ESOPHAGOTOMY. 579 



pensory ligaments and into the bulb, wounding thereby the 

 arteries ; whereas, by the former, all this danger is avoided, 

 besides that it renders the operation more simple and 

 facile. 



TRACHEOTOMY. 



Cases occur when this operation is required ; as in stran- 

 gles, when the tumours threaten suffocation, or when any 

 substance has remained unswallowed in the oesophagus, the 

 pressure of which obstructs respiration. In a distressing 

 case of gunpowder bursting immediately under a horse's 

 nose, the effects of which tumefied his mouth and nos- 

 trils, so as to prevent free inspiration, the animal owed 

 his life entirely to our excising a portion from the tracheal 

 rings, about ten inches below the angle of the throat. The 

 operation is a very simple one, and may consist either in a 

 longitudinal section made through two or three of the rings, 

 or a portion, occupying about an inch round, may be ex- 

 cised from the anterior cartilaginous substance. The proper 

 mode, when it can be done, however, is to make a circular 

 opening with a very narrow knife, removing a portion of 

 two cartilages, or taking a semicircular piece from each ; 

 and this last, although it is seldom performed, is by far the 

 best method : the integuments should be first divided in the 

 exact centre of the neck, three or four inches below the ob- 

 struction ; then the skin and tissues should be sufficiently 

 separated to allow a tube adapted to the size of the trachea 

 to be introduced ; the tube having an acute turn and a rim, 

 which must be furnished with holes for the adaptation of tapes 

 to secure it around the neck. There are several instruments 

 of this sort in use, of which that adopted by the French, 

 or the one invented by Mr. Gowing of Camden Town, is to 

 be preferred. The operation has been also performed in 

 cases of roaring, under an idea of dividing the stricture 

 which impeded respiration ; but unless the exact situation 

 of this were discovered, it would be but an experimental 

 attempt. 



ESOPHAGOTOMY. 



It was long thought that a wound in the oesophagus must 

 be necessarily fatal, but we have now sufficient proofs to the 



p p 2 



