TRACHEOTOMY. 701 



ring and in the lower portion of the ring immediately above it. 

 Instead of trusting to a knife to make am opening of suitable size 

 and shape, employ a tracheotome (that of Vandermarken for 

 preference) with which cut out a circular piece of cartilage of the 

 exact size required. This instrument has an arrow-headed rod in 

 the centre of its cutting surface, for insertion into the centre of 

 the piece of cartilage which is to be removed, sO' as to prevent it 

 from falling into the windpipe. Having removed the piece of 

 cartilage, the parts should be thoroughly dried with a disinfected 

 sponge (p. 70), or with a piece of antiseptic cotton wool ; and 

 the tube (which should have been previously disinfected) inserted. 

 Performed in this manner, there will be but little resulting 

 inflammation and swelling; and the horse will be ready for work 

 in a few days. 



THE OPERATION FOR TEMPORARY TRACHEOTOMY.— 

 Here, instead of making a preliminary cut through the skin, make 

 with one bold incision a longitudinal opening into the windpipe; 

 for experience teaches us that such a proceeding is followed by 

 less bleeding and swelling of the part, than if two or more cuts 

 , were made. The tube, after having been disinfected, is inserted 

 into the slit, which should have been made to correspond as nearly 

 as possible with the size of the body of the tube. In this temporary 

 operation, refrain from removing any of the tissue, so as to allow 

 the wound to heal up as accurately as possible, after the temporary 

 tube has been taken out. The precaution of limiting the incision 

 to the upper portion of one ring and the lower portion of the ring 

 immediately above it, should here be 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, 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 purpose, 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.— (1) 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 



