TRACHEOTOMY. 691 



strictly observed ; for if one or two rings be divided, the cut ends 

 may, during the healing of the wound, overlap and thus cause more 

 or less contraction of the windpipe with proportionate impediment 

 to breathing. If we are unable to obtain a tube, we can keep the 

 edges of the opening of the windpipe apart by means of a suitable 

 cord passed through them with a suture needle, and tied on the 

 top of the neck. When the artificial opening has served its pur- 

 pose, no sutures or any special treatment will be necessary for the 

 wound, which will heal up with remarkable quickness. 



PRECAUTIONS TO BE OBSERVED IN THE USE OF PERMA- 

 NENT TRACHEOTOMY TUBES.--(l) Before insertion, the tube 

 should be thoroughly cleaned. (2) It should be allowed to 

 remain undisturbed in the opening for a few days, so as to let the 

 surrounding tissues accommodate themselves to its presence. (3) 

 Subsequently, the tube should be removed every day, well cleaned 

 and disinfected with a solution of creolin or pure carbolic acid in 

 water (1 to 20), dried, and replaced. Here, the use of two similar 

 tubes would be an advantage. (4) After the daily removal of the 

 tube, the wound should be gently cleaned, and if necessary disin- 

 fected; care being taken that none of the antiseptic enters the 

 windpipe. (5) Mr. F. B. Jones advises that " the plug should be 

 taken out first thing in the morning and allowed to remain out all 

 day to accustom the horse to breathe through the tube, and also for 

 the lungs to get used to the fresh air. The plug should be put in 

 only at night to prevent any foreign body getting into the windpipe, 

 especially if peat moss litter is used in the stable. Previous to 

 inserting the plug, it is advisable to rub a little of the antiseptic 

 ointment (carbolic, iodoform, or salicylic acid ointment) round it, 

 as it causes the plug to come out easily next morning, and prevents 

 the mucus becoming hard round it." Although I am very loth to 

 differ from such a high authority, I would advise, as I have already 

 said, that with racehorses and chasers, the tube should always remain 

 closed except during a race, or when a strong gallop is being given, 

 (6) As remarked by Mr. Jones, no attempt to swim the animal 

 should be made without first closing the tube. (7) If possible, we 

 should have two or three tubes of different lengths, so as to obviate 

 the necessity of employing washers when the swelling due to the 

 operation has subsided. (8) In all probability it will be necessary, 

 from time to time, to dissect away growths of tissue which may 

 form inside the windpipe near the opening, and to enlarge the 

 opening and calibre of the windpipe near the tube. In all such 

 removals, we should take care not to allow any portion of the 

 divided tissues to fall into the windpipe. Here, a sharp-toothed 

 forceps will be useful. 



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