The first lines of the practice of surgery: designed as an introduction for students and a concise book of reference for practitioners (Volume 2).

  • Samuel Cooper
Date:
1835
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Licence: Public Domain Mark

Credit: The first lines of the practice of surgery: designed as an introduction for students and a concise book of reference for practitioners (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    objections to this mode of operating, which is not more eligible when the object is to inflate the lungs. The following is the common method of performing bron- chotomy. When a free opening in the trachea is requisite, an incision may be made in the integuments, beginning just below the inferior lobes of the thyroid gland, and extending directly downwards about two inches. Each sterno-thyroideus muscle is then to be pushed a little towards its own side of the neck, and a longitudinal wound, of the necessary size, is to be made in the front of the trachea. The knife must not be carried either to the right or left, in order to avoid all risk of injuring the large blood-vessels; and the incision ought never to extend too near the first bone of the sternum, lest the subclavian vein be wounded. When the design of the operation is merely to make a pas- sage for the air, the incision in the trachea need not exceed half an inch in length. In some cases, the introduction of a tube into the opening, produces such irritation as cannot be endured: in this circumstance, Mr. Lawrence recommends the removal of a thin slip of the trachea, which will leave an artificial open- ing sufficient for respiration.* CHAPTER XXVIII. W^RY-NECK. In this complaint, the head is drawn towards one of the shoulders. In general, the face is turned towards the opposite side; but, occasionally, towards that to which the head inclines. The affection, when in a high degree, renders the head quite immovable, so that neither the patient, nor any other person, can place it in its proper position. Hence, when the patient wishes to look in any direction, except immediately before him', * {To avoid the irritation caused by the introduction of the tube within the trachea, a curvilinear or oval shaped ring may be used; the outer mar- gin made concave, to prevent the edges of the incision from slipping off behind it, and the anterior part of the ring projecting laterally in the form of a plate, similar to the plate of the laryngotomy tube.—The small silver wire doubled and bent in the form of a broad hook, one of which hooks is attached to each side of the incision, and kept.apart by pieces of tape, fastened to them, and tied behind the neck; having been used by Professor G. M'Clellan for several years past, and have the advantage of being rea- dily made by the surgeon for every case requiring the operation.]
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