T R A 



T R A 



Ac vertebral procefles by fmall tendons, which produce 

 mufcular flips united in the body of tlie mufcle : a 

 flattened tendon is the tiiedimn of infertion in the head. 

 When the right and left mufcle aft together, they reftore 

 the head, after it has been bent forwards, and they carry it 

 backwards. T;:c mufcle of one fide inclines the head and 

 neck lateraily. 



TRACHELOPHYMA, a fwelling of the thyroid 

 gland. See Bronchocele, and Thyroid Gland. 



TRACHELOS, a word ufed by fome anatomical 

 authors to exprcfs the neck. 



TRACHENBERG, or Drachenberg, in Geography, 

 a principality of Silefia, bounded on the N. by Poland, on 

 the E. and S. by the principality of Oels, and on the W. 

 by Wohlau. It was formerly a part of Oels, but erefted 

 into a diilinft principality, in the year 1 741, by the king 

 of Pruffia, in favour of the count of Hazfeld and Gleiclien, 

 who was made a prince of the empire, by the emperor 

 Francis, in 1748. 



Trachenbero, or Straburck, a town of Silefia, and capital 

 of the principality of the fame name ; 14 miles W.S.W. of 

 Militfch. N. lat. 51° 28'. E. long. 16° 50'. 



TRACHEOCELE, an enlargement of the thyroid 

 gland. See Bronchocele, and Thyroid Gland. 



TRACHEOTOMY, (from Tfocxw,., the ivkd-pipe, and 

 T!fiix; to cut, ) in Surgery, denotes the operation of making an 

 opening into the wind-pipe. 



When a foreign body has entered the trachea, the only 

 means of relief confifls in making a longitudinal incifion 

 through the (kin and cellular fubftance of the neck, in order 

 to expofe the wind-pipe, and flit it open in the fame direction. 

 Several of the old praftitioners conceived the propriety of 

 this operation, which Junkers, in his " Confpeftus Medi- 

 cinae Clnrurgicae," profcribed in the moft pofitive terms. 

 How, indeed, would it be otherwife poffible to put an end 

 to the fuffocation and convulfive cough, which the extra- 

 neous fubllance produces ? Few praftitioners, however, 

 have ventured to do the operation. In the year 1650, the 

 performance of it was recommended by Bonnet, upon a 

 child feven years of age, who, in eating fome rice-ioup, 

 fwallowed a fmall bone, which pafled into the trachea. The 

 young patient pointed out with his finger the place where the 

 foreign body had Hopped, arid which was exaftly oppofite 

 the middle of the throat. A phyfician, who was confulted, 

 gave it as his opinion, that the operation was improper, 

 either becaiife he was not convinced of the prefence of the 

 bone in the trachea, or becaufe he thought that it could not 

 be taken out without expofing the child to a certain death. 

 At the end of five days the boy died, and the trachea 

 having been opened, the extraneous fubftance was taken out 

 of it willi the greateft eafe. Raw and Heiiler alfo fuc- 

 cefsfully extracted foreign bodies from the trachea ; the 

 former, a piece of muftiroom, which had been fwallowed 

 with Ibme foup ; the latter, a bean, which had fallen into 

 the wind-pipe. 



Louis was not equally fortunate, in a cafe where the 

 operation would have infalhbly faved the patient's life. A 

 child feven years old, hke that of Bonnet, was amufing 

 herfelf with throwing up fmall dry beans, and catching 

 them in her mouth. She fuppofed flie had fwallowed one 

 of them ; but was inftantly feized with a difficulty of 

 breathing, and a moft fatiguing convulfive cough. It was 

 fufpefted tliat the bean had ftopped in tlie throat, and every 

 thing was tried, which was thought to be likely to make it 

 defcend into the ftomach, or caufe it to be ejedled from the 

 mouth. The fymptoms, however, recurred from time to 

 time, with the addition of conviilfions of the hmbs. The 



cafe had gone on in this manner two days, when Louis wag 

 confulted. He found the child fitting up in bed, leaning 

 upon her two arms, and breathing with difficulty. When 

 he alked her where flie felt any thnig the matter, ihe placed 

 her left fore-finger upon the tracliea, betwixt the larynx aad 

 the fternum. The confideration of the various circum- 

 ftances of the cafe made him conclude, that the bean had 

 pafled into the wind-pipe, and tliat the praftlce of broncho- 

 tomy was indifpenfably neceflary for itsextraftioii. Others, 

 who were called into confultation, entertained a different 

 fentiment. M. Louis could not bring them over to his 

 opinion. The oppofition which they made even increafed, 

 as the child appeared for a time 3 httle better. But at 

 length a new fymptom occurred, ^vhich no one had yet 

 obferved, and which two hours previoufly did not exift. 

 The child was evidently aff^efted with an emphyfematous 

 fwelling on each fide of the neck above the clavicle. She 

 took an emetic, which only had the effeft of difturbing her. 

 The third day ftie feemed more tranquil, tliough her 

 refpiration was always difficult. In the evening fhe died. 

 When the trachea was opened, the bean was feen lodged at 

 the upper pai-t of this tube, whence it admitted of being 

 moft eafily extracted with a pair of forceps. 



The long intervals of eafe which the patient had, contri- 

 buted particularly to throw doubts on the prefence of the 

 extraneous body in the trachea. It was fuppofed, that it 

 would neceflarily have kept up there a continual irritation, 

 which could not have allowed of the alternations of fuffer- 

 ing and eafe which took place. But the faft is, the body 

 was fmooth, and it had 'defcended below the glottis, the 

 fenfibihty of which is doubtlefs greater than that of the 

 trachea, fo that it only produced urgent fymptoms, when 

 it was forced by the aftion of refpiration againft the lower 

 part of the glottis, whofe ligaments it hurt, and whofe 

 aperture it clofed in fuch a manner, that the air was no 

 longer capable of paffing through it with its wonted free- 

 dom. It is to this caufe that the emphyfema, which has 

 been fpoken of, muft be imputed ; for the air being urged 

 back into the lungs, muft have ruptured fome of the bron- 

 chial cells, infinuating itfelf into the cellular texture of this 

 vifcus, and extending from below upward to the lower part 

 of the neck, the integuments of which were elevated by it. 

 This fymptom is truly pathognomonic. It w.as alfo 

 imagined, that if the extraneous fubitance had been in the 

 trachea, it would have caufed more quickly a fatal fuffo- 

 cation ; but there are many cafes on record, proving that 

 patients have furvived the accident a long while. Bonnet's 

 child, and another mentioned by Marcellus Donatus, did 

 not die until the fifth day. The only fymptom which the 

 laft experienced, was a flight cough, with a Httle irritation. 

 The cough which occurred before death was attended with 

 efforts, in which the child turned livid, as if it had been 

 ftrangled with a rope. Otlier children alfo, who have 

 fwallowed beans, and whole cafes are related by Louis, 

 died ; one on the eighth or ninth day after the accident ; 

 the other at the end of three weeks, and after having in 

 the interim followed the amufements of their age. 



Perhaps it may be apprehended, that a foreign body, after 

 its entrance into the trachea, will defcend by its weight to 

 the bottom of this tube ; or, that after the proper incifions 

 are made, its extraftion will be attended with too much dif- 

 ficulty ; but to thcfe two objeftions, experience gives the 

 moft decifive anfwer. In almoft all cafes of this lort, the 

 foreign body has been found oppofite that part of the tra- 

 chea which would have been ope.ied, if tracheotomy had 

 been performed ; and the experiments relating to this oper- 

 ation which have been made upon living animals, for the 



purpofe 



