TRACHEOTOMY TUBE AND TROCAR. 
93 
present instance of fertile ability is a combination of two well- 
known tools which have long been in general use ; or, taking 
another view of it, we may say it is a novel application of the 
common trocar. The old pewter tracheotomy tube forms the canula, 
and into this the stilette, so far changed as to allow of its being easily 
withdrawn, is inserted. The reader will, from what we have said, 
comprehend the principle of the invention ; and it, therefore, now 
becomes our duty to refer to the benefits which its use bestows 
upon the patient, and the advantages it confers upon the operator. 
In the first place, it demands the very least possible amount of 
surgical skill. Those who are apt in the use of the knife may be 
inclined to view the circumstance we have named as scarcely an ad- 
vantage ; therefore it may be as well we should state the result of 
our professional experience on this subject. The old plan of operat- 
ing was not remarkable for being difficult ; but, nevertheless, under 
it we have seen various holes made, and pieces of cartilage re- 
moved, all of which we know were meant to be circular, but not 
one of which could be regarded as distantly representing such a 
figure. All kinds of eccentric shapes have been described ; and, 
among them, there were few irregular forms that were not in some 
manner depicted : but in each and all of them they seemed to have 
had a decided abhorrence of any thing round. The old tracheotomy 
tube was, however, round ; and as the space cut for its insertion 
was not round, it follows as a matter of course that, for its insertion, 
either more or less must have been taken away than ought to have 
been excised. Some persons may imagine an inch or two of carti- 
lage a point of small importance ; but that is a matter we should 
be ashamed to discuss publicly ; and to all who may entertain such 
an opinion we will content ourselves by stating, that in surgery it 
looks badly in the eyes of our employers when an act so perfectly 
gratuitous is performed. 
A circle of the dimensions needed for the old operation could not 
be cut with an ordinary scalpel, the blade of which is so broad that 
it renders the attempt ridiculous. Moreover, cartilage is not the 
best substance the surgeon could select for operation, especially as, 
in the trachea, that structure offers no special temptations, seeing 
it cannot be rendered fixed, and is always likely to be moved. 
There is, however, another difficulty which used to attend the old 
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