tRAClIEOtOMY 34$ 



transverse incision may be made through the connecting 

 band between two rings, requiring the use of a tube 'flattened 

 from above downward. The kind of tracheotomy must there- 

 fore depend upon the kind of tube at hand, but preference 

 should be given to the transverse incision through the con- 

 necting ligament, as this method lessens the danger of caus- 

 ing a stenosis. In the young horse no other tracheotomy 

 should ever be performed. 



Fourth Step. — Inserting the Tube. — The tube improvised 

 for insertion between the rings is wedge-shaped. Its point is 

 simply pressed into and then through the opening in a down- 

 ward direction, and then kept in place with a tape passed 

 around the neck. Kragness has perfected a self-retaining 

 tube of this same pattern that dispenses with the use of the 

 retaining tape. The other self-retaining tubes of circular 

 shape require division of the rings and are therefore less de- 

 sirable except for permanent intubation. 



AFTER-CAR E.— The tube should be removed and 

 cleaned in a hot antiseptic solution every day. Small tubes, 

 when considerable sputum flows through them, may require 

 a semi-daily cleansing to keep their lumen free from incrusta- 

 tions. At each removal the condition of the throat is tested 

 by plugging the opening and as soon as breathing is found 

 possible the tube is dispensed with. It is advisable to compel 

 the patient to force air through the obstructed throat fre- 

 quently in order to keep the passage open, as well as to deter- 

 mine the amount of obstruction that still remains: Prolonged 

 intubation should be avoided. 



SEQUELiE. — Tracheotomy may sometimes increase the 

 severity of or provoke a descending inflammation of the 

 aerial mucous membrane, but complications of this character 

 are, fortunately, rare. Strange to say, pneumonia is seldom 

 ever caused by tracheotomy, in spite of the fact that the 

 wound often becomes very putrid. 



The most formidable sequel occurs some weeks, months 

 or even a year after the operation, in the form of a perma- 

 nent constriction of the tracheal lumen, due to a collapse or 

 distortion of the rings, and a cicatricial contraction of the soft 

 tissues connecting and surrounding them. In the old, mature 

 horse, this sequel is much less liable to occur, because the 

 rings are hardened enough to preserve their contour against 

 inflammation and pressure. 



But in the suckling, the yearling, the two-year-old, tra- 

 cheotomy is positively damaging. The cartilaginous rings are 

 soft and "susceptible to injury that terminates in a permanent 

 deformity of their shape. 



