: TRACHEOTOMY " 345 



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method, -how'ever. effectual it might have proven in dispatch- 

 ing pulmonary inflammations. 



(2) Diseases Causing Permanent Stenoses. — Roaring in 



horses due to laryngeal hemiplegia or other causes has al- 

 ways been considered an indication for tracheotomy. Per- 

 fectly useless work-horses are made useful, and roaring race 

 horses made to run faster and farther. Sometimes the opera- 

 tion is in demand simply to prepare a running or trotting 

 roarer for the ordeal of a single race or two. In spite of the 

 fact that the operation is effectual enough for the time being, 

 it never proves satisfactory in the end, and is certain to cause 

 the development of a second still more formidable obstruc- 

 tion at the seat of intubation. Permanent intubation of the 

 trachea is a passing treatment. It is fast becoming obsolete 

 in the face of operations which tend to cure the causative dis- 

 .ease, instead of simply temporarily relieving the dyspnoea. 



Furthermore, the development of an ineurablc deformity 

 of the trachea at the seat of intubation is not the only objec- 

 tion to permanent intubation. The tube and wound becomes 

 a filthy pest that receives little attention from the ordinary 

 stable attendant. The area becomes putrid, fetid, unclean, 

 loathsome to the layman and a disgusting affair to a modern 

 practitioner. 



Permanent intubation should be avoided except in cer- 

 tain rare and special instances of strictly incurable conditions 

 of the larynx or trachea when it is desired to prolong a 

 horse's usefulness for a short period. Two, and even three 

 years of work have thus been obtained from otherwise use- 

 less horses, true enough ; but more often the attempt is aban- 

 doned in disgust after a few months. Where horses are 

 scarce, expensive, or impossible to procure, such measures 

 are defensible. Generally, they bring little applause. 



Purpura Haemorrhagica often threatens suffocation by 

 obstructing the anterior nares with a large cutaneous oedema, 

 that can not be met with any other remedy than tracheotomy. 

 Here also, however, the operation is postponed to the last 

 on account of the behavior of the surgical wound, which is 

 certain to become the seat of a new diseased focus. The re- 

 gion often swells enormously after the operation. Some- 

 times the tissues become so thick that the tube will not reach 

 the trachea. 



Tracheotomy is less damaging to the old horse than to 

 the young. It can be performed with impunity in an old, 

 hardened trachea, but is liable to collapse or distort the 



