of the one or two respirations that would be necessi- 
tated by making a single act of deglutition. As a rule, 
the longer the tube remains in the larynx the better the 
patient learns how to swallow. I have observed this in 
adults as well as in children. One woman declared after 
intubation that she could not swallow anything in either 
solid or liquid form, and it was necessary to feed her by 
the stomach-tube. After the laryngeal tube had been 
retained for two or three weeks she took as much food 34 
as the stomach would tolerate, and, in addition, large 
doses of iodide of potassium. 
Exceptions to this rule are found in those cases in 
which, before intubation, nourishment was refused be- 
cause of the painful condition of the pharynx, or because 
of anorexia induced by nephritis, and in others in which a 
great deal of pain and irritation, caused by ulceration on 
the anterior wall of the trachea, previously alluded to, 
are present. 
I always instruct children who are old enough to under- 
stand, to drink as rapidly as they can and then cough to 
expel any fluid that may have entered the tube, instead 
of coughing after each deglutition as they usually do. 
In quite a number of cases I have been obliged to sup- 
plement feeding by the mouth by rectal alimentation, 
with or without stimulants, as indicated. In only a few 
have I had to resort to the stomach-tube. 
Intimately connected with the question of feeding after 
intubation is that of food-pneumonia, so much talked 
about of late. I will first refer briefly to the most im- 
portant factors concerned in the causation of pneumonia 
as a complication of croup, and will then give some rea- 
sons for believing that food is not one of them. The 
several etiological factors may be grouped as follows: 
1. The presence of secretion in the lower air-pas- 
sages, in consequence of the frequent association of 
bronchial catarrh and croup. 
2. The excessive amount of blood drawn to the 
lungs when there is sufficient obstruction in the larynx 
to prevent the free ingress of air required to fill the 
vacuum produced by the inspiratory expansion of the 
chest. 
3. Atelectasis from the same cause or from plugging 
of some of the bronchi by pseudo-membrane. 
4. The presence of a tube, whether it be in the larynx 
or in the trachea, not because it may admit a little of 
the milk or other fluids swallowed, but because it pre- 
vents closure of the glottis, and consequently prevents 35 
that compression of the air which is essential in order to 
give full expulsive power to the cough. The irritating 
secretions, therefore, instead of being promptly expecto- 
rated, accumulate, and are aspirated into the air-cells, 
where they sooner or later excite inflammatory changes. 
When we consider the nature of these influences, some 
of which are constantly present in severe cases, it ought 
not to be surprising to find pneumonia, especially of the 
lobular form, a rather frequent complication of croup. 
And this is particularly so after operation, whether 
by tracheotomy or intubation. 
As opposed to the food-pneumonia theory, I offer the 
following : 
1. I do not believe, and there is no evidence, so far, to 
prove, that any of the fluid entering the tube ever reaches 
the bronchi, for it is promptly expelled by coughing. 
2. Those cases in which the croupous process does 
not invade the bronchi, and in which there is little or no 
bronchial catarrh, no matter how imperfectly they swal- 
low, rarely, if ever, develop pneumonia. 
3. Intubation in chronic stenosis of the larynx, in the 
adult, is not followed by any inflammatory changes in 
the lungs. In one case of this kind I have already in- 
troduced a tube over fifty times, leaving it in the larynx 
on several occasions as long as a week at a time. This 
patient, owing partly to a deformity of the epiglottis, 
swallowed both solids and liquids very imperfectly, but 
never developed even the slightest amount of bronchitis. 
Another female patient, who had worn a tracheal cannula 
for over two years and who was in failing health and 
suffering from bronchitis at the time that she was intu- 
bated, rapidly improved after the tube was inserted into 
her larynx, and the external wound was closed. The 
bronchitis also disappeared within a reasonable time. 
This patient wore the tube in her larynx continuouslyfor 
over ten months, and enjoyed excellent health during 
the entire time. 
There is no objection to the use of emetics, if indi- 36 
cated, after intubation, and there is no danger that the 
vomited matters will enter the tube, as no resistance is 
offered to their escape from the oesophagus, such as must 
be overcome when food or drink enters this canal from 
the pharynx 
Finally, I wish to show you two hard-rubber tubes, 
which are suitable for use in any form of acute stenosis 
of the larynx in the adult. The larger is intended for a 
large adult male, the smaller for a small-sized or young 
adult male, or for a female. Whether they will be any 
improvement on the metal tubes that I have been using 
remains to be settled by a more extended trial. I have 
used the smaller of these in two women, who had previ- 
ously worn metal tubes of a much smaller calibre. One 
of the patients expressed a decided preference for the 
heavy tube, which, she said, sank deeper in the larynx 
and enabled her to swallow more easily than did the 
light-rubber tube. But although one weighed one ounce 
and three-quarters and the other only one hundred 
grains, she could not appreciate any difference in the 
weight as it was in position in the larynx. The other 
patient, while she could not swallow as well with it, was 
equally strong in her preference for the lighter tube, 
saying that it gave her less pain and irritation, and en- 
abled her to expectorate more easily. These tubes are 
made by Tiemann & Co. PATHOLOGICAL ANATOMY OF THE RESPIR- 
ATORY TRACT AFTER DEATH FROM LA- 
RYNGEAL DIPHTHERIA AND INTUBATION.1 
W. P. NORTHRUP, M.D., 
In my paper read before this Academy in December last 
(see Medical Record of December n, 1886), entitled 
“ Laryngeal Diphtheria, Intubation, and Pathological 
Anatomy,” etc., I analyzed the cases found in the post- 
mortem records of the New York Foundling Asylum. 
There were at that time 87 cases recorded of death from 
laryngeal diphtheria. 
PATHOLOGIST TO THE NEW YORK FOUNDLING ASYLUM. 
Of these, 50 were males, 37 females. Average age 
was two years and seven months. Number of children 
dying under one year, 13 ; between one and two was 9 ; 
two and three, 10; three and four, 36 ; four and five, n ; 
five and six, 1 ; six and seven, 1 ; unknown, 6—total, 87 
cases. 
“ The greatest mortality, as we see, was from three to 
four years of age, where we find 36 of the 87 cases. The 
next number falls abruptly to 13, representing those dy- 
ing under one year.” 
In 56 the diphtheria began in the larynx. Of the 87 
cases 22 followed measles, 8 followed scarlet fever. In 
54 cases there was pneumonia, the diagnosis of which 
was made either from obvious signs of consolidation, or, 
where this was not well developed, from the microscopic 
findings. Not in all cases did there seem to be enough 
pneumonia to be the cause of death. In 29 cases there 
1 Read before the New York Academy of Medicine, June 2, 1887. 38 
was estimated to be enough. In 27 cases bronchial 
diphtheria was the prominent lesion. I will here repeat 
that I do not rule out pneumonia, because lung inflates 
easily by artificial means and returns nearly to its nor- 
mal color. lam not willing to admit that it is collapse, 
and not pneumonia, on that test. In cases of doubt the 
microscope has been used to determine the nature and 
extent of the lesion, and in the records referred to the 
diagnosis heading the history and post-mortem records 
has been made on the anatomical basis. 
Since January 1, 1887, there have been added to 
these records 20 cases, making in all 107. These will 
be interesting and instructive, because they are all cases 
of laryngeal diphtheria occurring in a fatal epidemic of 
measles. Of the 20 cases all had measles and pneumo- 
nia ; 8 had scarlet fever with measles; and 13 had, 
in addition, well-marked nephritis. These points are 
mentioned to show the severity of the epidemic, which 
in four months has added 20 cases to the former record. 
I said in my paper that I had never found any ulcers 
of the trachea which were more than a rubbing away of 
the epithelium. I have this evening to show you the 
lesions of a severe epidemic, in which the patients have 
been overwhelmed with scarlet fever and measles and 
pneumonia and nephritis and diphtheria. On these glass 
slides are shown the ulcers in gross, from four tracheas, 
which ulcers, you will see, extend in depth to the rings 
of the trachea, laying them bare. The lower end of the 
tube, at each movement of swallowing, rubs against 
the anterior wall of the trachea. In this severely fatal 
epidemic we find what we did not in previous cases, 
viz., deep ulcers. Of the 20 cases 5 had tracheal ulcers 
deep enough to be of serious moment. I have never 
seen ulcers made by the head of the tube worthy of 
consideration. It amounts simply to necrosis of the 
epithelium, and will heal without contraction. 
One of the first questions to be asked is whether or not 
milk, which occasions cough, passes into the finer bron- 39 
chi and alveoli and causes pneumonia—foreign body 
pneumonia, aspiration pneumonia, schluck pneumonic. 
I may answer, briefly, I have never found any evidence 
that it did find its way into the finer bronchi. lam fa- 
miliar, too, with the article of Orth, of Gottingen, recently 
published, and I find nothing corresponding to his de- 
scription. 
I am endeavoring by experiment to determine how 
far the fluid passes downward into the air-passages. 
Fluid bathing simply the under surface of the epiglottis 
may cause violent cough. The experiments are in this 
line. By some means register the depth to which the 
fluid descends, either by harmless staining-fluids or by 
finely divided carbon suspended in milk. Thus far I 
have no results to publish. 
This paper has but two points to add to that of De- 
cember on this particular feature of the discussion. 
First, after all that has been suggested on the sub- 
ject, I find no evidence that milk, or food of any kind, has 
passed into the finer bronchi and alveoli of patients wear- 
ing the laryngeal tube. 
Second, that in patients the subjects of previous ex- 
hausting disease the lower end of the tube may cause ul- 
ceration, even when worn the usual number of days. 
This ulceration may easily amount to a complication. CONTRIBUTION TO THE DISCUSSION ON 
INTUBATION OF THE LARYNX.1 
A. CAILIJE, M.D., 
NEW YORK, 
I wish to state at the onset that we cannot this evening 
speak a final word as to the actual merits of intubation. 
It is true that a large number of cases are on record, 
but it is equally true that many of these cases are re- 
ported in a superficial manner, and therefore lose their 
value as statistical material. 
I must confess that Dr. Huber and Dr. Brown have 
presented their cases in a manner calculated to inspire 
confidence in the conclusions which they formulated. 
I believe, moreover, that it is a good plan for those who 
have had experience with both tracheotomy and intuba- 
tion to come together occasionally and compare notes ; 
and taking this view, I will briefly state my own experi- 
ence. 
I have done tracheotomy 21 times, with 5 recoveries. 
I have intubated 16 times, with 6 recoveries. Of the 
intubated cases 9 were cases of nasal or pharyngeal 
diphtheria and laryngeal stenosis, with 2 recoveries ; 6 
were cases of true membranous laryngitis, and no visible 
diphtheritic exudate on fauces, with 3 recoveries; 1 
case was probably a severe simple inflammatory steno- 
sis of five days’ standing, which had not improved under 
ordinary treatment, with very urgent dyspnoea, 1 recov- 
ery. 
Most of these cases were seen in consultation, and 
intubation was done rather late, and I am convinced that 
1 Read before the New York Academy of Medicine, June 2, 1887. without active interference every one of these children, 
whose ages ranged from one to seven years, would have 
died of suffocation. 
I believe that I would be able to report at least one 
more recovery if intubation had been done earlier in one 
case, for breathing had actually ceased and artificial res- 
piration had to be practised. 
My best results in intubation were obtained in cases of 
undoubted membranous laryngitis, in which diphtheria 
of fauces was not visible at the time of intubation. 
Now this is quite the reverse of my experience with 
tracheotomy, for most of the children operated upon for 
true membranous laryngitis died from an extension of 
the membrane into the finer bronchi, and it made appar- 
ently no difference whether the trachea was incised above 
or below the thyroid gland. The cause of death in such 
patients as did not recover after intubation was, in the 
majority of cases, catarrhal pneumonia. In most of the 
fatal cases 1 gave some liquid nourishment, which may 
have provoked pulmonary inflammation through being 
aspirated. Of late, I have given only solids, chopped 
very fine and moistened, and small pieces of ice to 
quench thirst; since that time my results are much 
better. 
One case deserves special attention. I intubated a 
child, one year old, with extreme stenosis but no visible 
diphtheria. I removed the tube every other day to feed 
the child, as it could not swallow, but I was obliged to 
reintroduce it. On the twelfth day I noticed pharyn- 
geal and nasal diphtheria, and on the fourteenth day, the 
child died of exhaustion, with the tube in situ and the 
lungs free. If I were asked to express my personal 
opinion as to the value of intubation, I would say : 
1. In general practice intubation is preferable to 
tracheotomy in urgent laryngeal stenosis of children in 
the majority of cases. 
2. When pharyngeal or nasal diphtheria and laryn- 
geal stenosis are present at the same time, intubation 42 
should tbe practised in preference to tracheotomy, when 
the surrounding circumstances are such as to preclude 
the possibility of proper and intelligent after-treatment. 
3. Tracheotomy is preferable to intubation in such 
cases of larnygeal stenosis, with pharyngeal or nasal 
diphtheria, which appear from experience hopeless, with- 
out sufficient stimulation and nourishment and proper 
local treatment of naso-pharynx, provided the operation 
and after-treatment can be conducted under the most favor- 
able surroundings. 
4. These conclusions pertain to intubation with the 
present style of tube. DANGERS AND ACCIDENTS OF INTUBA- 
TION. 
DILLON BROWN, M.D., 
The accidents of intubation of the larynx are many, but 
the unavoidable accidents are few, and, with the excep- 
tion of pushing down pseudo-membrane before the tube 
—which is a rare complication—they are not important. 
I shall discuss, first, those accidents which can be and 
should be avoided, due to lack of skill, carelessness, or 
imperfect instruments, and second, the unavoidable acci- 
dents, and last, some of the dangers of intubation, theo- 
retical and practical. 
Avoidable accidents.—i. Asphyxia from prolonged at- 
tempts at introduction. 
2. False passages made in attempts at introduction. ■; 
3. Asphyxia from slow accumulation of secretions in 
the tube. 
NEW YORK. 
4. Slipping of tube into the trachea. 
5. Asphyxia from swelling over the head of the tube. 
6. Passing the tube into the oesophagus. 
7. Injuries to the larynx in attempts at removal. 
8. Miscellaneous. 
Unavoidable accidents.—9. Pushing down pseudo-mem- 
brane before the tube. 
10. Fatal obstruction from fragments of membrane in 
or below the tube. 
11. Coughing out of the tube. 
Dangers, theoretical and practical.—l 2. Shock of the 
operation. 
13. Inspired air being septic and causing pneumonia. 44 
14. Food and liquids entering the bronchi. 
15. Ulcerations due to the pressure of the tube. 
16. (Edema, from various causes. 
17, Dangers from applications by means of the tube. 
Asphyxia from prolonged attempts at introduction.— 
The tube, in most cases, should be inserted into the lar- 
ynx quickly, and on the first trial. Every additional at- 
tempt and every prolonged one is harmful; but there is 
less injury done by several short trials at introduction 
than by a single prolonged one, even if successful. 
