WOUNDS. 



Wounds of the trachea are either fimple or complicated. 

 In both defcriptions of cafes, the ufual fymptoms are, an 

 emiffion of air between the Ups of the wound, lofs of the 

 voice, and fometimes emphyfema. Such injuries of the 

 windpipe as are not comphcated either with hemorrhage, 

 emphyfema, or lofs of fubftance, may for the moll part be 

 eafily cured by means analogous to thofe which are em- 

 ployed for the cure of wounds in general. The re-union is 

 ftill more eafily accoraplifhed, when the trachea is divided 

 longitudinally, than when it is cut tranfverfely. If the 

 wound be of a certain fize, and attended with hemorrhage, 

 the firft indication is to tie the bleeding veffels, and, in par- 

 ticular, to obviate the inconvenience and danger which 

 would refult from the infinuation of the effufed blood into 

 the windpipe ; an occurrence which has fometimes proved 

 fatal. (Wilmer's Cafes and Remarks in Surgery, p. 92. ) 

 In order to prevent fuch an unfavourable event, fome fur- 

 gical writers recommend the external wound not to be 

 clofed while any oozing of blood continues, fo that this 

 fluid may readily find an external outlet, inftead of falling 

 into the trachea. (LafTus, Pathologie Chir. tom. ii. p. 291. ) 

 To us it appears, that the beft mode of preventing the 

 occurrence is to bring the edges of the wound of the tra- 

 chea into contaft by a fuitable pofition of the patient's head, 

 and, if requifite, even by a future. 



The greater fenfibility of the larynx, its complicated 

 ftrufture, and the number and fize of its blood-veflels, ceteris 

 paribus, render wounds of it much more dangerous than 

 thofe of the trachea. In the firft volume of the Memoires 

 de I'Acad. de Chirurgie in 410. many cafes may be con- 

 fulted which furnifli proofs of this obfervation. In general, 

 however, wounds of the thyroid cartilage heal very favour- 

 ably, when not accompanied with injury of other important 

 parts. 



Tranfverfe wounds, dividing oiJy the anterior half of the 

 upper part of the trachea, ufually have a favourable termi- 

 nation, and when the cafes are of this defcription, the 

 carotids and jugular veins for the moll part efcape injury. 

 Gun-fiiot wounds of the trachea are more dangerous, but 

 experience proves that they alfo frequently end well. 



The greater number of tranfverfe wounds of the trachea, 

 which have not divided this tube completely through, readily 

 admit of cure by the ftrift obfervance of a proper pofition. 

 When tlie patient's chin is brought downward and forward 

 towards the ilornum, and the head is maintained in tliis pof- 

 ture with pillows, the edges of the wound in the trachea 

 become fpontaneoufly approximated to each other, and in 

 time will grow together. 



The manner in which the employment of futures aggra- 

 vates the cougli, and iriflames the wound, often neceflitates 

 the furgeon to withdraw theni when they have been applied. 

 It may alfo be truly afferted, that befides the irritation 

 which they create in the trachea as extraneous fubftances, 

 they are (to fay the beft of them) very unnecefiary. No- 

 thing has a greater tendency to impede the union of a wound 

 of the trachea than the dillurbance of a frequent convulfive 

 cough ; and the irritation of futures always increafes this 

 hurtful fymptom in a much greater degree than they can do 

 good by maintaining the edges of the wound in contadl. In 

 faft, unlefs the greater portion of the diameter of the tra- 

 chea be divided, there never can be fuch a fpace between 

 the edges of the wound, that they cannot be brought to- 

 gether with the affiftsnce of a judicious pnftiire of the 

 head. 



When the patient is much afflifted with incelTant cough- 

 ing, and the inflamed Itate of the wounded parts appears to 

 operate as the caufe of this difagreeable fymptom, relief is 



to be obtained from bleeding, and the exhibition of foothing 

 and aperient medicines. In cafes in which no particular 

 local irritation can be fufpedled of giving rife to the cough, 

 the furgeon may prefcribe the almond emulfion, fpermaceti 

 mixture, and opium, which will frequently be found reme- 

 dies of the moil decided efficacy. 



In order to prevent the entrance of the difcharge and 

 blood into the trachea in particular inftances, the plan has 

 been tried of making the patient lie on his fide, with liis 

 face turned downwards. (See Mem. de I'Acad. de Chir. 

 tom. i. p. 581.) But, although the cafe here referred to 

 ended well, we believe, as already explained, that nothing 

 prevents the entrance of blood or matter into the trachea fo 

 effeftually as keeping the edges of the wound of this tube 

 accurately in contaft, which is to be principally effefted by 

 bringing the chin down towards the breaft. This is an 

 objeft which is far more difficult of accompliftiment, where 

 the patient lies on his fide, than when he remains, as is moft 

 ufual, upon his back. 



When a wound has detached the upper portion of the 

 trachea from the lower one, and it is not immediately fatal 

 from the injury of other important parts, the bleeding velFels 

 are firft to be tied, and the two ends of the trachea are then 

 to be brought into contadl. In this fort of cafe, we believe 

 that the employment of a future is warrantable, on account 

 of the immenfe feparation of the divided parts, and the in- 

 efEcacy of pofition alone to prevent it. But, even in fuch a 

 cafe, one ftitch will be quite enough when the chin is pro- 

 perly approximated to the fternum, and the needle ftiould 

 never be introduced through the membranous lining of the 

 windpipe, as it is very fenfible, and much difpofed to inflam- 

 mation. 



The hoarfenefs and weaknefs of the voice, fometimes 

 remaining after the wound is healed, often gradually dif- 

 appear. 



Many furgical writers recommend the patient to refrain 

 from making forcible expirations, and from drawing the 

 head fuddenly backwards, for a certain time after the wound 

 is healed. By fuch caules, it is alferted, the recent coa- ™ 

 lefcence of the wound may be eafily deftroyed. H 



Wounds made with bullets, which ftrike the fide of the 

 neck and lacerate the trachea, have frequently been ob- 

 ferved to terminate well. (Mem. de I'Acad. de Chir. tom. iii, 

 p. 151, &c. edit. i2mo. ) Ravaton mentions feveral in- 

 ftances, which not only got well, but were alfo followed by 

 a recovery of the voice. 



Sutures are not applicable to thefe cafes. A ftrift adop- : 

 tion of the pofition recommended above, and the application 

 of an emollient poultice contained in a fine linen bag, are 

 the chief local chirurgical meafures. The ufe of leeches, : 

 venefeftion, faline medicines, and antiphlogiftic remedies 

 of every defcription, will alfo be generally proper. (See 

 Firft Lines of Surgery, p. 387. edit. 3.) Opium is like- 

 wife not to be forgotten as an extremely ufeful medicine in 

 cafes of wounds about the throat : it not only appeafes the 

 cough with which fuch injuries are often accompanied, but 

 tends to quiet the great mental and nervous anxiety which 

 in examples of attempted fuicide cxifted previous to the in- 

 fliftion of the wound, and generally continues for fome time 

 afterwards in a very aggravated degree. Indeed, many of 

 the unhappy perfons who attempt to deftroy themfelves by 

 cutting their throats, ftill retain for a good while after the J 

 failure of the firft attempt, a determination to take another i 

 opportunity of accomplilhing their fatal purpofe ; hence . 1 

 fuch patients cannot be too clofely watched, and nothing j 

 like a razor or a knife (hould ever be put within their 

 reach. The neceffity of a conftant vigilant attendant is 



alfo 



