TRACHEOTOMY. 



699 



into the windpipe. (11) The body of the tube should be of sucli 

 a length tliat the shield can rest comfortably against the skin, 

 witliout the skin and muscles which cover the windpipe being in 

 any way compressed between the shield and the arms. Mr. Jones, 

 who had great experience in the application of tracheotomy tubes, 

 condemned the use of washers, which many place between the 

 shield and skin, when the swelling caused by the operation has 

 gone down. Their employment naturally interferes with the clean- 

 liness of the part, and can be dispensed with by having two or 

 three tubes of different lengths of body ; provided, of course, that 



Fig. 1S3. — Position of Iraclieotoiiiy tube. 



expense is no object. (12) The branches (arms) should be of such 

 a form and lengtli that while giving free passage to the air to and 

 from the larynx, they will irritate the interior of the windpipe as 

 little as possible. The larger the arms, other things being equal, 

 the more liable are they t« cause inflammation and ulceration of 

 the interior of the windpipe. 



CHOICE OF A TUBE.— Among English permanent tubes, that 

 of Jones, and among Continental ones, that of Peuch (in aluminium) 

 appear to be the best. Leblanc's tube has the advantage that its 

 shield can be shifted either backwards or forwards on its body, so 

 that, with it, there is no need to use washers to fill up the space 