False passages made in attempts at introduction.-—ln 
cases of acute stenosis the tube slips easily into the lar- 
ynx, and it requires no more force to push it well into 
position than it does to pass a sound through the healthy 
urethra. In the two cases which have come under my 
notice of false passages made in attempts at introduc- 
tion, an unjustifiable amount of force was used to push 
the tube in place. In both of these, its insertion caused 
a complete cessation of respiration, which was supposed 
to be due to the pushing down before it of membrane. 
The autopsies, however, showed that in the first case 
the tube had entered one of the ventricles of the larynx, 
and was forced down through the surrounding tissues 
along the outside of the trachea. In the second case 
there was a rupture through the wall which separates the 
oesophagus and the trachea, and respiration was pre- 
vented by the pressure of the tube against this yielding 
membranous division. 
Asphyxia from the slow accumulation of secretions in 
the tube.—ln a certain proportion of cases, especially in 
those in which the patient is weak and coughs but sel- 
dom, and in which the amount of secretion is small, the 
tube gradually becomes lined, sufficiently to cause ob- 
struction, with a mixture of what seems to be mucus and 
pus. Although this is not a common complication, and 
can be prevented to a great extent by the faithful use 
of the steam atomizer, it is well to be on our guard 
against it, and in all cases of secondary dyspnoea to re- 45 
move the tube, and make sure that it contains no ob- 
struction. 
Slipping of the tube into the trachea.—This is an acci- 
dent which, I believe, has never happened, and which, I 
believe, never can happen when a proper-sized tube is 
used, except as a result of injuries to the larynx made in 
attempts at removal. If the extractor is passed into the 
larynx, but outside of the tube, and is forcibly withdrawn 
with its blades widely open, great damage will be done 
to the larynx. It is possible in this manner to split 
open the cricoid cartilage, and so enlarge the opening 
of the glottis as to allow the head of a tube to slip 
through the larynx into the trachea. This is an accident 
which can always be avoided. 
The occurrence of this accident has been reported 
three times, but it seems to me that a careful analysis of 
these reports will show that such has not been the case. 
It should be remembered that the head of the tube, even 
if pushed below both the ventricular bands and the true 
cords, will still remain in the larynx, being held by its 
narrow, sub-glottic division. Again, as the head of the 
tube is smaller than the calibre of the trachea, it would 
fall by its own weight until its lower end was arrested at 
the bifurcation or became lodged in a bronchus. There- 
fore, if this accident should happen, the tube could not 
be felt by the finger, and neither could it be grasped and 
removed by the extractor in the usual manner. In Dr. 
Waxham’s case, after anaesthetizing the child, the tube 
was grasped by the extractor and removed without force 
in the usual way. He bases his diagnosis on the pres- 
ence of a croupy cough and the ability to swallow easily. 
These symptoms would also appear if the head were re- 
tained in the sub-glottic division of the larynx. In Dr. 
Eichberg’s first case an old-fashioned, small-headed tube 
was used, and it was pushed down in attempts at re- 
moval. Although the case is not reported minutely 
enough to state positively whether the head was in the 
sub-glottic division of the larynx or in the trachea, it 46 
seems to me that the evidence would indicate the former 
place rather than the latter as its position. The diag- 
nosis of its position was apparently based upon the fact 
that it had been pushed below the true cords, the retain- 
ing power of the sub-glottic portion of the larynx being 
ignored. After this an unsuccessful attempt was made 
to remove it, from which I inferred that it could be felt 
by the extractor. Again, the child’s breathing was per- 
fectly easy, and upon opening the trachea the head of 
the tube was found above this opening. In Dr. Eich- 
berg’s second case the tube, also one of the early ones, 
slipped through the chink of the glottis, and was there- 
fore supposed to be in the trachea. Of the three cases 
reported, in one of them the head of the tube was not in 
the trachea ; and in the other two, an old-fashioned, 
small-headed tube was used, and its position in the trachea 
was not demonstrated. When there is much swelling 
over the head of the tube, it may be erroneously sup- 
posed to have slipped below the cords. 
Asphyxia from swelling over the head of the tube.—This 
is a complication eaisly overcome by inserting a tube 
with a larger head. It has occurred in two of my cases, 
and in the first one I did not recognize the cause of the 
secondary dyspnoea until the autopsy, after the child had 
died from asphyxia. It is a good plan, before removing 
the tube in cases of secondary dyspnoea, to exclude this 
accident, as its cause, by a digital examination of the 
larynx. 
Passing the tube into the oesophagus.—There should be 
no difficulty in determining whether the tube is in the 
larynx or in the oesophagus, although this mistake has 
been made in two cases which have come under my no- 
tice ; and in both of them the child died from asphyxia. 
After coughing up the tube, it has been swallowed sev- 
eral times, and in attempts at introduction it has been 
lost in the stomach a number of times. In all these 
cases its presence caused no trouble, and if the patient 
recovered, it was passed per rectum without difficulty. 47 
In one case, where it was thought to have been swal- 
lowed, it was unexpectedly expelled from the larynx sev- 
eral days later, and in another case it was found in the 
pocket of one of the other children. 
Injuries to the larynx in attempts at removal.—ln re- 
moving the tube no force is required ; and in cases in 
which the extractor comes away with difficulty, it is be- 
cause it is caught in the tissues of the larynx, and much 
injury will be done if it is forcibly removed with the 
blades widely open. Not only will you lacerate the 
larynx, but may even split open the cricoid cartilage, 
and so enlarge the chink of the glottis that on the next 
attempt to remove it you will push it into the trachea. 
This accident has happened in practice on the cadaver. 
Miscellaneous.—At times, after the removal of the 
tube, there occurs a spasm of the glottis from the irrita- 
tion of the inspired air upon the larynx, which has been 
protected so long. This can be avoided to a great de- 
gree by giving an opiate just before its removal, but it is 
always advisable, before removing the tube, to have 
everything prepared for its immediate reinsertion, if nec- 
essary. This rapid return of the dyspnoea may also be due 
to a diphtheritic paralysis of the abductors or to an oedema 
of the glottis. The string should be of strong braided 
silk, not only to prevent its breaking, but to prevent the 
more serious complication of its untwisting and catching 
in the eye of the tube, so that it cannot be withdrawn with- 
out removing the tube. The string should be cut as short 
as possible and withdrawn slowly to prevent its cutting 
the surrounding tissues. The lacerations made by the 
gag, and by the finger in locating the larynx, are un- 
important. 
Pushing down pseudo-membrane before the tube. —This 
is the gravest accident which the operator can encounter, 
but fortunately it is an extremely rare one. On the 
first introduction of the tube, sufficient membrane has 
been pushed down to cause asphyxia in only one of Dr. 
O’Dwyer’s cases, and in two of my own. In each case 48 
after withdrawing the tube, the obstruction was expelled 
and the dyspnoea relieved. Later, when the membrane 
has become more or less detached and broken down, 
upon the reintroduction of the tube, the liability to this 
accident is increased. In connection with this danger, 
one point regarding the introduction of the tube must be 
closely observed. The tube should be pushed well down 
in position, and held down by the finger while the obtu- 
rator is being removed. Otherwise, when it is pushed 
into position after the removal of the obturator, the lower 
end is unprotected, and can easily strip off enough 
membrane to cause obstruction at that point. Upon the 
reintroduction of the tube I have pushed down sufficient 
membrane to cause obstruction in four cases, but in only 
one of these was it a fatal obstruction. This occurred 
eighteen days after the first intubation, and shows how 
long the membrane will sometimes persist. 
Other accidents, and those avoidable ones, may be 
mistaken for this—e.g., apnoea from prolonged attempts 
at introduction, pushing the tube through a ventricle of 
the larynx, and other false passages, etc. 
Fatal obstruction from fragments of membrane in or 
below the tube.—This is also a rare accident, and it has 
not occurred in any of my cases. If the tube becomes 
obstructed, it will usually be expelled, and it is on this 
account that it is advisable to have it retained in the 
larynx as loosely as possible. Certainly, the number of 
deaths from clogging of the tube after intubation, as 
shown in the reported cases, compares in a remarkably 
favorable manner with the number of deaths from the 
same cause after tracheotomy. 
Coughing out of the tube.—This is undoubtedly a 
source of danger, but it can be entirely obviated by 
making the retaining swell of the tube sufficiently large. 
It is intended by Dr. O’Dwyer that the tubes be held 
loosely in the larynx, so that when they are no longer 
needed, or become obstructed, they will be expelled. 
After being coughed out, if the dyspnoea does return, it 
is usually several hours before it becomes extreme, and 49 
there is time to reach the patient and reinsert the tube. 
In my own practice I have had one death from laryngeal 
obstruction after coughing out of the tube. It was a boy 
fourteen months old. I removed the tube on the fifth 
day, but was compelled to reinsert it the next day. 
From this time the tube was frequently expelled, being 
retained from five to sixteen hours. I had a special tube 
made with a very large retaining swell, but it was appar- 
ently expelled as easily as the others. There was pa- 
ralysis of the pharyngeal muscles, and of the external 
rectus of the eye, and it seems to me that the cause of 
the frequent expulsion was a paralysis of the muscles of 
the larynx. There was usually time to reach the child 
and reinsert the tube; but on the twenty-eighth day it 
was some time after the expulsion of the tube before I 
was sent for, and when I reached the patient two and 
one-half hours after it was coughed out, he was dead. I 
obtained the larynx, and there were no macroscopical 
appearances to account for the return of the obstruction. 
Shock of the operation.—This is very slight when the 
operation is done quickly and skilfully. In a certain 
number of cases of laryngeal diphtheria, soon after in- 
tubation, the temperature begins to rise, and the condi- 
tion of the patient rapidly grows worse. However, this 
occurs just as frequently after tracheotomy, and it does 
not occur after intubation of the larynx for stenosis due 
to other causes—e.g., syphilitic stenosis or catarrhal croup. 
Therefore, it seems to me that this change is not due to 
the operation itself, but is the result of relieving the la- 
ryngeal obstruction, this acting in some manner as an 
antipyretic. We know that nitrogen acts as an antipy- 
retic, and may not its action be due to its cutting off the 
supply of oxygen rather than to any effect of its own ? 
Inspired air being septic and causing pneumonia, and 
food a?id liquids entering the bronchi.—My experience 
has been that the cause of death, when due to pulmonary 
complications, is, in the vast majority of cases, not pneu- 
monia, but an extension of the disease to the bronchi— 
a diphtheritic bronchitis. Again, pneumonia is not a common complication of diphtheria when the larynx is 
not involved, although the same condition exists—the 
inspired air is septic. If the extension of the disease 
could be caused by this contaminated air, we would ex- 
pect laryngeal or bronchial diphtheria to occur oftener, 
for in not one case of diphtheria out of ten is the larynx 
or the bronchi involved. 
In no autopsy at the New York Foundling Asylum 
has food ever been found in the bronchi, and I believe 
that this is a theoretical danger rather than a real one. 
Ulcerations due to the pressure of the tube.—That ul- 
ceration may originate in this way is without question, 
but this will be fully discussed in the paper on the pa- 
thology of the larynx after intubation. In none of the 
cases reported has the presence of the tube caused any 
harm. Certainly the tracheotomy tube does do injury, 
and it is not very rare to see cases of retained tracheal 
tubes due to granulations, incurvation of the wound, etc., 
and occasionally also death from hemorrhage following 
ulceration through a blood-vessel. 
QLdema of the larynx; local applicatio?is.—ln cases 
of laryngeal diphtheria the stenosis is due not so much 
to the pseudo-membrane as to the swelling of the tissues 
beneath it. The pressure of the tube diminishes this 
swelling in a marked degree, besides hastening the dis- 
appearance of the membrane, if not even preventing its 
formation. This can be demonstrated at nearly every 
autopsy on cases dying after intubation. In making 
local applications by coating the tube with strong as- 
tringents, it is possible to cause an cedema of the glottis, 
which takes a long time to disappear. I lost one case 
from this cause, due to the too enthusiastic applica- 
tion of an ointment of nitrate of silver—3 ij. to f j.— 
just after reviewing the works of Dr. Horace Green. 
An application made in this manner is not one of short 
duration, but extends over several hours, or even days. 
Lacerations made in attempts at insertion or removal 
may set up an oedema. 
102 East Fifty-seventh Street. TRACHEOTOMY FOLLOWING INTUBATION 
OF THE LARYNX.1 
RESIDENT PHYSICIAN NURSERY AND CHILD’S HOSPITAL, NEW YORK. 
IRWIN H. HANCE, M.D., 
My object in writing this paper is to report in detail a 
case where tracheotomy was performed after the tube 
had failed to give relief in a child suffering from mem- 
branous croup and scarlatina. 
The following is a history of the case : Alfred J , 
aged twenty months. Father English; mother Irish. 
Admitted to the hospital October 16, 1886, Nursed 
for eighteen months. Has had measles. Is well nour- 
ished, but pale. No glandular enlargement. 
October 22d.—Appeared sick during day. Throat 
red. Slight elevation of temperature. 
October 23d.—Well-marked diphtheritic patches on 
the tonsils. 
October 24th.—In the morning was a little croupy; 
continued with croupy cough during the day, and was 
vomited three times, the symptoms thus being relieved. 
Child has developed a well-marked scarlatinous eruption. 
October 25th,—At 10.30 a.m. child was much worse, 
there being well-marked dyspnoea, with recession of chest- 
walls, cyanosis, and other signs of laryngeal stenosis. At 
10.45 a Wbe was introduced (No. 2), and almost imme- 
diately coughed out, along with much thick mucus ; oper- 
ation was again repeated with a like result. When the 
tube was introduced for the third time it became ob- 
structed, and caused a serious embarrassment of breath- 
ing. It was removed at once, and there was almost 
-1 Read before the New York Academy of Medicine, June 2, 1887. 52 
complete cessation of respiration, but artificial respira- 
tion revived the child in a few minutes. 
Dr. Wheelock, the attending physician, then advised 
that laryngotomy should be performed if the next intro- 
duction of the tube failed to give relief. At 11.30 a.m 
tube was reintroduced. At the end of ten minutes it was 
removed, and was found to be plugged with such thick 
mucus that almost a cast of the tube was formed. 
Cleansed and once more inserted ; this time the respira- 
tions improved for a short time. 
At 12.10 p.m. respirations worse, tube coughed up. 
Rapid incision was made through the crico-thyroid mem- 
brane and the cricoid cartilage, affording the child imme- 
diate relief. Wound was held open by retractors and 
the trachea thoroughly cleansed from mucus. Small 
hard rubber tracheal tube introduced. From this time on 
there was not the least return of any dyspnoea. 
