696 OPERATIONS. 



tracheotomy is employed, with extremely few exceptions, only on 

 horses which are at rest ; it may be concluded that, as a great 

 rule, it demands a much smaller opening than permanent 

 tracheotomy. 



INDICATIONS FOR THE USE. OF TEMPORARY TRACHE- 

 OTOMY. — The usual cases demanding this form of operation are 

 laryngitis which produces swelling of the part (oedema of the 

 glottis) ; abscess in or near the larynx ; and choking. The opening 

 may generally be allowed to close after about three days. 



ADVANTAGES OF PERMANENT TRACHEOTOMY.— The 

 relief obtained from the operation is often great and long con- 

 tinued. Leblano kept a roarer at work by means of his trache- 

 otomy tube for eighteen years. Since the year 1872, the tube 

 has been used with many roarers, among which were two 

 employed at fast paces. With this apparatus, which is very 

 simple and light, they were able to do their work as well as before 

 they became roarers, and have continued it for the past four 

 years. Several other practitioners have got equally favourable 

 results. Tracheotomy has enabled many horses, especially steeple- 

 chasers, to win races. In one cross-coimtry race a few years ago, 

 all the " placed " horses carried tubes in their throats. On the 

 other hand, we cannot get over the fact that in the majority of 

 cases, the full action of the relief, as would be required in racing, 

 lasts for only a comparatively short time; and very rarely, if ever, 

 restores the horse's " form " to what it would be, were he sound in 

 wind. That well-known steeple-chase horse, The Continental, may 

 be cited as a comparative exception j though even in his case, the 

 tube failed to render the breathing normal. 



DISADVANTAGES OF AND CONSEQUENCES FROM PER- 

 MANENT TRACHEOTOMY.-^Tlie wound must of necessity set up 

 to a greater or less extent, diseased changes in the bronchial tubes 

 and lungs on account of the putrid discharge which drops from it 

 into the windpipe. The presence of the tube, especially if the 

 instrument be unduly heavy and its branches inordinately long, is 

 liable to irritate and inflame the windpipe, with consequent ulcera- 

 tion of the mucous membrane, diminution of the calibre of the 

 windpipe from thickening of the mucous membrane and underlying 

 tissues, ossification of the rings of the windpipe in the neighbour- 

 hood of the opening, and formation of tumours. The air that goes 

 through the tube, lacking the natural preparation afforded by a 

 transit through the air-passages in front of the opening, is apt to 

 have an irritating effect on the bronchial tubes and lungs, especially 



