TRACHEOTOMY TUBE AND TROCAR. 
97 
place lays bare the trachea. He then takes a common scalpel, and, 
having selected one of the junctions to the numerous rings of which 
the trachea is composed, makes a puncture sufficiently large to 
admit of the entrance of the point of the stilette. This done, he 
takes the instrument into his right hand, and, having rested the end 
of the handle against the ball of the thumb, thrusts it through the 
orifice he has previously made. Should the hole not be sufficiently 
large, the cutting edges come into play ; and if during the thrust 
the point of the stilette could possibly be driven against the mucous 
membrane, it is incapable of doing serious injury, it being made blunt. 
The stilette is then withdrawn, the canula being left in ; and when 
the shield has been adjusted, and the tapes attached to it have been 
tied, the business for the present is concluded. 
Probably, however, swelling may hereafter set in : it is then 
that we feel the use of the pin and screw. A few turns render 
it loose, when we can slide forward the shield, and afterwards 
make it once more secure at any point required ; thus preventing 
the end of the tube from being pressed and retained against the 
interior of the trocar. 
The great advantage which Mr. Gowing’s instrument confers is 
contained in the release which it gives us from the necessity we 
were formerly under of destroying comparatively large portions of 
cartilage, without any certainty that these would ever be restored. 
When Mr. Gowing’s instrument is used, nothing is taken away. 
A simple puncture through a structure far more vascular than car- 
tilage is the only outrage committed, and this can be speedily 
performed. In accomplished hands small assistance and little light 
are absolutely required. We could operate in the dark, or by 
ourselves, or with a sense of convenience, if we only had a man 
to hold the horse’s head. In acute cases, therefore, this trocar is 
every thing that we could desire. It is quickly used — it can be 
fitted in an instant to the smallest or the largest animal — it is 
easily adapted — it takes away no substance, but it makes a small 
wound, leaving little to heal and nothing to be restored. It is 
admirable for emergencies, and there is generally a pressure of 
circumstances when tracheotomy is resorted to. 
Mr. Gowing’s instrument is certainly the most ingenious and 
the best thing of the kind that we have seen. In make and 