At 7 p.m. child was quietly sleeping, breathing without 
any apparent effort. No cyanosis existed, and the scar- 
latinous eruption had entirely returned. Was able to 
take liquid food. Temperature during the night reached 
io6|° F. Failed slowly and died at 8 a.m., October 
26th, from the systemic poisoning of the two diseases. 
Necropsy was held twenty-six hours after death by the 
pathologist, Dr. N. H. Henry. Rigor mortis absent. 
Marked post-mortem ecchymosis. An incision passes 
through crico-thyroid membrane and cricoid cartilage ; 
edges of wound are in a fair condition. Trachea shows 
an abundant fibrinous exudation, which is easily lifted 
from the surface. Lungs : Slight hypostatic congestion. 
Pericardium : Increase in the amount of pericardial fluid. 
Heart: Valves normal; muscular tissue pale. Liver 
and spleen congested. Kidneys somewhat enlarged. In- 
creased amount of cortical substance. Medullary portion 
very pale. Capsules easily separated. Brain not exam- 
ined. 
In reviewing the history of this case I may emphasize 
the statement that the tubes were given a thorough trial 53 
and proved utterly useless. Now, what was the cause of 
this failure on the part of the tube to relieve the child’s 
symptoms ? It seems to me that two things conjoined 
to bring about this result, viz., an excess of thick, tena- 
cious mucus in the trachea and a partial dislodgement of 
the false membrane by the introduction of the tube. 
The former was present to a marked degree, and we may 
safely assert that some membrane was dislodged, because 
on one occasion after the withdrawal of the tube, artifi- 
cial respiration was required to restore the child’s func- 
tion of breathing. Was the operation of tracheotomy 
deferred longer than was necessary ? At present, in 
view of my experience with this case, I think that on an- 
other like occasion I should resort to tracheotomy ear 
Her, because many attempts at the introduction of a tube 
unquestionably cause a more or less decided depression 
of the child. The selection of the crico-thyroid mem- 
brane as the best place to incise the trachea was decided 
upon because of the ease and rapidity with which the 
operation could then be performed, one rapid incision 
being all that was required. 
Would the child’s chances of recovery have been better 
if tracheotomy had been performed at first without using 
the tubes ? 
This is an extremely difficult question to answer; I 
can only say that tracheotomy in children under two years 
of age terminates fatally in a very large percentage of 
cases, and that intubation gives a fair showing. From 
my own experience I feel that intubation in such young 
children gives equally as good results as tracheotomy. 
Thus far I have considered only my own case ; I ask 
your attention now to a few other cases which have been 
reported in the medical papers. 
Dr, Ferguson,1 of Troy, reports a case similar to mine, 
in which the tube detached a piece of membrane. 
Tracheotomy was performed ; the result was a complete 
1 New York Medical Journal, March s, 1887, vol. 45, No. 10, p. 273.5 54 
relief to the dyspnoea, although the child died in thirty 
hours. 
Dr. Montgomery,1 of Philadelphia, did tracheotomy 
because he was unable to reach the tube with the retrac- 
tor. He thought that the tube, which, he states, was of 
small size for the child, had been forced below the vocal 
cords; it, however, had been coughed up and swallowed, 
being passed per rectum two days later. This child re- 
covered. Dr. J. Eichberg, of Cincinnati, reports2 two 
cases where he had to tracheotomize the child in order 
to recover the tube : 
Case i, aged seven. After the tube had been in the 
larynx for six days, he fpund that it had fallen “by its 
own weight ” down so far as to require tracheotomy in 
order to remove it.; the wound was made through the 
cricoid cartilage, and he tried to get primary union, but 
failed, but was obliged afterward to introduce a tracheal 
tube. Result, recovery. 
Case 2, aged three. Five days after its introduction 
he sought to remove the tube, but failed, because the 
instrument, which was an old extractor, slipped, and, 
in his attempts at removal, he forced the tube into the 
trachea. By operating he recovered the tube, and the 
child made a good recovery. Here again he tried to get 
primary union, but failed, having to resort later to the 
use of the tracheal tube. 
Dr. H. H. Mudel, of St. Louis, seems to have been 
very unfortunate in his experience of the use of intuba- 
tion, He reports3 six cases, in three of which he was 
obliged to resort to tracheotomy. His notes are scanty, 
and are as follows : 
Case i, seven years of age. Came near suffocating 
from loose membrane. Tracheotomy. No result noted. 
Case 2, four years of age. Had had intubation tube 
in for four days. Tracheotomy because there was an 
1 The Medical News, March 5, 1887, vol. 50, No. 10. 
•i ancet‘Clinic of Cincinnati, vol. 18, Nos. 4 and 11, pages 97 and 321, 
Weekly Medical Review of St. Louis, vol. 15, No. 3, January 15, 1887. 55 
excess of secretion, and child was unable to swallow. 
Result: three weeks have elapsed since the operation, 
and he thinks child will recover. 
Case 3, three to four years of age. Tracheotomy 
because tube could not be retained. Result: recovery. 
Dr. Dillon Brown, of New York, reports one case : 
Child between one and two years of age. Tube failed 
to give relief. Cause was supposed to be due to loose 
membrane. Tracheotomy tube was introduced, but this 
failed to relieve the child’s symptoms, death occurring 
on the table. Autopsy revealed the probable cause of 
failure, as the membrane extended down to the third and 
fourth division of the bronchi. 
Thus, of 9 reported cases of tracheotomy following intu- 
bation, there were 3 deaths, 5 recoveries, and in one the re- 
sult was not noted ; so we have a very good showing, as to 
the results of this secondary operation. Further, we must 
not forget that the operation was performed in one-third 
of the cases after the tube had been worn from four days 
up, and consequently to them is due some credit for 
having tided the child over the most critical period of 
the disease. 
That accidents will occur these cases prove, but acci- 
dents of just as serious a nature occur during the per- 
formance of tracheotomy; in both, however, they are the 
exception and not the rule. 
The above-described accidents suggest to my mind 
the following queries : 
1. What causes will necessitate the performance of 
tracheotomy after intubation ? 
2. Can we avoid any of these causes or accidents ? 
3. Can we tell beforehand whether intubation is going 
to fail? 
The causes which have called for in the past and may 
in the future call for operative interference are as fol- 
lows : 
(a) An intolerance on the part of the larynx to retain 
the tube. 56 
(£) Inability to administer a proper amount of nourish- 
ment to the child. 
(c) A plugging up of the tube with false membrane 
and mucus, or a dislodgement of pieces of membrane 
during the process of introduction. 
(d) A return of the dyspnoea with an absence of the 
tube from the trachea, as in Dr. Montgomery’s case. 
(e) A wedging of the tube In the larynx, so that it can- 
not be removed through the mouth. 
(/) A forcing of the tube, during its introduction, 
through the floor of the ventricle in place of passing it 
into the larynx. 
Fortunately we can do something to avert the most of 
these accidents. Spasm of the larynx, as indicated by a 
short spasmodic cough, along with a frequent ejection of 
the tube, can be relieved by cracked ice by the mouth 
and counter-irritation to the neck. In the way of medi- 
cation, I have found that full doses of belladonna and 
nitre, with a small dose of chloral, afford speedy relief to 
laryngeal spasm. 
Inability on the part of the child to swallow will, I 
trust, soon be overcome by some modification of the 
present tube. As it is now, we can make use of rectal 
alimentation and skin inunctions, and when necessary 
we can feed through a rubber catheter. 
When we are certain that the tube has been swal- 
lowed, tracheotomy could be postponed if we had an- 
other tube of the right size at hand. Wedging of the 
tube into the larynx, or passing it forcibly through the 
neighboring tissues will only occur where great violence 
is used by the operator and can be easily averted. 
The only truly serious accident which has thus far 
been met with in the history of intubation is a dislodge- 
ment of pieces of membrane during introduction. In 
any individual case we cannot say whether such an acci- 
dent will occur, yet it is gratifying to know that it does 
not happen as often as one would naturally suppose. 
When one is unfortunate enough to have such a case, 57 
after the withdrawal of the tube, the child may relieve it- 
self by coughing, or we may aid it by producing emesis, 
or by extracting the membrane with a pair of long 
tracheal forceps, as done once by Waxham, of Chicago, 
or as a dernier ressort we must perform tracheotomy. 
In avoiding this accident strict attention to the details 
of the position of the child and of the management of the 
introducing instrument, along with great care and gentle- 
ness on the part of the operator, will be of some assist- 
ance. 
Let us hope that the future will reveal to some one of 
us an improvement whereby this unfavorable accident 
may be overcome. 
Finally, can we tell beforehand whether intubation is 
going to fail ? 
I think not, and since it has been clearly shown that 
intubation is able to accomplish the same result as 
tracheotomy, in the light of my own experience, and of 
the expressed opinions of many others, I am inclined to 
resort to tracheotomy only after I have proved that in- 
tubation has failed. STATISTICAL 
RECORDS OF INTUBATION, 
WITH 
REPORT OF EIGHT HUNDRED AND 
SIX CASES. 
By DILLON BROWN 
M.D., 
NEW 
YORK. 
Duration before intuba- 
u 
V 
Date. 
Sex. 
Age. 
tion of 
Urine. 
Cause of 
Complications. 
Result. 
operator. 
Larvneeal 1 
Pharyngeal 
death. 
'A 
symptoms. 
diphtheria. 
I 
Dec., 1885 
Joseph O’Dwyer. 
F, 
3 yrs. 3 mos. 
2 days. 
1 day. 
Not exam. 
Extension t o 
Died 2 days after intubation. 
(( 
14 months. 
18 months. 
Several days 
4 days. 
ft 
Died 6 hours after intubation. 
3 
u 
u 
u 
M. 
1 day. 
“ 
Extension 10 
Died 7 hours after intubation. 
bronchi. 
4 
44 
44 
44 
F. 
3 yrs. 4 mos. 
5 days. 
4 days. 
Albumen, 
Extension 10 
Died 2 days 10 hours after intubation. 
bronchi. 
Feb., 1886 
44 
44 
M. 
2 yrs. 3 mos. 
3 days. 
None. 
44 
Nephritis. 
Died 8 days 3 hours after intubation. 
6 
Mar., 1886 
44 
44 
M. 
5 years. 
3 days. 
3 days. 
“ 
Uraemic con- 
Died 1 day 9 hours after intubation. 
vulsions. 
7 
April, 1886 
“ 
“ 
M. 
3 yrs. 1 mo. 
2 days. 
7 days. 
“ 
Suppression of 
Died 4 days 1% hour after intubation. 
urine. 
M. 
F. 
2 yrs. 5 mos. 
3 yrs. q mos. 
1 day. 
i>£ day. 
Several days 
None. 
Not exam. 
Albumen. 
May, 1886 
tt 
Sepsis. 
Died 6 hours after intubation. 
3 yrs. 2 mos, 
6 years. 
i>£ day. 
2 days. 
Next day. 
Several days 
Not exam. 
No albu- 
Pneumonia. 
Exhaustion. 
Died 5 days 8% hours after intubation. 
Died 5 days after intubation. 
II 
» 
tt 
F. 
Followed scarlet 
men. 
fever. 
12 
44 
F. 
7 years. 
3 days. 
Not noted. 
Not exam. 
Pneumonia. 
Pneumonia when 
intubed. 
Died 18 hours after intubation. 
<4 
M. 
F. 
3 yrs. 3 mos. 
18 months. 
4 days. 
2 days. 
1 week. 
Several days 
tt 
Recovered. Tube worn 4 days. 
Died 2 days after intubation. 
x3 
14 
• 1 
tt 
“ 
Extension 10 
bronchi. 
15 
June, 1886 
44 
44 
F. 
3 yrs. 6 mos. 
2 days. 
1 day. 
44 
44 
Convulsions. 
Died 1 day 8 hours after intubation. 
M. 
2 yrs. 6 mos. 
Few hours. 
Died 2 days 6)4 hours after intubation. 
iC 
bronchi. 
17 
44 
44 
44 
F. 
2 yrs. 6 mos. 
1 day. 
2 days. 
44 
Sepsis; con- 
Died 1 day 8 hours after intubation. 
vulsions. 
18 
July, 1886 
M. 
4 yrs. 2 mos. 
1 day. 
3 days. 
Albumen. 
Recovered. Tube worn 4 days iSJtf 
hours. 
*9 
44 
44 
M. 
23 months. 
1 day. 
1 day. 
Extension 10 
Died 3 days 7 hours after intubation. 
bronchi. 
M. 
M. 
M. 
5 yrs. 6 mos. 
4 years. 
7 years. 
2 days. 
2 days. 
7 days. 
Next day. 
Several days 
4 days. 
Exhaustion. 
Died 2 days ia)4 hours after intubation. 
Recovered. Wore tube 5 days 6 hours. 
Recovered. Wore tube 3 days. 
20 
u 
22 
•* 
“ 
Not exam. 
23 
24 
4 yrs. 6 mos. 
3 yrs. 1 mo. 
2 days. 
2 days. 
Several days 
4 days. 
Albumen. 
Died 1 day 22% hours after intubation. 
Died 7 days after intubation. 
« 
“ 
“ 
F. 
Extension and 
pneumonia. 
Died 2 days after intubation. 
25 
Aug., 1886 
44 
44 
M. 
4 yrs. 8 mos. 
2 days. 
2 days. 
Not exam. 
Extension 10 
bronchi. 
26 
Sept., 1886 
tl 
si 
P. 
2 years. 
26 hours. 
Several days 
tt 
Died 13 hours after intubation. 
bronchi. 
27 
44 
44 
M. 
5 yrs. 10 mos. 
4 yrs. 4 mos. 
3 years. 
1 day. 
2 days. 
44 
Exhaustion. 
Died 1 day 14% hours after intubation. 
28 
29 
F. 
F. 
3 days. 
2 days. 
5 days. 
None. 
Recovered. Wore tube 4 days 8 hours. 
Died 2 days 9J6 hours after intubation. 
Oct., 1886 
11 
it 
Albumen, 
Extension 10 
bronchi. 
3° 
44 
44 
44 
F. 
6 yrs. 7 mos. 
2 days. 
4‘ 
44 
Pneumonia 25 
Bronchitis. 
Died 3 days 20 hours after intubation. 
hours after 
removal ot 
tube. 
31 
Nov., 1886 
44 
F. 
3 yrs. 2 mos. 
2 days. 
Several days 
tt 
Died 4 days 22)4 hours after intubation. 
cedema of 
lungs. 
32 
33 
34 
44 
M. 
M. 
F. 
36 hours. 
3 days. 
12 hours. 
None. 
4 days. 
2 days. 
Recovered. Wore tube 5 days. 
Recovered. Wore tube 68 hours. 
Died 15 hours after intubation. 
u 
u 
44 
S yrs. 6 mos. 
18 months. 
Not exam. 
u 
t( 
bronchi. 
35 
36 
37 
38 
(( 
44 
44 
F. 
F. 
4 years. 
1 day. 
4 days. 
4 days. 
3 days. 
1 day. 
7 days. 
