140 years ago: On Inhalation in Diseases of the Throat
Croup is one of those inflammatory diseases in which, at an early period, we are enabled to do much good, and to save the patient’s life, by the timely application of proper remedies.
Croup is one of those inflammatory diseases in which, at an early period, we are enabled to do much good, and to save the patient's life, by the timely application of proper remedies.
By far the greatest number of throat diseases which commonly come under our notice are of an inflammatory character, and if such a disease be situated in the pharynx, including the uvula, tonsils, and soft palate, the diagnosis will be easily made by simple inspection; but if the lesion be limited to the epiglottis, the vocal chords, or the lining membrane of the larynx, or if perhaps all these parts together be simultaneously affected, the nature of the disease cannot be discovered without the aid of the laryngoscope. It is not my intention, however, to dwell on the methods of application of this valuable instrument, and I merely refer the reader to the works of Johnson, Gibb, Mackenzie, Turck, Bruns, and others.
Croup is one of those inflammatory diseases in which, at an early period, we are enabled to do much good, and to save the patient's life, by the timely application of proper remedies; but in which a short delay may very often prove fatal. At the same time it is a disease very liable to be mistaken for another not less fatal, viz. diphtheria.
In croup I combine, wherever it is possible, as I do in other diseases of the organs of respiration, internal treatment with inhalations, or apply them alternately as the case may be; but very soon the little patients are either unfit or unwilling to swallow, and sometimes persist in their refusal very obstinately: here atomised fluids and vapours therefore are of particular value for two reasons; firstly, because some children who refuse medicine, look at the atomiser as a kind of toy, and willingly submit to its action; secondly, because there is no difficulty, in case of need, in forcing a child to expose his pharynx and larynx to the action of the remedy, as the very act of screaming is very favourable to the entrance of the spray into the air-passages. The remedies employed by different physicians are the following:–
1. Bromide of potassium was first used in the atomised state in this disease by Dr.Schnitzler. In one of his cases, a boy, three years of age, was severely attacked, and his breathing became difficult in the extreme; in order to gain at least some momentary relief, large doses of tartar emetic were given without producing vomiting, and inhalation was merely tried as a last resource; a solution of bromide of potassium, five grains to the ounce, was applied in the form of spray, and its use was followed almost immediately by the expulsion of shreds of false membrane. The breathing became easier, without stertor; the child felt relief for two hours, when it relapsed to its former condition. It was subsequently relieved five times under the same circumstances; and although the relief felt was considerable, the progress of the disease could not be arrested at this stage. In other instances the same drug (ten grains to the ounce) was employed with success. I have myself tried this remedy at an early stage of this disease, and found the symptoms arrested.
2. Tannin has been strongly recommended, both in croup and diphtheritis, by Barthez and Trousseau. The solution applied contained five per cent. of tannin; each inhalation lasting from fifteen to twenty minutes.
3. Lime water has been found useful by many authors, who attribute to the agent the power of dissolving the pseudo-membranes, both of croup and diphtheria; in the latter disease it has found a strong advocate in Dr. Geiger of Philadelphia. In croup I was myself enabled to try it in several cases, in one of which it relieved the child in the course of twelve hours after other inhalations had been employed without producing any marked improvement.
4. Watery vapour has been recommended by MacIntosh for croup as well as for bronchitis. The same has been used by Budd, who combined it with the administration of emetics.
5. Oxygen has been recommended by Dr. Miquel. His patient was a little boy, twenty-one months old, who was suffering from croup: respiration abrupt, stertorous, whistling, and irregular, numbering forty times in the minute; pulse small, very frequent, so as not to be counted; face and lips livid; the child's expression anxious; the patient was so exhausted as scarcely to be able to cough, and when he did so it was with a low barking voice. A large number of remedies were employed without success, while the administration of oxygen restored the child to health.
On reviewing these different remedies, it may be remarked that whenever we are called upon to act in cases of croup, it would be advisable to apply, in the first instance, the medicated sprays, these being very easily obtained, and the apparatus being always in readiness. The drugs above-mentioned I would from my own experience arrange in the following order, in respect to their value: first, lime water; second, tannin; third, bromide of potassium.
I need not repeat that, with these, the administration of emetics or other remedies may and must be combined if considered necessary. The vapours and oxygen are not equally simple in their administration, and therefore can be applied only in those cases in which a suitable apparatus may be obtained. For the production of steam, an apparatus may readily be extemporized by holding a funnel over a vessel of boiling water, the patient inhaling through the tube of the funnel.