FRACTURE OF THE TRACHEA. 
209 
extending from the submaxillary space to behind the shoul- 
ders. There was a peculiar state of the injured part, to be 
referred to again hereafter, but no external wound. 
Professional aid having been obtained, the case w T as re- 
garded as of little importance, and treated accordingly ; and 
on the following morning (Dec. 16 ), a dose of cathartic 
medicine having been administered, nothing further was 
thought necessary to be done. The medicine was given 
about 8 a.m. At 9 o’clock, the mare appeared to Mr. 
Griffiths as if dying, and my attendance was requested 
this afternoon. On an examination, I gave as my diagnosis 
■—fracture of the trachea. 
Symptoms , — Pulse weak, indistinct, and 50 per minute. 
Respiration 30, not painful or laboured, but any attempt 
being made to move induces extreme dyspnoea, which is 
attended with efforts, frequently ineffectual, however, to 
cough. The air is arrested in its passage upwards, giving 
rise to urgent symptoms bordering on suffocation. After 
shaking the head to and fro for a short time, relief is obtained 
by the escape of the air with, however, scarcely any audible 
sound. The mucous membranes are moist and red; a little 
coagulated blood adheres to the nostrils; the expired air 
is of the natural temperature ; the action of the lungs is not 
much disturbed ; the body, legs, &c. are comfortable. The 
most serious symptom is great depression. The patient for- 
tunately possesses a good constitution and is in admirable 
condition ; a circumstance, by the bye, which has materially 
limited the extension of the emphysema. 
The skin of the neck is merely scratched, but there is 
a hemispherical enlargement, four or five inches in diameter, 
which is rendered tense in expiration, and when the animal 
coughs it is particularly so. In inspiration it is soft and 
much diminished in size. It consists of the skin separated 
from the adjacent tissues, and distended with air, derived 
directly from the trachea. By pressure, the swelling may be 
made totally to disappear, but not without creating much 
annoyance, and some difficulty of breathing. The pain of 
coughing seems to be due to an arrestation of air in this 
receptacle, and its alternate ingress and escape gives rise 
to a peculiar flapping sound. The right sterno-maxillaris 
muscle is dissevered, so to speak, in the natural direction 
of its fibres, forming an opening sufficiently large to admit 
the tips of the fingers. 
The precise direction of the fracture is not discoverable. 
The absence of any sensible depression in the neighbour- 
hood, and the amount of dyspnoea lead to the inference 
xxvm. 27 