3 days. 
S days. 
Recovered. Wore tube 10 days 6 hours. 
Died 1 day 4 hours after Intubation. 
Died 36 hours after intubation. 
Died 2)4 days after intubation. 
(( 
a 
44 
Sepsis. 
u 
a 
4 ( 
F. 
M. 
20 months. 
2 yrs. 11 mos. 
u 
ti 
44 
Albumen. 
bronchi. 
39 
ki 
44 
It 
F. 
F. 
15 months. 
20 months. 
6 days. 
1 day. 
9 days. 
3 days. 
Not exam. 
Measles. 
Recovered. Wore tube 9 days. 
Died 2 days after intubation. 
40 
44 
tt 
ft 
bronchi. 
41 
Dec., 1886 
44 
M. 
11 years. 
2 days. 
4 days. 
Albumen. 
Died 12 hours after intubation. 
lungs. 
42 
43 
44 
M 
5 years. 
2 yrs. 6 mos. 
2 days. 
7 days. 
None. 
Recovered. Wore tube 6 days. 
Died 2 days after intubation. 
44 
44 
M. 
Broncho pneu- 
monia. 
44 
44 
4 4 
44 
M. 
2 years. 
3 days. 
6 days. 
Died 1 day 20 hours after intubation. 
bronchi. 
45 
44 
44 
44 
M. 
3 yrs. s mos. 
1 day. 
2 days. 
None. 
Extension 10 
Died 2 days 9 hours after intubation. 
bronchi. 
46 
44 
44 
44 
M. 
3 yrs. 2 mos. 
10 months. 
7 days. 
1 day. 
7 days. 
2 days. 
Recovered. Wore tube 6 days 19 hours. 
Died 1 day 14 hours after intubation. 
47 
44 
44 
44 
F. 
Not exam. 
Extension 10 
bronchi. 
48 
44 
44 
44 
M. 
6 yrs. 2 mos. 
7 days. 
3 days. 
44 
Extension 10 
Died ig% hours after intubation. 
bronchi. 
49 
50 
41 
44 
44 
M. 
8 years. 
36 hours. 
2 days. 
5 days. 
4 days. 
Recovered. Wore tube 2 days 9 hours. 
Died 2 days 22 hours after intubation. 
44 
44 
<4 
• M. 
Albumen. 
Extension 10 
bronchi. 
Si 
44 
it 
44 
F. 
2 days. 
10 days. 
Measles. 
Recovered. Wore tube 7 days 22% 
hours. 
52 
Jan., 1887 
ft 
44 
M. 
3 yrs. 3 mos. 
1 day. 
Present. 
None. 
Extension 10 
bronchi. 
Died 3 days 21 hours after intubation. 
S3 
ti 
44 
F. 
6 yrs. s mos. 
36 hours. 
44 
Albumen. 
Extension 10 
Died s days 2 hours after intubation. 
bronchi. 
54 
“ 
“ 
M. 
3 yrs. 5 mos. 
1 day. 
Next day. 
Not seen after 
Died 4 days after intubation. 
55 
« 
» 
F. 
3 yrs. 4 mos. 
1 day. 
Present. 
Albumen. 
Sepsis. 
Sepsis. 
Died 17 hours after intubation. 
56 
44 
44 
44 
M. 
4 yrs. 6 mos. 
3 days. 
44 
4‘ 
Extension 10 
Died 8 days after intubation. 
bronchi. 
<( 
44 
44 
F. 
2 yrs. 10 mos. 
36 hours. 
None. 
Died 1 day 2 hours after intubation. 
0 i 
bronchi. 
58 
44 
4< 
44 
M. 
3 yrs. 5 mos. 
Pneumonia. 
Died 62 hours after intubation. 
monia. 
59 
Feb., 1887 
44 
44 
M. 
4 yrs. 6 mos. 
36 hours. 
None. 
Extension 10 
Died 1.6)4 hours after intubation. 
bronchi. 
60 
44 
44 
F. 
2 yrs. 6 mos. 
15 hours. 
3 days. 
Not exam. 
Died 1 day after intubation. 
bronchi. 
6l 
44 
44 
M. 
2 yrs. 8 mos. 
4 days. 
5 days. 
Albumen. 
Died 9 days after intubation. 
bronchi. u 
J5 
B 
3 
£ 
62 
63 
64 
65 
66 
67 
68 
6g 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
8s 
86 
87 
88 
89 
90 
91 
92 
93 
94 
95 
96 
97 
Date. 
Operator. 
Sex. 
Age. 
Duration before intuba- 
tion of 
Urine. 
Cause of 
death. 
Complications. 
Result. 
Laryngeal 
symptoms. 
Pharyngeal 
diphtheria. 
Mar., 1887 
April, 1887 
May, 1887 
(( 
July, 1885 
Oct., 1885 
Nov., 1885 
a 
Dec., 1885 
“ 
a 
Jan., 1886 
Feb., 1886 
Joseph O’Dwyer. 
Dillon Brown.30 
if it 
a a 
(i it 
tt a 
a a 
(t n * 
< t k 
a a 
a tt 
M. 
F. 
F. 
F.’ 
F. 
M. 
M. 
M. 
F. 
F. 
F. 
M. 
M. 
F. 
F. 
M. 
M. 
M. 
M. 
F. 
M. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
F. 
M, 
3 yrs. 6 mos. 
2 yrs. 6 mos. 
5 years. 
18 months. 
4 months. 
8 yrs. 9 mos. 
3 yrs. 7 mos. 
23 months. 
2 yrs. 2 mos. 
19 months. 
4 years. 
4 yrs. 9 mos. 
5 yrs. 9 mos. 
7 yrs. 1 mo. 
3 yrs. r mo. 
4 yrs. g mos. 
3 yrs. 3 mos. 
16 months. 
I yr. 11 mos. 
3 years. 
3 yrs. 4 mos. 
3 yrs. 4 mos. 
3 yrs. 6 mos. 
3 yrs. 7 mos. 
II months. 
3 yrs. 3 mos. 
4 yrs. 8 mos. 
1 year. 
3 yrs. 9 mos. 
3 yrs. 5 mos. 
5 months. 
4 yrs. 6 mos. 
3 yrs. 4 mos. 
2 yrs. 2 mos. 
5X months. 
3 days. 
1 day. 
2 days. 
36 hours. 
2 days. 
4 days. 
14 days. 
3 days. 
3 days. 
3 days. 
3 days. 
3 days. 
1 day. 
X day. 
36 hours. 
1 day. 
3 days. 
2 days. 
1 day. 
1 day. 
6 hours. 
Several days 
1 day. 
3 days. 
1 day. 
X day. 
1 day. 
2 days. 
1 day. 
1 day. 
1 day. 
2 days. 
X day. 
1 day. 
1 day. 
1 day. 
6 days. 
None. 
4 days. 
7 days. 
7 days. 
14 days. 
1 day. 
None. 
10 days. 
3 days. 
21 days. 
None. 
14 days. 
Present. 
4 days. 
5 days. 
4 days. 
8 days. 
4 weeks. 
Present. 
2 days. 
3 days. 
1 day. 
None. 
2 days. 
None. 
11 days. 
1 day. 
2 days. 
None. 
6 days. 
1 day. 
1 day. 
Albumen. 
Not exam 
Albumen. 
Not exam 
None. 
Not exam. 
None. 
Albumen. 
None. 
Not exam. 
Recovered. Wore tube 26 hours. 
Died 1 day after intubation. 
Recovered. Wore tube 6 days. 
Recovered. Wore tube 4 days 4 hours. 
Died 1 day 16 hours after intubation. 
Died 2 days after intubation. 
Recovered. Wore tube 3 days ziX 
hours. 
Died 1 day after intubation. 
Died 2 days after intubation. 
Died 2 days after Intubation. 
Died 2 days 4 hours after intubation. 
Died 7 days after intubation. 
Recovered. Wore tube 4 days 10 hours. 
Recovered. Wore tube 1 day. 
Died 2 days 5 hours after intubation. 
Died 2 days after intubation. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 14 days. 
Died 1 day after intubation. 
Died 6 days 16 hours after intubation. 
Died zX days after intubation. 
Died 8 days after intubation. 
Died zX days after intubation. 
Died 38 hours after intubation. 
Recovered. Wore tube 3 days 15 hours. 
Died 14X hours after intubation. 
Died 3 days after intubation. 
Recovered. Wore tube zX days. 
Died 18 hours after intubation. 
Recovery. Wore tube 39 hours. 
Died ziX hours after intubation. 
Died ziX hours after intubation. 
Died X day after intubation. 
Died 2 days after intubation. 
Recovered. Wore tube 12 days. 
Died 1 day after intubation. 
Extension 10 
bronchi. 
Broncho-pneu- 
monia. 
Exhaustion. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Asthenia. 
Nephritis. 
Sepsis; ex- 
haustion. 
Bronchitis. 
Scarlet fever 
su p p u r a ting 
cervical glands 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Sepsis. 
Albumen. 
Extension 10 
bronchi. 
Double bron- 
cho-p neu- 
monia. 
Double bron- 
cho-pneumo- 
nia. 
Tuberculosis. 
Extension 10 
bronchi. 
Extension. 10 
bronchi. 
Rickets. 
Tuberculosis. 
Albumen. 
Not exam. 
Pneumonia and 
pertussis. 
Swelling over 
the top of the 
tube. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Pertussis. 
Varicella. 
Pertussis. 
None. 
Extension 10 
bronchi. 
Extension to 
bronchi. 
Exhaustion^ 
Extension 10 
bronchi. 
Not exam. 
Albumen. 
Syphilis; maras- 
mus. 
Pertussis. 
Double bron- 
98 
99 
100 
101 
102 
103 
104 
105 
106 
107 
108 
109 
HO 
111 
112 
113 
114 
US 
116 
117 
1,8 
119 
120 
121 
122 
123 
124 
125 
Mar., 1886 
April, 1886 
May, 1886 
Mar., 1886 
May, 1886 
June, 1886 
a 
July, 1886 
Aug., 1886 
Sept., 1886 
Oct., 1886 
u 
S'ov., 1886 
a tt 
u u 
it (( 
u 
H it 
* i it 
u ( 
it U 
it li 
a tt 
u a 
F. 
M. 
M. 
F. 
M. 
M. 
F. 
F. 
M. 
F. 
M. 
M. 
F. 
M. 
M. 
M. 
F. 
F. 
M. 
M. 
M. 
F. 
F. 
F. 
M. 
F. 
F. 
M. 
7 months. 
3 yrs. 6 mos. 
3 years. 
3 years. 
8 months. 
2 years. 
18 months. 
8 years. 
13 months. 
2 yrs. 8 mos. 
2 yrs. 4 mos. 
6 years. 
2 yrs. 6 mos. 
4 years. 
4 years. 
3 years. 
2 yrs. 9 mos. 
4 yrs. 6 mos. 
21 months. 
4 yrs. 6 mos. 
yrs. 1 mo. 
years. 
yrs. 6 mos. 
5 years, 
yrs. 2 mos. 
yrs. 2 mos, 
years, 
year. 
6 hours. 
4 days. 
2 days. 
1 day. 
1 day. 
1 day. 
10 hours. 
18 hours. 
4 days. 
2 days. 
1 day. 
3 days. 
1 day. 
36 hours. 
2 days. 
1 day. 
1 day. 
32 hours. 
2 days. 
9 days. 
3 days. 
5 days. 
4 days. 
1 day. 
day. 
4 days. 
5 days. 
5 days. 
2 days. 
1 day. 
2 days. 
1 day. 
None. 
4 days. 
Several days 
9 days- 
None. 
4 days. 
Several days 
None. 
Several days 
None. 
7 days. 
4 days. 
4 days. 
6 days. 
2 days. 
Present. 
7 days. 
6 days. 
10 days. 
3 days. 
7 days. 
7 days. 
Not exam. 
Albumen. 
Not exam. 
Albumen. 
Not exam. 
Albumen. 
Not exam. 
Albumen. 
Albumen. 
Albumen. 
Not exam. 
cho pneu- 
monia. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Pneumonia. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Exhaustion. 
Nephritis. 
Extension 10 
bronchi. 
Broncho -pneu- 
monia. 
Suppression of 
urine. 
Extension to 
bronchi. 
Extension 10 
bronchi. 
Varicella. 
Varicella. 
Died 2 days after intubation. 
Recovered. Wore tube 4 days 2 hours. 
Died 2 days 14 hours after intubation. 
Died 2 days after intubation. 
Died 9 hours after intubation. 
Died 24 hours after intubation. 
Died 7 hours after intubation. 
Died 4 days after intubation. 
Died 16 days after intubation. 
Died 2 days after intubation. 
Died 2 days 21 hours after intubation. 
Died 5 days after intubation. 
Died iX day after intubation. 
Died 1 day 13X hours after intubation. 
Recovered. Wore tube $Xm days. 
Died.1 day 6X hours after intubation. 
Died 3 days after intubation. 
Died 4 days after intubation. 
Died 1 day \X h°urs after intubation. 
Recovered. Wore tube 4 days. 
Died 7 days after intubation. 
Died 6 days after intubation. 
Died 1 day 9 hours after intubation. 
Died 2 days 1 hour after intubation. 
Died 7 days after intubation. 
Died 2 days 10 hours after intubation. 
Died 4 days after intubation. 
Died s days after intubation. 
Exhaustion. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Uraemic con- 
vulsions. 
Suppression of 
urine. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Extension 10 
bronchi. 
Extension 10 
bronchi.  
Duration before intuba- 
Cause of 
Date. 
Operator. 
Sex. 
Age. 
Urine. 
Complications. 
Result. 
p 
Pharyngeal 
death. 
3 
Laryngeal 
fc 
symptoms. 
diphtheria. 
126 
Nov., 1886 
Dillon Brown. 
M. 
2 yrs. 7 mos. 
5 years. 
7 days. 
X day. 
5 days. 
27 hours. 
1 day. 
14 days. 
7 days. 
4 days. 
None. 
Died 1 day 17 hours after intubation. 
127 
Dec., 1886 
M. 
128 
44 
44 44 
M. 
3 yrs. 2 mos. 
2 yrs. 1 mo. 
Albumen. 
Recovered. Wore tube 4 days 5 hours. 
Died 19 hours after intubation. 
Died 2 days zX hours after intubation. 
I29 
“ 
44 14 
F. 
Convulsions. 
130 
“ 
*4 44 
M. 
13 months. 
4 days. 
44 
Measles. 
131 
F. 
2 years. 
3 days. 
Several days 
“ 
Pushing down 
membrane. 
Died 18 days after intubation. 
132 
44 4 4 
F. 
3 yrs. 6 mos. 
18 hours. 
4 days. 
44 
Sepsis. 
Sepsis. 
Died 12 hours after intubation. 
133 
44 
44 4 4 
F. 
5 years. 
3 days. 
2 days. 
