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Show ('9 Or Bnoncnorozur. or enoxcno'rom . The fact that those who die by suffocation from irritation or obstruction of the trachea are at length carried off by an infiltration into the cellular substance of the lungs, suggests with it an important consideration in surgical practice, viz. that in this as in many other operations, those performed, for the relief of the immediate paroxysm are unsuccessful, because they have been too long delayed and another disease has supervened to the first. 'Z' itence of the thyroid cartilage, or pomum Adami, carries his finger down upon the fore part of the threat for the space of a full inch; he finds there a depression and softness; moving his finger further down he feels the cricoid cartilage like a ring encircling the throat, but it is above this ring and in the spot where he feels the depression into which he is to introduce his canula. A large silver catheter, or the canula of a trocar, or even a large goose quill, or best of all, a piece of sheet lead rolled into a tube and smoothed, will be a substi- an" mum ‘ The occasions which may, according to general opinion, call for the operation of BROXCHOTOMY are, swelling of the tongue ; or swelling of the glands from salivation ; tumours of the amygdalzeés; ulceration of the upper part of the trachea or cpiglottis ; sudden and violent inflammation of the top of the larynx ; bodies wedged in the pharynx, or upper part of the oesophagus from which there is instant danger of suffoca, tute for regular apparatus. These I mention now, because it is an operation which requires to be done on the spur of the occasion. The regular instrument with the double canula is to be found in the shops; but I imagine a simple canula, hav- ing a slight but equal curve, and with a blunt stilette Would serve every purpose. For the perforation being made into tion, while our efforts to extract the bodies are ineffectual. ' instrument would easily follow. The size of the canula should be that of one of the nostrils. The surgeon makes an incision over this place with a small scalpel if he has it, or with his common lancet. _He then In these emergencies if the operation is to be done ten to one that no regular apparatus is prepared, but if it should be de liberately set about, then we may thus perform it. the trachea by the common lancet, the conical point of this clears the blood away and if possible waits until the bleeding OPERATION OF BRONCHOTOMY. ‘-Ia>. .1 ._ a} -"-*-'»:&-5". er-‘n-v" . ‘ .1 Tmans are two places at which the operation may be done. 1. Above the cricoid cartilage. 2. Nearer to the sternum and on the face of the trachea. The latter of these places I should prefer where there is inflammation. In the first place because it is more removed from the moveable glottis, the spasmodic constriction of which is probably the cause of the suffocation; and also because I conceive the operation may be performed in the trachea by merely making an incision and holding the edges of the trachea asunder with a small spatula, or any such instrument. To perform the operation betwixt the thyroid and cricoid cartilages, the surgeon, placing his finger upon the promi~ 'i'hese_ I .usput s m . 1.1}. cause much alarm, but not actual suffocation. is stopt, (using what means he can to that effect) then with the point of his lancet he perforates and introduces his canula obliquely downward and backward. In performing the operation on the fore part of the trachea these precautions ought to be observed. As in the other case we ought to have a scalpel, a lancet, eanula, and stiletto. When the finger is carried from the art. coirl cartilage downward, a softer eminence is felt on the fore part of the trachea, immediately after the finger has passed the cricoid cartilage :--This is the isthmus of the thyroid gland, and is carefully to be avoided. Below this, then, the external incision ought to be made, and carried downward an inch and a half. In the next touch of the knife the thyroid veins are to be avoided, and the sterno-hyoidei and thyroidei muscles put aside. If the veins have been put carefully aside, not cut across, and the thyroid gland, has been avoided. there |
