SURGICAL TREATMENT OF COLICS 65 



out a stylet entrance into the trachea was a very fre- 

 quent occurrence, and sometimes the operation would 

 have to be abandoned, because despite everything, the 

 tube could not be made to enter the esophageal infundi- 

 bulum, but instead, it persisted in dropping into the 

 larynx. Sometimes it would pass as far down as the 

 lungs without warning. 



It would seem that the entrance of a tube into the 

 glottis would immediately and certainly cause a fit of 

 coughing, but this is not the case. Coughing does not 

 occur to warn the operator. The only real warning that 

 a tube has entered the trachea is the ease with which it 

 enters the trachea as compared with the force required 

 to push it down the esophagus. 



The danger of forcing a tube into the lower air pas- 

 sages is negligible when the stylet is used. In fact, we 

 have not had this accident occur since using a stylet. 

 Furthermore, a styletted tube can always be felt in the 

 neck. Holding the free end of the tube to the ear to 

 listen for respiratory sound must not be depended upon 

 as blowing sounds synchronous with the respirations may 

 be heard from the esophagus, as well as from the trachea. 

 The only auscultation of any service here is that which 

 reveals the gurgling sounds of escaping gases, and these 

 can always be heard as the tube approaches the cardiac 

 orifice. 



When the tube has entered the stomach, determined 

 either by measurement or by the gushing of gas or 

 chyme the stylet is removed. This feat requires the full 

 strength of a man, who pulls forward on the stylet as the 

 operator pulls backward upon the tube. It is here that 