3 days. 
None. 
44 
Exhaustion. 
Died 3 days after intubation. 
Recovered. Wore tube 3 days. 
Died 5 days 17 hours after intubation. 
134 
Jan., 1887 
44 44 
F. 
2 years. 
4 years. 
1 day. 
7 days.. 
None. 
13s 
“ “ 
F. 
E-xtension 10 
Measles. 
136 
bronchi. 
“ 
4< 44 
M. 
2 years. 
X day. 
“ 
Extension t o 
Died 2 days after intubation. 
bronchi. 
T37 
“ 
44 44 
F. 
17 months. 
1 day. 
Several days 
Albumen. 
Convulsions. 
“ 
Died 1 day 6 hours after intubation. 
138 
44 
44 44 
F. 
5 years. 
1 day. 
None. 
Not exam. 
Extension 10 
Died 19 hours after intubation. 
bronchi. 
!39 
44 44 
M. 
5 yrs. 4 mos. 
8 days. 
2 days. 
Albumen. 
Pneumonia. 
44 
Died 1 day 19 hours after intubation. 
I4O 
44 
44 44 
M. 
13 months. 
2 days. 
Several days 
Not exam. 
Extension 10 
Died 1 day 1 hour after intubation. 
bronchi. 
141 
44 
44 (4 
M. 
19 months. 
20 months. 
8 days. 
1 day. 
tt 
Recovered. Wore tube 4 days. 
Died 2 days 1 hour after intubation. 
142 
44 
“ 44 
F. 
1 day. 
Not exam. 
Extension 10 
bronchi. 
*43 
M. 
19 months. 
1 day. 
7 days. 
“ 
Extension 10 
bronchi. 
Died 8 hours after intubation. 
144 
Feb., 1887 
44 44 
M. 
3 yrs. 2 mos. 
Convalescent 
Albumen. 
Recovered. Wore tube 6X days. 
Died 1 day after intubation. 
145 
44 44 
F. 
23 months. 
1 day. 
4 days. 
Sepsis. 
Sepsis. 
146 
44 
44 4 4 
F. 
22 months. 
2 days. 
Several days 
“ 
Extension 10 
Died 1 day 4 hours after intubation. 
bronchi. 
147 
44 4 4 
M. 
14 months. 
36 hours. 
“ 
After coughing 
Died 28 days after intubation. 
148 
out the tube. 
44 4 4 
M. 
2 yrs. 9 mos. 
iX day. 
10 days. 
Not exam. 
Extension 10 
Measles. 
Died 1 day 6 hours after intubation. 
bronchi. 
149 
‘4 
4 4 44 
M. 
4 years. 
2 days. 
6 days. 
44 
Extension 10 
Died iX day after intubation. 
bronchi. 
150 
Mar., 1887 
4 4 4 4 
M. 
2 yrs. 9 mos. 
5 years. 
2 days. 
36 hours. 
Several days 
4 days. 
Recovered. Wore tube 6 days. 
Died 1 day after intubation. 
"Si 
44 44 
M. 
Not exam. 
Extension 10 
bronchi. 
152 
44 
4 4 44 
M. 
5 years. 
3 days. 
4 days. 
Several days 
None. 
Recovered. Wore tube 4 days. 
Died 1 day after intubation. 
153 
44 
44 44 
M. 
2 yrs. 5 mos. 
Not exam. 
Extension 10 
bronchi. 
554 
44 
44 4 4 
M. 
3 years. 
4 years. 
4 days. 
zX days. 
7 days. 
8 days. 
Albumen. 
Recovered. Wore tube 2 days. 
Died 10 days after intubation. 
i5S 
44 
4 4 44 
M. 
Pneumonia. 
150 
April, 1887 
4 4 44 
F. 
3 yrs. 9 mos. 
2 days. 
7 days. 
44 
Sepsis. 
Died 2 days after intubation. 
*57 
44 44 
F. 
20 months. 
2 days. 
2 days. 
Not exam. 
Pneumonia. 
Died 2 days 6 hours after intubation. 
•58 
4fc 
4 4 4 4 
M. 
5 years. 
2 days. 
4 days. 
Albumen. 
Sepsis. 
Died 7 days 18 hours after intubation. 
159 
*4 
44 44 
M. 
6 years. 
16 months. 
4 days. 
1 day. 
7 days. 
3X days. 
it 
Recovered. Wore tube s days. 
Died 19 hours after intubation. 
160 
44 
44 4 4 
F. 
Not exam. 
Sepsis. 
l6l 
44 
44 4 4 
F. 
4 yrs. 6 mos. 
2 days. 
Extension 10 
Sepsis. 
Died 1 day after intubation. 
162 
May, 1887 
bronchi. 
4 4 44 
F. 
3 yrs. 6 mos. 
1 year. 
2 years. 
2 yrs. 8 mos. 
6 years. 
3 yrs. 8 mos. 
3 years. 
2 days. 
7 days. 
Present. 
Albumen. 
Recovered. Wore tube 6 days. 
163 
Francis Huber. 
Heart failure. 
Sepsis. 
164 
I65 
4 4 4 4 
Recovered. Wore tube 6 days.' 
Recovered. Wore tube s days. 
Died 3X days after intubation. 
Died 6 hours after intubation. 
166 
44 44 
*< 
Measles. 
167 
44 44 
Nephritis; 
pneumonia. 
Uraemic con- 
vulsions. 
(4 44 
(( 
Measles. 
160 
4. 44 
2 yrs. 2 mos. 
3 years. 
44 
Recovered. Wore tube 5 days. 
Recovered. Wore tube 5 days. 
170 
44 44 
** 
carditis. 
I71 
4 4 44 
2 yrs. 6 mos. 
4t 
Pulmonary 
oedema of 
Bright’s dis- 
ease. 
Measles. 
Died s days after intubation. 
172 
1 year. 
2 yrs. 6 mos. 
44 
Recovered. Wore tube 3 days. 
Died 4 hours after intubation. 
173 
174 
J75 
44 44 
** 
Sepsis. 
Sepsis. 
44 44 
tt 
15 months. 
tt 
Exhaustion. 
Measles and gas- 
tro-enteritis. 
Died 12 hours after intubation. 
176 
4 4 44 
18 months. 
Pneumonia. 
Died zX days after intubation. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 4 days. 
Died ?X days after intubation. , 
Died 3 days after intubation. 
Died 2 days after intubation. 
Died 2 days after intubation. 
Recovered. Wore tube 10 days. 
I?? 
4 4 44 
3 years. 
4 years. 
2 years. 
3 years. 
Measles. 
178 
44 44 
Present. 
I7Q 
4 4 44 
l8o 
Sepsis. 
Pneumonia. 
Sepsis. 
Hemiplegia. 
18. 
l82 
*< 
183 
44 44 
2 yrs. 8 mos. 
None. 
184 
44 4k 
Heart failure. 
Pneumonia. 
Measles. 
i85 
4 yrs. 6 mos. 
2 yrs. 8 mos. 
3 yrs. 6 mos. 
None. 
Recovered. Wore tube 6 days. 
Died 3X days after intubation. 
Recovered. Wore tube 5 days. 
Recovered. Wore tube 3X days. 
186 
Pneumonia. 
187 
44 44 
Present. 
188 
44 44 
10X months. 
“ 
Pneumonia on 
second day. 
18a 
2 yrs. 10 mos. 
44 
Died 2 days after intubation. 
bronchi. 
TOO 
3 years. 
4 yrs. 6 mos. 
2 years. 
11 months. 
44 
Sepsis. 
Sepsis. 
Pneumonia. 
Died 2 days after intubation. 
Recovered. Wore tube 5 days. 
Died. 
Recovered. Wore tube 7 days. 
Died zX days after intubation. 
Died 6 hours after intubation. 
Recovered. Wore tube 5X days. 
Recovered. Wore tube 64 hours. 
Died 2 days after intubation. 
191 
192 
J93 
44 4* 
44 
44 44 
None. 
4 4 4 4 
>94 
•95 
196 
197 
198 
44 44 
13 months. 
Present. 
Exhaustion. 
Pneumonia. 
Measles. 
4 4 44 
44 44 
2 yrs. 6 mos. 
7 years. 
3 yrs. 6 mos. 
Present. 
44 44 
Extension t o 
bronchi. 
J99 
18 months. 
None. 
Heart failure. 
Convulsions. 
Died 18 hours after intubation. 
Died 10 hours after intubation. 
Recovered. Wore tube 5 days. 
Recovered. Wore tube 6 days. 
Died 6 days after intubation. 
Died 2 days after intubation. 
18 months. 
gX months. 
None. 
2 yrs. 6 mos. 
S yrs. 6 mos. 
Present. 
203 
204 
<4 44 
44 44 
2 yrs. 9 mos. 
Extension 10 
bronchi. 
205 
206 
22 months. 
44 
Recovered. Wore tube 6 days. 
Recovered. Wore tube 5 days. 
Died 2 days after intubation. 
4 years. 
3 years. 
tt 
207 
44 
Extension and 
pneumonia. 
Pneumonia. 
n months. 
None. 
Extension and 
pneumonia. 
Died zX days after Intubation. 
209 
5 years. 
Present. 
Died 3 days after intubation. 
bronchi.  
Duration before intuba- 
" ‘ - 
0) 
tion of 
Date. 
Operator. 
Sex. 
Age. 
Urine. 
Complications. 
Result. 
6 
Laryngeal 
death. 
3 
fc 
Pharyngeal 
symptoms. 
diphtheria. 
210 
July, 1885 
F. E. Waxham (re- 
M. 
16 months. 
3 days. 
9 days. 
Died 27 hours after intubation. 
ported by M. P. 
lungs. 
Hatfield.16, 28 
211 
April, 1885 
F. E, Waxham.15 
2 yrs. 1 mo. 
1 day. 
3 days. 
Died 30 hours after intubation. 
212 
t* 28 
bronchi. 
3 years. 
Two hours after 
removal 0 f 
Died 36 hours after intubation. 
tube from 
213 
Sept., 1885 
Nov., 1885 
“ “ 
F. 
5 years. 
2 days. 
1 day. 
7 days. 
3 days. 
5 days. 
6 days. 
stenosis. 
Recovered. Wore tube 1 week. 
Died 6 days after intubation. 
Recovered. Wore tube 9 days. 
Died 2 days after intubation. 
Recovered. Wore tube 13 days. 
Died 2 days after intubation. 
214 
u a 17 29 
F. 
M. 
2 yrs. 7 mos. 
PneumoniS. 
215 
216 
20 months. 
3 days. 
F. 
4 years. 
2 days. 
Sepsis. 
218 
2 yrs. 2 mos. 
3 years. 
219 
M. 
bronchi. 
5 years. 
8 days. 
8 days. 
14 days. 
Present. 
Died 50 hours after intubation. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 3X days. 
Died 4 days after intubation. 
Died 1 day 9 hours after intubation. 
220 
May, 1886 
tt tt 19 
M. 
5 years. 
2 days. 
bronchi. 
]4 months. 
Measles. 
3 years. 
223 
Oct., 1886 
tt tt 21 
F. 
8 years. 
6 days. 
bronchi. 
Pneumonia. 
Electrolysis. 
9 months. 
1 day. 
Several days 
Nov., 1885 
a it 29 
M. 
1 day. 
Several days 
Recovered. Wore tube 3 days. 
Died 1 day after intubation. 
7 years. 
Congestion 01 
lungs. 
226 
Dec., 1885 
u « 
M. 
5 years. 
227 
228 
229 
Measles. 
Recovered. Wore tube 3 days. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 3 days. 
Recovered. Wore tube 3 days. 
Died 2 days after intubation. 
Recovered. Wore tube days. 
Died 1 day 13 hours after intubation. 
f 
U tt 
M. 
F. 
4 years. 
3 days. 
2 days. 
Present. 
Jan., 1886 
Dec., 1885 
a 
4 years. 
7 days. 
it tt 
5 years. 
3 years. 
Several days 
6 days. 
Sepsis ; pneu- 
monia. 
231 
232 
Mar., 1886 
April, 1886 
W. P. Northrup.26 
a tt 39 
F. 
F. 
2 yrs. 9 mos. 
1 day. 
Albumen. 
5 yrs. 3 mos. 
i Jri day. 
ijtf day. 
4* 
Extension 10 
233 
234 
May, 1886 
“ *• 
F. 
M. 
5 years. 
3 days. 
1 day. 
ff 
bronchi. 
Recovered. Wore tube 5 days. 
Died days after intubation. 
3 yrs. 9 mos. 
5 days. 
5 days. 
“ 
Extension 10 
U 
u tt 
M. 
3 yrs. 9 mos. 
bronchi. 
236 
237 
June, 1886 
(( a 
M. 
F. 
3 days. 
7 days. 
Recovered. Wore tube 40 hours. 
Died 4 days after intubation. 
t< « 
5 yrs. 10 mos. 
1 day. 
4 days. 
Pneumonia. 
i day. 
2 days. 
“ 
Sudden heart 
Died day after intubation. 
238 
239 
u tt 
M. 
M. 
5 years. 
2 days. 
1 day. 
None. 
failure. 
Sepsis. 
Died 1 day after intubation.. 
Sept., 1886 
it tt 24 
F. 
* V1* n mos. 
5 yrs. 2 mos. 
ii days. 
Present. 
Albumen. 
Recovered. Wore tube 6 days. 
Died 1 day after intubation. 
1 day. 
1 day. 
Not noted. 
Extension 10 
241 
242 
Oct., 1886 
“ ft 
M. 
F. 
7 years. 
5 days. 
5 days. 
Albumen. 
bronchi. 
Recovered. Wore tube s days. 
Died 1 day after intubation. 
2S months. 
2 days. 
Present. 
Not exam. 
Extension 10 
243 
Nov., 1886 
it if 
F. 
4 yrs. 4 mos. 
2 days. 
2 days. 
bronchi (?). 
Died 31 hours after intubation. 
Died 59 hours after intubation. 
244 
“ 
“ “ 
F. 
4 yrs. 6 mos. 
2 days. 
2 days. 
Albumen. 
bronchi (?). 
Extension to 
245 
ff if 
M. 
2 yrs. 6 mos. 
Not exam. 
bronchi (?). 
Died 2 hours after intubation. 
Died 45 hours after intubation. 
246 
“ 
“ 
M. 
14 months. 
8 hours. 
2 days. 
bronchi (?). 
Double pneu- 
247 
Dec., x886 
tt tt 
M. 
23 months. 
1 day. 
2 days. 
<f 
mnnia. 
Extension t o 
Died 51 hours after intubation. 
00 on 
•'t' ■'t- 
ft it 
F. 
F. 
22 months. 
10 months. 
% day. 
1 day. 
bronchi. 
Died 20 hours after intubation. 
Died 62 hours after intubation. 
h day. 
250 
Jan., 1887 
“ 
F. 
