TRACHEOTOMY. 



487 



Hemorrhage is rare, the small amount of bleeding which 

 occurs proceeding from the division of some of the arterioles, 

 branches of the carotid, passing between the cartUages over the 

 surface of the inter-cartHaginous ligament. It ceases spontane- 

 ously, and never requires any special attention. 



Emphysema of the neck may take place when the cellular tis- 

 sue is very loose and the edges of the skin overlap the tracheal in- 

 cision. It generally subsides without interference, or by moder- 

 ate, regulated pressure. 



Tracheocele. — Eenault so denominates certain growths which 

 appear on the tracheal mucous membrane, as the result of the ir- 

 ritation produced by the friction of the branches of the tube which 

 come in contact with it. He claims to have noticed their appear- 

 ance six weeks after the removal of the instrument. The nature 

 of the tumor varies much. They may be purulent, but they are 

 more commonly fibrous and of slow growth ; and may sometimes 

 take the character of ossification of the cartilages. If these ob- 

 structions appear above the seat of the operation, the trouble is 

 easily remedied by the reintroduction of the tube, but if, how- 

 ever, they are found below that point, it is a more serious com- 

 plication, since it requires a second operation at a point below 

 that of the first. 



The obstruction of the trachea by plastic exudation above and 

 below the seat of the operation, or its contraction, caused by the 

 overlapping of the divided ends of the rings which may have been 

 incised, may also be met with, and can only, as in the former case, 

 be overcome by a second operation. We personally remember a 

 case in which the formation of a post-tracheal abscess, which had 

 produced extensive contraction in the calibre of the trachea, 

 proved fatal through the impossibility of the introduction of a 

 tube after a second operation. The patient had been treated sev- 

 eral weeks previously for an attack of strangles, which had re- 

 quired an operation, and some six weeks after his recovery was 

 brought back suffering with a severe attack of roaring. As he 

 entered our hospital he fell to the ground, and the second opera- 

 tion was rapidly performed by a longitudinal incision, but the 

 tubes we had at hand were all too large, and in a few moments 

 the animal died. At the post-mortem a large abscess was found 

 behind the trachea, just opposite the seat of the first operation, 

 and the pus in collecting had so compressed and deformed the 



