Joseph O'Dwyer

Joseph O'Dwyer (October 12, 1841 – January 7, 1898) was an American physician. He developed a valuable system of intubation in diphtheria cases. O'Dwyer is often cited as the "father of laryngeal intubation in croup".

Intubation

In the 1800s diphtheria was a devastating disease, especially lethal in children. The cause of death was usually asphyxia due to an obstructed airway.

A tracheotomy was often a necessary procedure to save a patient suffering with diphtheria from suffocation. This was, at that time, a high-risk procedure, even post-operative. In 1858, Paris pediatrician Eugene Bouchut devised a method to bypass the diphtheria pseudomembrane obstructing the larynx without resorting to a tracheotomy. However, Bouchut's proposal was not well received, due in part to the opposition of Armand Trousseau, the known authority on tracheotomies.

The use of tracheotomy had fallen into disrepute at the Foundling Hospital with a record 100% death rate, among children due to suffocation when diphtheria brought about closure of the larynx. O'Dwyer and his colleague at the Foundling Hospital, W.P.Northrup, experimented with various approaches to keep the laryngeal airway open. At first, O'Dwyer experimented with his device on cadavers.

The use of a tube for intubation had often been attempted but unsuccessfully. After five years of study, working with surgeon George Fell, by 1885 O'Dwyer had devised a set of tubes of graduating in size to fit children from one to ten years of age. He also developed a procedure for the insertion and extraction of the tube, using specially designed instruments. After a number of refinements the final tubes, made by George Tiemann and Company of New York, were made of brass, lined with gold, and came in five different sizes. These were later supplanted by Annandale's rubber endotracheal tube. The method proved successful in relieving difficulty in breathing. In 1885, O'Dwyer presented his findings. According to Sperati and Felisanti, O'Dwyer's modifications in Bouchut's concept "were determinant". His tubes and the accompanying instruments for intubation and extubation, with his methods for the care of these patients, came to be employed throughout the medical world, gradually reducing the use of tracheotomy for croup, and thereby "leading to a significant reduction in the death rate". When the development of antitoxins reduced the need for intubations, O'Dwyer was among the early practitioners to switch from intubation where appropriate. O'Dwyer did not make much money from the development of his intubation method and according to his friend Northrup, "died poor". Family friends arranged for the education of his three other sons.

Legacy His work at the Foundling Hospital helped greatly to make that institution one of the best of its kind.

O'Dwyer introduced the use of tubes in children with diphtheritic pseudomembranes in the larynx, to substantially increase their survival chances at a time when tracheotomy still had a high failure rate. The tubes proved of great value in stenosis of the larynx due to various other diseases and to strictures of the larynx, especially consequent on burns or scalds. The Fell-O'Dwyer apparatus supplied practical instrumentation for intermittent positive pressure ventilation.