4 yrs. 8 mos. 
3 days. 
2 day.:. 
bronchi. 
251 
“ 
“ 
M. 
4 yrs. 8 mos. 
4 days. 
2 days. 
bronchi. 
Died 38 hours after intubation. 
Died 32 hours after intubation. 
252 
“ 
“ 
F. 
4 years. 
3 days. 
Not exam. 
bronchi. 
Extension 10 
253 
254 
.( 
tt 
F. 
M. 
4 years. 
2 years. 
% day. 
4 hours. 
1 day. 
bronchi. 
Pneumonia. 
Died 65 hours after intubation. 
3 days. 
2 days. 
Died 12 hours after intubation. 
Died 48 hours after intubation. 
Died 48 hours after intubation. 
255 
“ 
.. 
M. 
20 months. 
1 day. 
bronchi. 
256 
44 
ff it 
M. 
3 years. 
1 day. 
3 days. 
bronchi. 
Extension 10 
Measles. 
257 
258 
Feb., 1887 
April, 1887 
a ft 
F. 
M. 
4 yrs. 6 mos. 
% day. 
None. 
Albumen. 
bronchi. 
Recovered. Wore tube 7 days. 
Died 15 hours after intubation. 
Died days after intubation. 
2 days. 
9 days. 
259 
260 
“ 
;; - 
F. 
3 years. 
5 hours. 
Albumen. 
bronchi. 
F. 
16 months. 
% day. 
17 days. 
Extension 10 
Scarlatina. 
261 
May, 1887 
“ “ 
M. 
4 yrs. 3 mos. 
5 days. 
5 days- 
bronchi. 
Extension 10 
Rickets. 
262 
263 
Sept., 1886 
Nov., 1886 
James McManus. 
M. 
F. 
F. 
M. 
M. 
M. 
2 years, 
ii months. 
x day. 
4 days- 
None. 
bronchi. 
Asthenia. 
264 
Dec., 1886 
tt 
3 days- 
Not exam. 
Measles. 
265 
266 
Mar., 1887 
April, 1887 
tt (( 
None. 
Recovered. Wore tube 3 days. 
Died 8 hours after intubation. 
ff (C 
9 yrs. 2 mos. 
12 hours. 
5 days- 
Asthenia. 
267 
July, 1886 
E. L. Cocks. 
2 hours. 
day* 
Recovered. Wore tube 4 days. 
Died, Coughed out tube. 
6 years. 
16 hours. 
5 days- 
Laryngeal ob- 
268 
269 
Aug., 1886 
tf it 
M. 
M. 
7 years. 
10 hours. 
5 days- 
struction. 
Cardiacfailure. 
Died s days after intubation. 
7 hours. 
Extension 10 
After tracheot- 
Died. 
270 
271 
Sept., 1886 
Nov., 1886 
it it 
F. 
F. 
5 years. 
12 hours. 
4 days- 
bronchi. 
omy. 
Recovered. Wore tube 3 days. 
Died. 
2 years. 
10 hours. 
4 days- 
Tracheotomy re- 
Dec., x885 
272 
273 
274 
275 
“ “ 
F. 
3 years. 
6 hours. 
5 days. 
fused. 
Tube obstructed. 
Died 4 days after intubation. 
Recovered. Wore tube 3 days. 
Recovered. Wore tube 2 days. 
Died 11 days after intubation. 
Jan., 1887 
Mar., 1887 
tt <1 
F. 
7 years. 
12 hours. 
5 days- 
3 days. 
7 days- 
<< if 
F. 
2 years. 
10 hours. 
M. 
9 years. 
ii hours. 
days after re- 
276 
May, 1887 
ff tt 
F. 
2 years. 
7 hours. 
4 days- 
movalof tubs. 
Exhaustion 3 
Died s days after intubation. 
days after re- 
277 
May, 1886 
F. Van Fleet. 
F. 
2 yrs. 6 mos. 
1 day. 
3 days- 
moval of tube. 
Extension 10 
bronchi. 
Died 2 days after intubation. 
Recovered. Wore tube 7 days. 
278 
279 
Oct,, 1886 
“ 
M. 
M. 
3 years. 
Vz day. 
1 day- 
14 days. 
Present. 
Albumen. 
Nov., 1886 
6 years. 
2 days. 
Recovered. Wore tube 3 days. 
Died 2 days after intubation. 
Died 4 days after intubation. 
281 
« 
F. 
M. 
2 years. 
10 years. 
1 day. 
1 day. 
Pneumonia. 
i 
Sepsis.  
Duration before intuba- 
_ 
, 
tion of 
Date. 
Operator. 
Sex. 
Age. 
Urine. 
Complications. 
Result. 
Larvnareal 
death. 
3 
Fharyngeal 
£ 
symptoms. 
diphtheria. 
282 
Dec., 1886 
F. Van Fleet. 
F. 
4 years. 
4 days. 
8 days. 
Pneu monia ; 
Pneumonia. 
Died 12 hours after intubation. 
283 
exhaustion. 
i< tt 
M. 
s years. 
10 hours. 
2 days. 
Exhaustion. 
Broncho - pneu- 
Died 55 hours after intubation. 
284 
285 
monia. 
„ 
if it 
M. 
9 years. 
11 years. 
2 days. 
5 hours. 
Recovered. Wore tube 10 days. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 5 days. 
Died 4 days after intubation. 
“ 
(f ii 
M. 
3 days. 
4 days. 
2 days. 
286 
M. 
5 years. 
4 years. 
2 days. 
36 hours. 
287 
Jan., 1887 
ft ft 
M. 
Broncho-pneu- 
monia. 
288 
44 44 
F. 
3 years. 
X day. 
6 days. 
Died 3 days after intubation. 
bronchi. 
2S9 
ft if 
M. 
2 years. 
6 hours. 
1 day. 
Heart failure. 
Broncho - pneu- 
Died 4 days after intubation. 
M. 
2 days. 
8 hours. 
monia. 
** 
4* 
1 yr. 10 mos. 
None. 
Died 5 days after intubation. 
Died 2 days after intubation. 
291 
44 
U it 
M. 
2 yrs. 3 mos. 
3 days. 
Asthenia. 
Pneumonia. 
292 
“ 
ft l< 
M. 
x yr. 6 mos. 
2 days. 
4 days. 
10 days. 
3 days. 
Died 3 days after intubation. 
Died 2 days after intubation. 
Died 18 hours after intubation. 
293 
11 
It it 
M. 
7 years. 
8 days. 
2 days. 
294 
Mar., 1887 
it ft 
M. 
3 years. 
Albumen. 
Convulsions. 
295 
it It 
M. 
4 years. 
i day. 
3 days. 
5 days. 
Died 7 days after intubation. 
Died 4 days after intubation. 
296 
April, 1887 
44 44 
F. 
3 years. 
2 days. 
bronchi. 
297 
M 
it tt 
F. 
3 years. 
36 hours. 
Recovered. Wore tube 18 days. 
Recovered. Wore tube 15 days. 
298 
May, 1887 
it it 
F. 
9 years. 
1 day. 
1 day. 
12 hours. 
5 days. 
299 
Mar., 1887 
Frank Tipton.41 
M. 
4 years. 
300 
Nov., 1886 
J. M. Bleyer. 
M. 
2 yrs. 10 mos. 
2% days. 
7 days. 
Sepsis. 
Broncho-pneu- 
monia. 
Died 1 day after intubation. 
Died 2 days 3 hours after intubation. 
301 
44 
M. 
6 years. 
to hours. 
302 
if ti 
M. 
2 years. 
6 days. 
S days. 
4% days. 
Albumen. 
Recovered. Wore tube 4 days. 
Died 2 days 2 hours after intubation. 
Recovered. Wore tube 4 days 18 hours. 
303 
Dec., 1886 
a ti 
M. 
18 months. 
Heart failure. 
304 
Jan., 1887 
a a 
M. 
7 years. 
15 hours. 
Albumen. 
Scarlet fever. 
305 
*4 44 
M. 
3 years. 
4 years. 
2 yrs. 6 mos. 
2 years. 
3 years. 
2 years. 
7 hours. 
iX days. 
3X days. 
2 days. 
8 days. 
3% days. 
3 days. 
Recovered. Wore tube 3 days 20hours. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 3 days. 
Died 7 hours after intubation. 
Died 15 hours after intubation. 
Died 2 days after intubation. 
30b 
a it 
F. 
17 hours. 
307 
44 
a it 
F. 
10 hours. 
308 
44 
a ti 
M. 
1 day. 
7 hours. 
Bronchitis. 
3°9 
“ 
it ti 
M. 
310 
Feb., 1887 
a a 
M. 
5 hours. 
Pneumonia. 
3>i 
a a 
M. 
3 yrs. 6 mos. 
3 years. 
9 hours. 
iX day. 
3 days. 
Recovered. Wore tube 3X days. 
Died 10 hours after intubation. 
312 
M. 
7 hours. 
Extension 10 
Rachitis. 
bronchi. 
313 
44 
If u 
F. 
13 months. 
5 hours. 
2 days. 
Died 15 hours after intubation. 
bronchi. 
314 
it ti. 
M. 
1 day. 
7X days. 
2 days. 
Bronchitis. 
Died 18 hours after intubation. 
Recovered. Wore tube 4 days. 
Died 1 day after intubation. 
3iS 
44 
it it 
M. 
7 years. 
18 months. 
316 
Mar., 1887 
F. 
7 hours. 
monia. 
317 
“ 
tt tt 
M. 
2 yrs. 2 mos. 
5 hours. 
Recovered. Wore tube 3X days. 
Died 2 days after intubation. 
Died iX day after intubation. 
Died 1 day after intubation. 
3lis 
44 
it it 
M. 
2 yrs. 4 mos. 
13 months. 
4 days. 
4X days. 
$X days. 
3i9 
44 
ti tt 
M. 
320 
tt a 
M. 
3 years. 
12 hours. 
tis. 
Double pneu- 
monia. 
321 
a u 
F. 
2 years. 
None. 
Recovered. Wore tube 2 days. 
Died 23 hours after intubation. 
322 
44 
a ti 
M. 
2 yrs. 3 mos. 
10 hours. 
2 days. 
Heart failure. 
Erysipelas of 
face. 
323 
April, 1887 
M. 
2 years. 
S hours. 
2.X days. 
3 days. 
a 
Died 1 day after intubation. 
Died iX day after intubation. 
324 
44 
tt it 
M. 
4 years. 
11 hours. 
chitis. 
325 
44 
it u 
M. 
4 yrs. 6 mos. 
3 hours. 
4 days. 
2X days. 
Recovered. Wore tube 3X days. 
Died iX day after intubation. 
326 
44 
a a 
F. 
2 yrs. 3 mos. 
7 hours. 
Asphyxia; tube 
expelled and 
not notified. 
327 
44 
ti ti 
M. 
1 yr. 6 mos. 
15 hours. 
3X days. 
Double pneu- 
monia. 
Died 1 day after intubation. 
328 
May, 1887 
tt ti 
M. 
22 months. 
12 hours. 
S3 hours. 
Bronchitis. 
Died 1 day after intubation. 
329 
tt n 
F. 
3 yrs. 6 mos. 
12 hours. 
9 days. 
Exhaustion. 
Died 2 days after intubation. 
330 
t it 
M. 
2 years. 
13 months. 
14 days. 
4 days. 
Rachitis. 
Died 4 days after intubation. 
Died 15 days after intubation. 
331 
44 
a a 
F. 
5 hours. 
bronchi. 
332 
** 
44 (< 
M. 
1 yr. 6 mos. 
7X hours. 
3X days. 
Albumen. 
Extension 10 
Died s days after Intubation. 
bronchi. 
333 
tt a 
M. 
2 yrs. 6 mos. 
15 hours. 
7 days. 
2X days. 
Recovered. Wore tube 4 days. 
Died 2 days after intubation. 
334 
M. 
2 yrs. 3 mos. 
4X hours. 
335 
F. 
bronchi. 
Jan., 1887 
3 yrs. 1 mo. 
9 hours. 
5 days. 
Pneumonia. 
Swallowed tube. 
Died iX day after intubation. 
336 
M. 
6 years. 
14 hours. 
3 days. 
Scarlet fever. 
Scarlet fever. 
Died 22 hours after intubation. 
337 
April, 1887 
M. 
4 yrs. 6 mos. 
7 hours._ 
8 days. 
Albumen. 
Extension to 
Died iX day after intubation. 
338 
M. 
bronchi. 
May, 1887 
1 yr. 6 mos. 
4 hours. 
4 days. 
5 days. 
Died 27 hours after intubation. 
Died 12 hours after intubation. 
339 
44 4< 
M. 
15 months. 
4 hours. 
Mar., 1887 
340 
t ti 
M. 
6 months. 
8 hours. 
3 days. 
Extension 10 
Died iX day after intubation. 
May, 1887 
341 
M. 
5 years. 
gX hours. 
1 day. 
Died 2 days 6 hours after intubation. 
J. J. Reid. 
342 
F. 
7 yrs. 6 mos. 
3 days. 
1 day. 
Recovered. Wore tube 7 days. 
Died 4 days after Intubation. 
343 
44 4 4 
F. 
Extension 10 
bronchi. 
344 
M. 
7 years. 
3 days, 
i day. 
3 days. 
2 days. 
Recovered. Wore tube 18 hours. 
Died 16 hours after intubation. 
345 
44 “ 
M. 
2 yrs. 7 mos. 
346 
bronchi. 
M. 
2 yrs. 6 mos. 
2 days. 
Broncho-pneu- 
monia. 
Pneumonia. 
Died 10 days after intubation. 
347 
F. 
2 years. 
1 day. 
2 days. 
Recovered. Wore tube 18 days. 
348 
M. 
4 years. 
19 months. 
3 years. 
1 day. 
2 days. 
3 days. 
3 days. 
7 days. 
Recovered. Wore tube 11 days. 
Died 5 days after intubation. 
Died 3 hours after intubation. 
349 
a a 
F. 
Pneumonia. 
350 
a a 
F. 
bronchi. 
351 
,i u 
M. 
3 years. 
2 hours. 
2 days. 
Extension 10 
Died 3 days after intubation. 
Geo. McNaughton. 
bronchi. 
352 
4 years. 
3 years. 
3 days. 
2 days. 
Present. 
Albumen. 
Recovered. 
Died 40 hours after intubation. 
353 
Broncho-pneu- 
monia. 
354 
4* 44 
6 years. 
3 years. 
6 days. 
3 days. 
44 
Sepsis. 
Broncho-pneu- 
monia. 
Died 24 hours after intubation. 
Died 40 hours after intubation. 
355 
a n 
ft 
Measles. 
356 
44 
4 years. 
11 months. 
3 days. 
2 days. 
ct 
Died 96 hours after intubation. 
Died 36 hours after intubation. 
357 
4 4 44 
ft 
Broncho-pneu- 
monia. 
