TRACHEOTOMY BY PUNCTURE OR INCISION. 
195 
is so slightly developed that no particular notice need be taken of it. 
In man, however, the operation is distinguished as superior, infeiioi, 01 
medial, according as the operation is performed above, below, or through 
the isthmus. 
In animals, and especially in horses, there is, therefore, a wide field 
for operation, comprising the space from the uppei end of 
the trachea to near its entrance into the thorax. The uppei 
third is covered by the panniculus of the neck, by the 
subscapulo-hyoideus, sterno-thyro-hyoideus, and stemo- 
maxillaris, but the last named passes on to the lateial 
aspect of the neck at the lower border of the upper thiid, 
thus leaving the anterior wall of the trachea coveied only 
by the first-named muscles below this spot. Gunther, 
therefore, prefers for the operation a point about one-thiid 
of the distance from the larynx to the chest, though he 
admits that it may be carried out higher or lower without 
disadvantage. Lafosse chooses the space between the thiid 
and fourth tracheal rings; Krieshaber, that between the 
larynx and trachea. As a rule, the space between the 
upper and middle thirds of the neck is the point selected, 
because it is convenient, interferes less with the appearance 
of the animal, and in the event of stenosis supervening, the 
operation may be repeated at a lower point. The pieju- 
dice existing in human surgery against tracheotomy as a 
dangerous operation has led to modifications, few of which, 
however, are practical. The various complicated tiacheo- 
tomes and bronchotomes proposed by Brogniez, Maity> 
Thompson, and others, and intended to simplify and facili¬ 
tate the operation, are not needed by practised operators, 
and are of little use in unpractised hands. Two operation 
methods can be distinguished: (1) Puncture ; and (2) Incision 
of the trachea. 
(1) Puncture of the trachea was recommended by Pilger, 
Gowing, Hayne, and others. Hayne’s method met with 
most approval, and consisted in passing a trochar, provided 
with a canula having lateral openings, transversely through 
the trachea (fig. 82). This operation required some skill 
and care, particularly in horses having well-developed necks, 
in order to avoid injuring the jugular and carotid; while _ 
even the large canula, used for heavy working-horses, did not admit suffi¬ 
cient air. The origin of this procedure, which does not possess even the 
advantage of being rapidly carried out, could only have been fear of using 
the knife Thompson’s tracheotome was designed to simplify operation, 
o 2 
Fig. 82.— 
Hayne’s 
tracheal 
trocliar. 
