78 



THE OPERA riON FOR ROARING. 



tached cartilage and remove them by cutting through the 

 inter-annular ligament. 



A third and to us preferable method is to insert a narrow 

 bladed scalpel transversely at about the lower third of the 

 lowermost bared tracheal ring and cutting outwards and 

 upwards in a curved line, pass through the first inter-annu- 

 lar ligament and continue into the succeeding segment until 

 near its superior border, when the incision is curved down- 

 ward to eventually reach the starting point, the isolated 

 section of the trachea being securely grasped with a pair of 

 forceps before its excision is completed. By this method 

 no tracheal ring is severed. 



The trachea tube is to be removed and cleansed daily as 

 long as its use is necessary, and when discontinued the 

 wound should be left open and dressed antiseptically. 



13. THE OPERATION FOR ROARING. 

 Plate XV. Figs. 3-5. 



Instruments. Razor, hypodermic syringe, scalpels, 

 tenaculum, artery forceps, laryngeal speculum, two long 

 curved dressing forceps, hard rubber syringe with long pipe, 

 ventricular burr, reflecting lamp, razor-shaped scalpel, long 

 curved scissors. 



The following technic has for its aim two fundamental 

 objects which are to be kept constantly in mind : 



I. It is aimed to bring about a prompt, firm, complete 

 and permanent adhesion of the arytenoid cartilage and vocal 

 cord against the inner face of the thyroid cartilage in the 

 normal position of forced iu.spiration, so that no air can 

 become impacted into the ventricle to force the vocal cords 

 and arytenoid cartilage downwards and inwards to obstruct 

 the free ingress of air. 