358 
3 years. 
3 days. 
Fatal asphyxia 
after cough- 
ing out tube. 
Died 96 hours after intubation.  
Duration before intuba- 
V 
rO 
Date. 
Operator. 
Sex. 
Age. 
tion of 
Urine. 
Cause of 
Complications. 
Result. 
s 
death. 
3 
Laryngeal 
Pharyngeal 
symptoms. 
diphtheria. 
359 
Geo. McNanghton. 
5 years. 
1 day. 
2 days. 
Present. 
Albumen. 
Nephritis. 
Broncho-pneu- 
monia. 
Died 36 hours after intubation. 
Died 30 hours after intubation. 
360 
19 months. 
Measles. 
361 
(( 44 
3 years. 
S days. 
4 days. 
kk 
362 
Sept., 1886 
A. Caille. 
F. 
2 yrs. 6 mos. 
8 days. 
Albumen. 
Broncho-pneu- 
Scarlatina. 
Died 4 hours after intubation. 
363 
F. 
monia. 
Feb,, 1887 
k( (k 
5 years. 
7 days. 
2 days. 
1)4 week. 
4 days. 
Not exam. 
Recovered. Wore tube 4 days. 
Died 3 days after intubation. 
364 
44 4 < 
M. 
2 yrs. 6 mos. 
Broncho-pneu- 
365 
F. 
monia. 
U. 
3 yrs. 6 mos. 
3 days. 
6 days. 
44 
Broncho-pneu- 
Died 2 days after intubation. 
366 
Mar., 1887 
“ “ 
M. 
4 years. 
2 days. 
4 days. r 
monia. 
Double pneu- 
Died 2 days after intubation. 
367 
“ 
“ 
1 M.j. 
1 year. 
4 days. 
After Intuba- 
-• 
monia. 
Sepsis. 
Died 14 days after intubation. 
368 
April, 1887 
» “ 
F. 
3 years. 
2 days. 
4 days. 
tion. 
None. 
,, 
Recovered. Wore tube 2 days. 
Died 2 days after intubation. 
3t>9 
“ “ 
M. 
1 Vr- 3 mos. 
44 
Pneu monia; 
F. 
heart failure. 
370 
41 
1 yr. 2 mos. 
S days. 
2 days. 
it 
‘I 
Recovered. Wore tube 3 days. 
Died 2)4 days after intubation. 
371 
44 
“ 
F. 
F. 
M. 
M. 
1 yr. 6 mos. 
3 days. 
44 
Pneumonia. 
44 
7 years. 
3 days. 
2 days. 
3 days. 
Recovered. Wore tube 2 days. 
Recovered. Wore tube 4 days. 
Died 3 days after intubation. 
373 
May, 1887 
4 4 “ 
5 years. 
3 days- 
4 days. 
Not exam. 
374 
41 
2 years. 
Sudden heart 
375 
May, 1886 
W. K. Simpson. 
M.- 
2 yrs. 6 mos. 
4 days. 
2 days. 
None. 
failure. 
Extension 10 
Died 58 hours after intubation. 
376 
Oct., 1886 
(( kk 
F. 
3 yrs. 4 mos. 
5 days. 
None. 
Albumen. 
bronchi. 
Extension 10 
Died 3 days after intubation. 
Jan., 1887 
ki 
F. 
F. 
bronchi. 
377 
2 yrs. 7 naos. 
3 days. 
None. 
Heart failure. 
. ... - 
Died 3 days 19 hours after intubation. 
378 
‘4 
7 years. 
1 day. 
1 day. 
Died 2 days 6)4 hours after intubation. 
379 
M. 
bronchi. 
* 
5 years. 
5 days. 
1 day. 
1 day. 
3 days. 
Died 2 days 3 hours after intubation. 
Died 3 days after intubation. 
380 
Feb., 1887 
“ 
F. 
8 months. 
1 day. 
bronchi. 
381 
Mar., 1887 
“ 
F. 
M. 
x5 months. 
bronchi. 
Sepsis. 
Pushing down 
382 
April, 1887 
2 yrs. 8 mos. 
None. 
383 
M. 
May, 1887 
3 years. 
2)4 days. 
44 
None. 
Extension 10 
Died 30 hours after intubation. 
384 
<t (i 
M. 
T3 months. 
bronchi. 
day. 
2 days. 
2 days. 
6 days. 
6 days. 
5 days. 
385 
May, 1886 
G. H. Cocks. 
F. 
F. 
6 years. 
Not exam. 
bronchi. 
Recovered. Wore tube 2 days. 
Died 4 days after intubation. 
380 
Aug-, 1886 
2 years. 
CEdema 0 f 
887 
Sept., 1886 
“ 
M. 
M. 
3 yrs. 10 mos. 
1 day. 
1 day. 
3 days. 
lungs. 
Recovered. Wore tube 3 days 7 hours. 
Died 40 hours after intubation. 
380 
Oct., 1886 
5 years. 
kk 
389 
kl tt 
18 months. 
bronchi. 
Nov., 1886 
fk kk 
mT 
F. 
“ 
Sepsis. 
Died 4 hours after intubation. 
39° 
3 years. 
7 days. 
4 days. 
it 
Recovered. Wore tube 4 days. 
Died 4 days after intubation. 
391 
Feb., 1887 
Mar., 1887 
2 yrs. 6 mos. 
7 days. 
“ 
Sepsis. 
392 
393 
“ “ 
M. 
M. 
18 months. 
2 days. 
2 days, 
t day. 
7 days. 
4 days. 
4 days. 
44 
Died 3 days after intubation. 
Recovered. Wore tube 3 days. 
Died 36 hours after intubation. 
394 
April, 1887 
'years. 
“ 
Extension 10 
395 
“ 
» 
M. 
4 yrs. 6 mos. 
3 days. 
4 days. 
« 
bronchi. 
Extension 10 
Died 48 hours after intubation. 
396 
May, 1887 
“ 
F. 
5 years. 
2 days. 
bronchi. 
Died 36 hours after intubation. 
9 years. 
bronchi. 
397 
2 days, 
day. 
fk 
Paralysis 0 f 
heart. 
Sepsis. 
Died 5 hours after intubation. 
Died 24 hours after intubation. 
398 
Mar., 1887 
U (k 
F. 
2 yrs. 8 mos. 
8 days. 
tt 
399 
May, 1886 
H. F. Ivins.14 
M. 
23 months. 
1 day. 
1 day. 
Died 8 hours after intubation. 
400 
May, 1886 
4 ycais. 
2 days, 
40 hours. 
5 days. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 3 days. 
401 
June, 1886 
F. 
4 yrs. 8 mos. 
402 
2 years. 
Several days 
None. 
403 
44 
(i ft 
M. 
S yrs. 6 mos. 
1 day. 
Extension t o 
Died 39 hours after intubation. 
404 
» 
I. H. Hance.38 
bronchi. 
405 
April, 1886 
F. 
i3><j months. 
1 day. 
1 day. 
None. 
406 
t( kf 
M. 
14 months. 
1 day. 
Died 14 hours after intubation. 
May, 1886 
M. 
23 months. 
bronchi. 
407 
1 day. 
1 day. 
Albumen. 
Sepsis. 
Died 1 day 8 hours after intubation. 
408 
June, 1886 
F. 
2 yrs. 3 mos. 
3 days. 
11 days. 
Several days 
Recovered. Wore tube 4 days. 
Died 17 hours after intubation. 
Died 13 hours after intubation. 
Died 5 days after intubation. 
409 
J. A. Anderson.34 
F. 
3 yrs. 7 mos. 
3 years. 
Sepsis. 
Sepsis. 
410 
M. 
411 
4 4 44 
2 yrs. 6 mos. 
None. 
chitis. 
412 
“ 44 
18 months. 
ik 
Died 72 hours after intubation. 
bronchi. 
4i3 
<* ik 
M. 
Present. 
Recovered. Wore tube 19 days. 
Died 14 hours after intubation. 
414 
44 kt 
F. 
38 months. 
35 months. 
26 months. 
415 
44 44 
kk 
Died 8 days after intubation. 
Died 3 days after intubation. 
4lO 
4 * “ 
None. 
4i7 
bronchi. 
*< kt 
3 yrs. 6 mos. 
17 months. 
3 years. 
5 years. 
Died 2 days after intubation. 
Died 20 hours after intubation. 
418 
kk ik 
None. 
Broncho-pneu- 
monia. 
4i9 
Dec., 1886 
F. 
M. 
3 days. 
1 day. 
Recovery. Wore tube 5 days. 
Died 5 days after intubation. 
Died 3 days after intubation. 
Died 1 day after intubation. 
420 
Jan., 1887 
W. E. Shaw.-2 
Extension 10 
421 
“ U 36 
M. 
4 yrs. 6 mos. 
Extension to 
Measles. 
Jos. Eichberg.36. 
422 
M. 
5 years. 
Present. 
Extension t o 
Died 5 days after intubation. 
42; 
tk kk 
3 yrs. 7 mos, 
7 years. 
1 day. 
1 day. 
Several days 
Exhaustion. 
424 
fk kt 
M. 
Tracheotomy to 
Recovered. Wore tube 5 days. 
remove tube. 
420 
427 
tt kk 
F. 
5 years. 
Present- 
Recovered. Wore tube 8 days. 
Died 3 days after intubation. 
Died 2)4 days after intubation. 
Oct., 1886 
A. S. Hunter. 
F. 
M. 
3 yrs. 6 mos. 
7 yrs. 6 mos. 
2 days. 
3 days. 
Not exam. 
Bronchitis. 
Measles. 
Measles and 
bronchitis. 
Died 2 days after intubation. 
428 
Dec., 1886 
“ 44 
F. 
3 yrs. 6 mos. 
4 days. 
4 days. 
“ 
Extension 10 
bronchi. 
Died is hours after intubation. 
429 
Jan., 1887 
it kk 
F. 
2 yrs. 6 mos. 
3 yrs. 6 mos. 
3 days. 
24 hours. 
2 days. 
t€ 
43° 
Jan., 1887 
J. B. Wheeler.8 
F. 
None. 
Laryngeal ste- 
nosis from 
sudden plug- 
ging of the 
tube by 
pseudo- 
membrane. 
Died 14 hours after intubation. I 
Duration before intuba- 
u 
Cause 01 
Date. 
Operator. 
Sex. 
Age. 
Urine. 
Complications. 
Result. 
•a 
death. 
3 
Laryngeal 
Pharyngeal 
£ ! 
symptoms. 
diphtheria. 
43 4 
Dec., 1886 
G. W. Mason.8 
F. 
8 yrs. 5 mos. 
4 days. 
Present. 
Died 2% days after intubation. 
the lungs. 
432 
433 
44 
i( fi 
M. 
8 years. 
4 years. 
2 days. 
3 days. 
2 weeks. 
Recovery. Wore tube 5 days. 
Died 12 hours after intubation. 
Jan., 1887 
u (( 
F. 
Asthenia. 
Followed whoop- 
ing-cough and 
croupous pneu- 
monia. 
434, 
l886 
C. G. Jennings.10 
F. 
6 years. 
3 days. 
Exhaustion. 
Died iY day after intubation and Y 
day after tracheotomy. 
435 
Aug., 1886 
12 months. 
None. 
Pneumonia. 
Measles. 
Died same day (?). 
436 
Sept., 1886 
<4 ti 
F. 
4 years. 
Present. 
Died 1 day after intubation. 
bronchi. 
437 
, 1886 
u 
F. 
44 
Died 6 days after intubation. 
bronchi. 
438 
Oct., 1886 
W. Cheatham.12 
F. 
2 days. 
9 days. 
Died 17 hours after intubation. 
the bronchi. 
439 
, l886 
ti if 
Present. 
Pulmonary com- 
plications. 
Died 24 hours after intubation. 
the bronchi. 
440 
Nov., 1886 
H ft 
F. 
2 years. 
1 day. 
2 days. 
Recovered. Wore tube 3 days 21 
hours. 
441 
442 
443 
444 
44 
fi ft 
F. 
13 months. 
10 yrs. 6 mos. 
3 years. 
7 years. 
Not known. 
Died 41 hours after intubation. 
Recovery. Wore tube &Y days. 
Recovery. Wore tube short time. 
Mar., 1887 
Austin G. Case..1 
David Prince.3 
F. 
3 days. 
M. 
Several days 
None. 
Dec., 1886 
M. 
Recovered. Wore tube 4 days 10 hours. 
form. 
445 
Dec., 1886 
L. L. Palmer.4 
F. 
s yrs. 3 mos. 
2 days. 
4 days. 
Died 28 hours after intubation. 
bronchi (?). 
446 
Jan., 1887 
B. T. Shimwell.6 
M. 
8 years. 
4 days. 
None. 
Albumen. 
Capillary bron- 
Died 15 days after intubation. 
chitis. 
447 
Mar,, 1886 
L. L. Dunning.36 
F. 
2 yrs. 6 mos. 
18 hours. 
ff 
Broncho-pneu- 
monia, 
Died 3 days after intubation. 
448 
449 
ft ft 6 
F. 
2 yrs. 4 mos. 
2 yrs. 4 mos. 
6 days. 
5 days. 
Present. 
Recovery. Wore tube 3 days. 
Died 2 days 8Y hours after intubation. 
Dec., 1886 
<4 if 
F. 
bronchi. 
45° 
44 
ii fi 
M. 
3 yrs. 6 mos. 
1 day. 
5 days. 
Recovery. Wore tube 4 days 15X 
hours. 
451 
452 
453 
Jan., 1887 
Feb., 1887 
April, 1887 
44 41 
F. 
2 yrs. 3 mos. 
6 years. 
4 yrs. 5 mos. 
6 days. 
Exhaustion. 
Died 1 day after intubation. 
Recovered. Tube dislodged a cast of 
the larynx and the obstruction did 
M. 
Measles. 
N. S. Roberts. 
F. 
2 days. 
Present. 
None. 
not return. 
Recovered. Wore tube 10 days. 
Died 13 hours after intubation. . 
454 
May, 1887 
“ “ 
F. 
2 yrs. 9 mos. 
11 years. 
3 years. 
iY day. 
“ 
Sepsis. 
Sepsis. 
455 
456 
Langmann.42 
Carl Beck. 
F. 
1 day. 
2 days. 
Schluckpneumo- 
nie. 
Measles. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 6 days. 
Jan., 1887 
M. 
6 days. 
Albumen. 
4S7 
Feb., 1887 
n a 
M. 
2 yrs. 6 mos. 
20 hours. 
3 days. 
Pneumonia. 
Died 3 days after intubation. 
458 
459 
460 
461 
a a 
M. 
3 yrs. 3 mos. 
4 years. 
6 years. 
6 months. 
12 hours. 
4 days. 
Recovered. Wore tube iY days. 
Recovered. Wore tube 4 days. 
Recovered. Wore tube 2Y days. 
