B R O 



B R O 



lagiwoiis rings, (i. e. in the diredlion of the wind-pipe itfi:lf), 

 exaftly oppofite, or a htt'.e below the foreiii;ii fiibltance. 



Several kinds of inltrumcnts have been propofed for exe- 

 cuting this fimple operation ; l\ich as concealed lancets, 

 trocars and cdnuLt, guarded fcalpcls, Sec. But, we cannot 

 conceive what hazard or difficulty (honld occur to a fur- 

 geon who is at all ufed to handle a common dilFcfting knife, 

 in making a longitudinal incilion through the fore-pnrt ol 

 the neck and trachea. Wc are very much inchned to iiin- 

 plify all chirurgical operations and inftrunienls ; nithcr than 

 to make a parade, which fom^times tends to magnify real 

 difficulties, or to create imaginary ones in the eyes of a 

 young praAitioner. Befidcs, the operation of wtiich wc are 

 now treating is among the number of thofe which nfually 

 call for prompt and definitive mcafures ; wherein the fur- 

 geon has no opportunity, (except in large cities), to ftutch 

 for curious inftruments, and, tiierefoie, (hould feci confi- 

 dent, that his bufmefs may be well periormtd without them. 

 The apparatus eifentially necelTi^ry, on this and many other 

 important occafions, will, doubtlefs, be in the pofllfTion of 

 every furgeon, or may be cafily obtained when called for. 



The following has been recommended as one of the bed 

 modes of performing the operation of Bronchotomy : 



The patient is placed upon a low ilool, or in that pofture 

 in which he finds it moll cafy to breathe ; his head is held 

 lipri;iht, but by no means bent backwards, and fecured by 

 an affiftant. Oppofite the third or fourth cartilaginous ring 

 of the trachea, the ficin is now drawn up into a high ciofs 

 fold ; and it is cut through exaftly at the middle of the 

 trachea, to fuch a d'.pth, that when the fold is let go, the 

 incifion extends itfelf longitudinally from the fird cartilagin- 

 ous ring down to near the upper extremity of the fternum. 

 By making the incifion of a proper length, the operation 

 will be greatly facilitated, as its edges can then be drawn 

 farther from each other. 



As foon as the haemorrhage has been entirely (lopped, that 

 part of the trachea, where the inciiion is finally to be made, 

 mud be laid bare, by diffeifling away the cellular I'ubll.nice 

 and mufcular fibres fittiated about the membranous iiitcrftice 

 between the third and fourth ring, and by either entirely 

 removing them or prcfTing them fideways. The operator 

 then places the nail of the fore-finger of his left hand upon 

 this interftice; and applying the thumb and middle finger of 

 the fame hand to botli fides of the trachea, he pulhcs the 

 point of his inftrument, which mull previouHy be dipped in 

 fome frelh oil of almonds, along the nail of his fore-finger, 

 through the above mentioned menribranous intetilice, be- 

 tween the third and fourth cartilaginous ring, into the tra- 

 chea. He then applies the fore-finger of his left hand to 

 one or the other ol the cartilaginous rings, clofe to the tube 

 or canula, in order to hold it back whilft he withdraws tlie 

 blade of his inllrument. If we make ufe of Richter's curved 

 inftrument, we mult move the hand upwards in pufliing it 

 in, in order that we may turn the point of the inllrunicnt 

 downwards, and prevent its touching the back part of the 

 trachea. 



But in order that we may prevent the tube from (lipping 

 out of the wound, and alfo to prevent its movnig to and fro 

 in the trachea, feveral dolTils are introduced above and be- 

 low into the wound, fo as to keep the lips afuiider. To the 

 rings, on both fides of the external opening of the tube, two 

 narrow flips of linen are applied, which prefs the rings 

 down upon the trachea ; and the whole is covered and fecured 

 with adhefive plaller. And that none of the fluids which 

 are coUefted in the wound may make their way into the 

 canula and wind-pipe, the patient mud lie or fit inclined on 

 ore fide, and the wound mud, from time to time, be wiped 



dry with a fponge. '^Vhen the tube filli with miiciif, it 

 mud be cleaned with a fmall feather; or two fiich tube;; may 

 be employed, one cnclofing tlie other, and cither of them 

 removed, when necellary, tor the [xirpofc ol cLaring it of 

 mucus. 



