OSSIES 
OF 
Tciirlreotonm for fjtroap and IjtiiljfficrtiL 
E. FLETCHER INGALS, A. M.f M. D., 
'Lecturer on Physical Diagnosis and Diseases of the Chest and on Laryngology 
in Post Graduate Course, Rush Medical College. 
Reprinted from the Chicago Medical Journal and Examiner 
for June, 1880. 
Case I. About the middle of March, 1880, I was called by 
Dr. David Dodge to operate on Miles, a boy about six 
years of age, suffering from diphtheritic croup. 
We found the child breathing laboriously and much exhausted, 
but not markedly cyanotic. Assisted by Drs. Dodge, Mulfinger 
and Waters, I operated at once. 
Shortly after the introduction of the tube the child ceased 
breathing and was apparently dead, but the heart was found to 
be still beating, and the tube was clear. Artificial respiration 
and vigorous rubbing of the limbs, kept up for about twenty 
minutes, had the happy effect'of restoring the patient. Subse- 
quently the child did well. Lime water was kept boiling in the 
room and an atomizer was kept in use part of the time, throwing 
a spray of carbolic acid. The patient was kept on tonics, quinia 
and iron, and made a good recovery. 
The tube was removed on the twelfth or thirteenth day (I am 
not quite certain which) Case 11. Freer, set. abbut two years, true croup. April 
6, 1880. I saw the patient first about oa.m. on this date and 
found him breathing laboriously and partially cyanotic. I at 
once told the mother that an operation offered the only chance 
for saving her child. She wished it performed and I hastened for 
my instruments. 
I returned about-ten o’clock with Dr. D. W. Graham, who had 
kindly consented to assist me, and, finding the child unconscious 
and extremely cyanotic, we made preparations for the operation 
with the greatest despatch. When the child was placed on the 
table it manifested no sensation on touching the eyeball, therefore 
no anaesthetic was used. The operation was completed without 
difficulty, but, as I had at hand no tube of proper size, silk 
threads were passed through the trachea near the edges of the 
opening on each side and fastened with an elastic behind the 
neck. Two students, Messrs. T. E. Webb and L. W. Pontius, 
volunteered to stay with the patient and give all necessary care. 
The patient rallied and seemed very bright that evening, but 
early the next morning Mr. Pontius telephoned to me that the 
child was rapidly sinking. I hastened to the house and found 
the patient, as he had stated, in a precarious condition. The 
tissues about the wound were dry and the opening into the tra- 
chea partially contracted and the trachea itself partially filled 
with inspissated mucus. 
I made a solution of bi-carbonate of soda, a teaspoonful to a 
pint of water, of which I directed a spray with the steam ato- 
mizer on the tracheal opening for about half an hour, by which 
time the mucus was aoftened, so that we removed it and, upon 
inserting a tube, the child again breathed easily and rapidly im- 
proved. In the evening the child continued better than early in 
the morning, but it showmd some symptoms of filling of the bron- 
chial tube with the croupy exudation. 
Mr. P. remained with the child until one o’clock of that night, 
when it died from the gradually increasing obstruction below the 
trachea, thirty-nine hours after the operation. This patient had 
been hoarse for two or three days, but had no alarming symptoms 
until the night previous to the operation. The mother had 
treated these as she had been accustomed to treat croup, by free- use of substances which caused vomiting. After the operation 
the child was given fluid diet, which it took sparingly, and 
whisky, which was administered freely. 
Case 111. True Croup. April *4l, 1880. L. Gingsburg, 
set. six, had been sick about two, days. 
This case was very similar to the above. I was called by tele- 
phone at midnight to see “ a child dying in croup,” therefore I 
took my instruments with me. I found the child cyanotic, rest- 
less, breathing laboriously and nearly unconscious. 
An operation was advised and consented to. I sent for Dr. 
Bartlett, who lived only a block distant, and, as soon as lamps 
could be procured, we made the operation. When the child was 
placed on the table she was nearly insensible but a small amount 
of chloroform was administered to keep her quiet. 
The operation was made as the preceding and ligatures were 
passed for convenience through the cut edges of the trachea. 
This case progressed almost exactly as the preceding, and death 
occurred in forty hours, from a similar cause. The treatment was 
the same as in the preceding, with the addition of the internal 
use of benzoate of soda. Mr. Pontius, who watched the preceding 
case for me, stood faithfully by the little patient to the last, and. 
to his careful and assiduous attendance are to be attributed the 
last twenty hours of the patient’s life. 
The first of these cases was diagnosticated diphtheritic croup. 
It was operated on comparatively early and recovery occurred. 
The two latter were undoubtedly cases of true croup; they 
were operated on after they were moribund and their lives were 
prolonged about forty hours, to the great comfort of parents and 
friends, and death finally came quietly, without a strudgle. 
188 Clark St., Chicago.