220 TRACHEOTOMY OF THE NECK, &c. 



anxiously inquired whether there might not be established an artificial opening 

 for the passage of the air, when the natural one could no longer be used ; and 

 it has been ascertained that it is both a simple and safe operation, to excise a 

 portion of the trachea, on or below the point of obstruction. 



The operation must be performed while the horse is standing, and secured by 

 a side-line, for he would, probably, be suffocated amidst the struggles with 

 which he would resist the act of throwing. The twitch is then firmly fixed on 

 the muzzle ; the operator stands on a stool or pail, by which means he can more 

 perfectly command the part, and an assistant holds a scalpel, a bistoury, scissors, 

 curved needles armed, and a moist sponge. 



The operator should once more examine the whole course of the windpipe, and 

 the different sounds which he will be able to detect by the application of the 

 ear, and likewise the different degrees of temperature and of tenderness which 

 the finger will detect, will guide to the seat of the evil. 



The hair is to be closely cut off from the part, the skin tightened across the 

 trachea with the thumb and fingers of the left hand, and then a longitudinal 

 incision cautiously made through the skin, three inches in length. This is 

 usually effected when there is no express indication to the contrary on the fifth 

 and sixth rings ; a slip from which, and the connecting ligament above and 

 below, about half the width of each ring, should be excised with the intervening 

 ligament. The remaining portion will then be strong enough to retain the per- 

 fect arched form of the trachea. 



If the orifice is only to be kept open while some foreign body is extracted, 

 or tumour removed, or ulcer healed, or inflammation subdued, nothing more 

 is necessary than to keep the lips of the wound a little apart, by passing some 

 thread through each, and slightly everting them, and tying the threads to the 

 mane. 



If, however, there is any permanent obstruction, a tube will be necessary. It 

 should be two or three inches long, curved at the top, and the external orifice 

 turning downwards with a little ring on each side, by which, through the means 

 of tubes, it may be retained in its situation. 



The purpose of the operation being answered, the flaps of integument must be 

 brought over the wound, the edges, if necessary, diminished, and the parts kept 

 in apposition by a few stitches. The cartilage will be perfectly reproduced, 

 only the rings will be a little thicker and wider. 



The following account will illustrate the use and the danger of the tracheo- 

 tomy tube. A mare at Alfort had great distortion of the rings of the trachea. 

 She breathed with difficulty. She became a roarer almost to suffocation, and 

 was quite useless. Tracheotomy was effected on the distorted rings, and a 

 short canula introduced. She was so much relieved that she trotted and 

 galloped immediately afterwards without the slighest distress. Six months 

 later she again began to roar. It seemed that the rings were now distorted 

 below the former place. 



M. Barthelemy introduced another canula, seven inches long, and which 

 reached below the new distortion. She was once more relieved. She speedily 

 improved in condition, and regularly drew a cabriolet at the rate of seven or 

 eight miles in the hour ; and this she continued to do for three years, when the 

 canula became accidentally displaced in the night, and she was found dead in 

 the morning. 



THE BRONCHIAL TUBES. 



The windpipe has been traced through its course down the neck into the 

 chest. It is there continued through the mediastinum to the base of the heart, 

 and then divided into two tubes corresponding with the two divisions of the 