As an improvement upon the iiidruments heretofore employ- 

 ed, Mr. Btrjamiii Bill propofts one which has nearly thctorm 

 of a flat draight tiocar, and ought iii ver to be Icfs than two 

 inches in length. Before it is pu(hcd between the two car- 

 tiiagis, it mud fird be thrud through feveral linen comprcd'es, 

 winch not only leive to cover the j)lcdgit of ointii'.ent in- 

 tended to proteft the wound, but tvllo produces the advan- 

 tage that (by removing one or more of the conipr.-n'c', whie'i 

 may be done by cutting them open at the fides with a pair ol 

 fcilTars,) we are able to incrcafe the length of the tube at 

 pleafure. In order to fecure the tube in the fituati.-n where 

 it is left after the opeiation, he pafRs it through an optn- 

 ing in a plate of pohihid Heel, which is curved fo as t > fit 

 to the fhape of the fore-part of the neck, and fa'.ltr.rj be- 

 hind with draps and a buckle. To prevent any foreign lub- 

 dance fiom getting through the orifice of the canula into 

 the trachea, it may be covered with a piece of fine gau/e, 

 which (liould previoufly be wttted, that the dud may not 

 penetrate through it, but dick to the outfide. 



When the caufe which gave rife to the operation hai 

 been removed, and the patient can again breathe through 

 his moutti, the tube is withdrawn, and the orifice healed up 

 like any other wound ot the windpipe; in doing whicli 

 great caution (hould be uled, led any thing fliould get irlo 

 the trachea, which might pioduce dangerous confcciUfncet. 



MelTrs. Chojjart and Default propofc, that the ir,cifioii 

 into the trachea ihould be made between the thyroid and 

 cricoid cartilages, and through the ligamentum ciio-thyroi- 

 deum ; which, however, we cannot recommer.d, on account 

 of the far greater fenfibi!ity and irritability of the larynx, 

 whereby the moll violent fymptoms, threatening immedhde 

 (udocatiim, might be excited. 



When this operation becomes necelTary, on account of anv 

 foreign fubdance lodging in the trachea, it may be per- 

 formed in the toUowing manner. The i;itegumcnts arc 

 fird divided as above defciibcd ; and a longitudinal incifion 

 is made at the anterior part of the tracliea, from above, 

 downwards, through three or more of the cartilaginov.s 

 lings. An affidaiit then draws afunder the fides of the 

 wounded trachea with ^ blunt hook, upon which the ope- 

 rator introduces a crooked forceps, with which, he carefully 

 feeks for, and extratls the lortigii body. 



In this cafe, it is alfo indllpcnfably neceiTary, that the 

 himorrhagc from the external wound fhould be entirely 

 ftopped before any incifion is made into the trachea, as 

 otheiwife a very violent cough would be excited. 



If an extraneous lubdance Ihonld dick in the larynx, it 

 might perhaps be dangerous, (as lomc have advifed), to cut 

 the thyroid cartilage longitudinally, firce this operation 

 would excite very violent coughing ; and might likewife be 

 fuperfluous, if it were poffible to lay hold of tlie foreign 

 fubitance with a crooked forceps, introduced through an 

 incifion made at the ufual place, below the cricoid cartilage. 



BRONCHUS, in Avatotin; properly denotes the lower 

 part of the ajpcra arterla, dividing into bronchije, or branches. 

 In which lenfe bronchus dands contradillinguidied fio;n 

 larynx. 



The name bronchus is alfo extended to the whole afpcra 

 arterla, or trachea. 



Bronchus alfo denotes a perfon affll^-ied with a bron- 

 choctle, or tumour of the throat, called by Uipina guttu- 

 roj'us. 



5 BRON- 



