. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. osis. Northrup thmks that this is due toswelling of the mucous membrane at the level of the cricoid these cases introduction of the tube is very difficult. The operatormay be compelled to use force to push the tube past the stenosis ora smaller tulie may be employed. While the tube is being worn, itmay become obstructed by membrane. This is indicated by a returnof the croupy cough, a snarling, flapping somid, and obstruction toexpiration. To obviate these difficulties, OT)wyer
. The diseases of infancy and childhood : designed for the use of students and practitioners of medicine. osis. Northrup thmks that this is due toswelling of the mucous membrane at the level of the cricoid these cases introduction of the tube is very difficult. The operatormay be compelled to use force to push the tube past the stenosis ora smaller tulie may be employed. While the tube is being worn, itmay become obstructed by membrane. This is indicated by a returnof the croupy cough, a snarling, flapping somid, and obstruction toexpiration. To obviate these difficulties, OT)wyer has had short tubes con-structed witliout a retaining flange. These tubes ha^e a special intro-ducer. The largest size for the age is chosen, and the tube forcedinto the larynx. These tubes should be used only by skilled opera-tors. The tubes are allowed to remain but a short time in the complications are the formation of granulations or ulcerationsaroimd the lower end of the tube if it is too long, and at the cricoidcartilage if it is too large. The former condition is not serious; the. Fig. 84,—Built-up tubes. 394 THE SPECIFIC INFECTIOUS DISEASES latter may destroy the cartilage. Granulations may form about thehead of the tube. In this case tubes with built-up heads are used topress on the granulations, thus causing them to atrophy (Fig. 84). Feeding.—Veediuii the patient after introduction of the tube requirescare. ]Most infants will nurse with the tube in the larynx. In somethere is considerable difficulty in swallowing. The patient is takenin the lap of the nurse and fed with the head held a little lower thanthe l:)od\. Fluids thus cannot enter the trachea and cause pneumonia. Treatment of the Complications.— Bronchopneumonia.—The treat-ment of the bronchopneumonia which complicates diphtheria is similarto that employed m the treatment of a primary affection. Thequestion of the further administration of antitoxin always rises inthese cases. I gi^?e it
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