Died 45 hours after intubation. 
April, 1887 
May, 1887 
June, 1886 
ti n 
M. 
iY day. 
ti it 
F. 
T. H. Meyers. 
M. 
3 days. 
4 days. 
None. 
Convulsions. 
462 
463 
July, 1886 
Aug., 1886 
M. 
23 months. 
2 years. 
1 day. 
1 day. 
Recovered. Wore tube 8 days. 
Died 23 hours after intubation. 
“ “ 
M. 
1 day. 
Pulmonary 
oedema. 
464 
465 
it 44 
M. 
7 years. 
2 years. 
1Y day. 
6 hours. 
Recovered. Wore tube 44 hours. 
Died 22 hours after intubation. 
Jan., 1887 
44 44 
M. 
6 hours. 
None. 
Heart failure. 
466 
467 
(4 f f 
M. 
i,Y months. 
3 yrs. 6 mos. 
ft 
Died 41 hours after intubation. 
Died 6 days after intubation. 
“ 
“ “ 
M. 
3 days. 
1 day. 
Albumen. 
Heart failure. 
Measles; pneu- 
monia. 
468 
469 
F. 
25 months. 
3 yrs. 6 mos. 
Yz day. 
iY day. 
ft 
Died 73 hours after intubation. 
Recovered. Wore tube 4 days. 
Feb., 1887 
“ “ 
M. 
None. 
Albumen. 
Pneumonia., 
470 
Mar., 1887 
44 44 
M. 
4 years. 
Y day. 
Y day. 
Nephritis. 
Died 1 day after intubation. 
471 
472 
April, 1887 
M. 
7 months. 
3 years. 
4 days. 
4 days. 
Heart failure. 
Measles ; pertus- 
sis. 
Measles ; pertus- 
Died 14 hours after intubation. 
Died 70 hours after intubation. 
“ 
M. 
3 days. 
473 
.< <> 
F. 
3 yrs. 6 mos. 
1 day. 
1 day. 
Albumen. 
Scarlet fever. 
Recovered. 
474 
Hay, 1887 
4 4 44 
M. 
3 yrs. 6 mos. 
1 day. 
1 day. 
“ 
Tuberculosis. 
44 
Died 34 hours after intubation. 
475 
if if 
F. 
3 yrs. 3 mos. 
1 day. 
Y day. 
Nephritis, 
Scarlet fever; 
Died 13 hours after intubation. 
measles. 
476 
tt fi 
F. 
3 yrs. 6 mos. 
Y day. 
Y day. 
None. 
Heart failure. 
Scarlatina ; mea- 
Died 5 hours after intubation. 
sles. 
477 
U 
ii fi 
M. 
3 years. 
Y day. 
None. 
Albumen. 
Sepsis, 
Measles. 
Died 43 hours after intubation. 
478 
F. 
3 years. 
14 hours. 
t-Y day. 
Exhaustion. 
Scarlatina; mea- 
Died 6hi days after intubation. 
sles. 
479 
“ 
M. 
4 yrs, 3 mos. 
30 hours. 
4 days. 
“ 
Rdtheln; pneu- 
monia. 
Died 20 hours after intubation. 
ft 44 
F. 
Y day. 
2 days. 
Y day. 
1 day. 
Died 42 hours after intubation. 
Died 10 days after intubation. 
482 
44 fi 
M. 
4 yrs. 4 mos. 
Albumen. 
Pneumonia. 
Scarlatina ; mea- 
sles. 
483 
D. C. Cocks. 
M. 
11 months. 
CEdema 0 f 
lungs. 
Died 6 hours after intubation. 
484 
44 <4 
M. 
4 years. 
Extension 10 
bronchi. 
Died. 
omy. 
485 
486 
487 
44 44 
M. 
8 years, 
3 years. 
4 years. 
Recovered. 
4 4 4 4 
F. 
Recovered. 
44 44 
M. 
Died. 
and never 
rallied. 
488 
4 4 44 
F. 
3 years. 
3 years. 
Recovered. Wore tube 5 days. 
Died 48 hours after intubation. 
489 
44 44 
F. 
lung. 
490 
44 44 
F. 
2 yrs. 6 mos. 
Died 7 days after intubation. 
bronchi. 
491 
44 4 4 
F. 
4 years. 
Extension 10 
Died 6 days after intubation. 
bronchi. 
492 
493 
494 
495 
496 
497 
fta* 
44 4 4 
M. 
2 yrs. 6 mos. 
4 years. 
7 years. 
3 years, 
5 years. 
4 years. 
Recovered. Wore tube 7 days. 
Died 10 days after intubation. 
Died 3 days after intubation. 
Recovered. Wore tube 6 days. 
Died 1 day after intubation. 
Died 9 days after intubation. 
fi 44 
F. 
44 44 
F. 
Sepsis. 
44 44 
F. 
44 44 
F. 
Sepsis. 
Erysipelas. 
44 44 
M. 
After tracheot- 
omy. 
498 
44 44 
M. 
3 years. 
Died 15 hours after -utubation. 
lungs. 
499 
44 44 
1 yr. 6 mos. 
Died 48 hours '.Ter intubation. 
lungs. 
500 
501 
502 
503 
4 4 4 4 
M. 
4 years. 
3 years. 
4 years. 
3 years. 
Recovered. Wore tube 6 days. 
44 ft 
F. 
Sepsis. 
44 44 
M. 
44 44 
F. 
Clogging of 
tube. 
Died 60 hours after intubation. The foregoing tables give the details of 503 cases of 
laryngeal diphtheria treated by intubation. The follow- 
ing list includes, in addition to these, the result of 303 
cases, the details of which I did not obtain. 
In fatal cases, average length of life after intubation, 2 days 8 hours. 
In cases of recovery, average time of tube in larynx, 5 days 3% hours. 
Cause of death in 339 cases ; 
Diphtheritic bronchitis 139 
Pneumonia 55 
Sepsis 37 
Exhaustion 33 
Nephritic complications 25 
Operator. 
Cases. 
Recov- 
eries, 
Operator. 
Cases. 
Recov- 
eries. 
Pulmonary cedema 9 
Bronchitis 8 
Asphyxia, from clogging of tube 2 
“ ,l pushing down membrane 2 
Joseph O’Dwyer * 
F. E. Waxham 
81 
106 
20 
31 
James McManus ..... 
L. L. Dunnin'sr 
5 
2 
“ “ swelling over head of tube i 
“ “ neglect to notify operator after coughing out tube. 4 
Tuberculosis 2 
Congestion of lungs 1 
87 
18 
F. Huber 
O’Shea 
A. B. Strong 
47 
37 
3i 
20 
14 
1 
w. Cheatham S 
P-Ingraham 
A. S. Hunter.. 
4 
3 
1 
0 
Scarlatina 1 
. , 339 
’» 1 Medical Review, Pittsburgh, 1887, 1., 114. 
2 Cincinnati Lancet-Clinic, 1887, Ivii., 97. 
5 St. Louis Medical and Surgical Journal, 1887, lii., 115. 
4 Canadian Practitioner, Toronto, 1887, xii., 1. 
6 Medical Register, Philadelphia, 1887, i., 174. 
J. M. Bleyer 
W. P. Northrup 
42 
32 
11 
6 
O. W. Mason 
N. S. Roberts .. 
3 
1 
C. E. Denhard 
24 
10 
David Prince. 
2 
2 
F. Van Fleet 
22 
7 
W. E. Shaw 
2 
0 
D. C. Cocks 
21 
6 
J-W. Niles 
T. H. Meyers 
21 
4 
6 Journal of the American Medical Association, 1887, viii., 199. 
7 Journal of the American Medical Association, 1887, viii., 342. 
8 New York Medical Journal, 1887, xlv., 238. 
E. E. Montgomery 
G. H. Cocks 
is 
14 
8 
4 
F-HonaE/j- 
Charles 
1 
0 
73 
5 
1 
1 
9 Medical News, Philadelphia, 1887, I., 341. 
E. F. Ingalls 
12 
3 
Frank Tipton 
10 American Lancet, Detroit, 1886, N. S.. x., 401. 
II 
4 
H. F. IvL 
11 Maryland Medical Journal, 1886, xvi., 67. 
W. K. Simpson 
IO 
O 
12 American Practitioner and News, Louisville, 1886, N. S., ii., 321. 
T. A. Anderson 
IO 
I 
|a. G. Case 
13 The Medical Record, 1886, xxx., 665. 
14 Hahnemannian Monthly, June, 1886. Reprint. 
16 Chicago Medical Journal and Examiner, 1885, I., 475. 
E. L. Cocks 
IO 
3 
J. J. Reid 
IO 
4 
0 
Geo. McNaughton 
IO 
2 
IW. L. Carr" 
16 Archives of Pediatrics, Philadelphia, 1885, ii., 657. 
17 Chicago Medical Journal and Examiner, 1885, li., 511. 
A. E. Hoadley 
9 
O 
iS- Priest.. 
F. Henrotin 
J. Eichberg 
7 
6 
3 
2 
h Winters 
lo* W. Merriam 
6 
0 
18 Chicago Medical Journal and Examiner, 1886. lii., 353. 
19 Chicago Medical Journal and Examiner, 1886, liii., 132. 
20 Buffalo Medical and Surgical Journal, 1886, xxvi., 226. 
21 Medical and Surgical Reporter, Philadelphia, 1886, Iv., 586. 
22 Maryland Medical Journal, Baltimore, 1886, xvi., 168. 
23 Weekly Medical Review, St. Louis, 1887, xv., 57. 
H. O. Bates 
W. H. Prescott 
6 
3 
1 
H.AWWB4illia- -• 
3 
8 
0 
W. P. Bolles 
H. L. Smith 
2 
2 
f 2 
Harieflllfinger 
2 
1 
H. H. Mudd 
6 
5 
2 
1 
1 
0 
94 The Medical Record, New York, 1886, xxx. 487. 
23 The Medical Record, New York, 1886, xxx. 683. 
26 Medical Journal, New York, 1886, xliii., 3S4. 
27 Journal of the American Medical Association, Chicago, 1886, vii., 35. 
28 Chicago Medical Journal and Examiner, 1885, li., 401. 
29 Chicago Medical Journal and Examiner, 18S6, lii., 214. 
30 The Medical Record, New York, 1886, xxix., 410. 
31 Medical Register, Philadelphia, 1887, i., 146. 
32 Journal of the American Medical Association, Chicago, 1887, viii., 337. 
33 Journal of the American Medical Association, Chicago, 1887, viii., 359. 
34 Pacific Medical and Surgical Journal, San Francisco, 1887, xxx., 129. 
35 Cincinnati Lancet-Clinic, 1887, N. S., xviii., 321. 
38 Journal of the American Medical Association, Chicago, 1886, vi., 426. 
37 Journal of the American Medical Association, Chicago, 1886, vi., 147. 
38 New York Medical Journal, 1886, xliv., 273. 
39 New York Medical Journal, 1886, xliv., 322. 
40 Medical Times, Chicago. Reprint. 
41 The Medical Record, 1887, xxxi., 608. 
42 New Yorker Medizinische Presse, 1887, hi., 259. 
Carl Beck 
s 
4 
Torscheimer 
4 
0 
G. W. Gay 
1 4 
* Cases in private practice only. 
Total number of operators, 65. 
Total number of cases, 806, with 221 recoveries, = 27 cent Male 22_, 
female, 198 ; not stated, 383. 7,4 Per cent- lviale> 225* 
Average age of fatal cases, 3 years 2 months. 
Average age of cases which recovered, 4 years 1 y3 month 
Duration of laryngeal symptoms before intubation i„ caws nf rmwcrv , 
9 hours ; in cases of death, 1 day 19 hours. cases of recovery, 2 days 
Urine contained albumen in 117 cases, and no albumen in 31 cases. Not 
stated in 658 cases. 3 67 
' In closing the discussion, The President said that the 
large gathering of fellows who came to listen to the pa- 
pers of so many gentlemen on the same subject proved 
the interest the profession was taking in the new procedure. 
For, indeed, it was new, as he had taken an opportunity 
to say before the last meeting, in February, of the Med- 
ical Society of the State of New York. As he had 
stated on that occasion, it gave him pleasure to recog- 
nize the fact that Dr. O’Dwyer, in planning and perfect- 
ing intubation through patient labors extending over 
many years, had deservedly earned celebrity for himself 
and added to the discoveries which shed glory on the 
American profession. On the other hand, O’Dwyer’s 
method of working, while apparently slow, was apt to 
teach our young men the lesson, that no great reputation 
is made by looking for premature notoriety, by rushing 
into print, and otherwise trying to harvest before sowing. 
In regard to intubation, it was true that it had been 
tried and practised before. “Tubage” was introduced 
into French practice nearly thirty years ago.1 Bouchut, 
then as to-day one of the active workers in Parisian 
medicine, tried to find a substitute for tracheotomy, 
and related cases in which a tube had been intro- 
duced into the larynx successfully. He claimed that 
the tube was carried into the larynx with the greatest 
ease, did not interfere with the movements of the epi- 
glottis, was well tolerated by the larynx, relieved as- 
phyxia in croup without tracheotomy being resorted to, 
and allowed the passage of false membianes. Indeed, 
and unfortunately, he went as far as to assert that a boy 
of three years, who had been intubated, spoke with a 
clear, loud voice. 
This enthusiasm, to call it nothing else, carried him 
1 The subject is fully discussed in Contributions to Midwifery, and Diseases of 
Women and Children, etc., by E. Noeggerath, M.D., and A. Jacobi, M.D., pp. 
397-400. New York, 1859. 68 
too far. The Paris Academy of Medicine killed intuba- 
tion in consequence of an adverse report made by La- 
tour, Trousseau, and others. It was not heard of since. 
If the study of the history of our science were more 
common among us than, unfortunately, it was, Dr. 
O’Dwyer would have found his task much easier. As 
he was not informed of the existence of previous efforts, 
he had to undergo a large amount of labor which might 
have been spared him. But, after all, his industry and 
ingeniousness had overcome every obstacle. 
He was gratified at having had this opportunity of in- 
troducing to the Academy the array of observations 
presented. The profession of America and Europe 
would soon profit by it, and would often have to recur 
to the meeting of to-night as one of unusual importance. 
Personally, he would say that the first speaker (Dr. 
Huber) was quite correct in what he said of him, without 
mentioning his name. While appreciating the compli- 
mentary remarks referring to him, he acknowledged the 
correctness of the statement that, until a recent period, 
he never had anything but adverse criticism for intuba- 
tion. Even in the third volume of “ Pepper’s Cyclo- 
paedia ” he had expressed himself in the same spirit. 
He was willing and anxious to admit that he was then 
mistaken ; that he was now, and had been for some 
time, convinced of the correctness of everything that had 
been claimed for intubation, and was looking forward 
for such improvements in instruments and methods as 
would make intubation more and more both easy and 
successful.