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Diphtheria intubation set c. 1890
Diphtheria (corynebacterium diphtheriae), an acute bacterial infection spread by personal contact, was the most feared of all childhood diseases. One child out of every ten that became infected died from this disease. Symptoms ranged from a severe sore throat to suffocation by the formation of a 'false membrane' over the larynx. Between 1880 and 1887, Joseph O'Dwyer devised a series of tubes to be inserted into the larnyx and thus maintain air supply until the crisis period of the illness passed. O'Dwyer's intubation tubes were not foolproof, nor simple to use, but desperate doctors and parents grasped this innovation as a precious last resort. The American medical community hailed O'Dwyer, a Cleveland native, as the medical savior of thousands of children in the United States.
Joseph O'Dwyer (1841-1898) was born in Cleveland but his family moved to London, Ontario (Canada), when he was still young. O'Dwyer graduated from the College of Physicians (New York) in 1865, and he pursued further training in pediatrics and obstetrics in several New York hospitals. In 1868, he took up private practice and four years later was appointed to the staff of the New York Foundling Asylum. There he developed the intubation tube to keep the larynx open during diphtheria. Others had tried, yet failed, to devise instruments for intubation. O'Dwyer designed a tube that would remain in place and fashioned instruments for inserting and removing it. His success came after careful trials upon cadavers at the Foundling Asylum. After several years of diligent study, this method of relieving difficulty of breathing proved successful. Before his death, it was universally acknowledged that O'Dwyer had made the most important practical discovery of his generation. The tubes are also of great value in stenosis of the larynx due to various other diseases, such as syphilis, and to strictures of the larynx, especially the consequence of burns or scalds.
Ironically, O'Dwyer lived to see his intubation tubes rendered largely obsolete by laboratory-based remedies. Medical research by von Behring and Kitasato yielded an anti-toxin remedy for diphtheria in 1890. Public trials of the anti-toxin, first undertaken in New York City in 1896, demonstrated its effectiveness. Immunization against diphtheria began soon after, but intubation instruments
did not disappear from the medical scene until the mid-20th century. They were still needed in communities that lacked effective immunization programs.
Craig Gelfand, "Dr. Joseph O'Dwyer and his intubation tube," Caduceus 1987 3,2 (Summer,1987):1-35.
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