The Indianapolis journal. [volume] (Indianapolis [Ind.]) 1867-1904, 1888-02-11
rr.oheotony and How Il Is Performed

Cincinnati Enquirer.
The operation of tracheotomy is of great in-
terest and has called forth much comment, es-
pecially among the medical profession. The
operation in itself is not unusual one, but is.
at the same time, very delicate. There is great
danger of striking an artery, and the deviation
OF quarter of an inch from the middle line OF
the throat may mean death to the patient DR..
Joseph Ransohof, one of the most prominent
physicians and surgeons in the city, was found
in his study and kindly gave the reporter de-
scription of the operation TO which the Crown
Prince was subjected, and also Interesting
points concerning his disease. Said the Doctor:
s'Tracheotomy is operation resorted to
when from any cause there is obstruction to
the free entrance of air to the lungs through the
upper part of the air passages. These air pas-
sages consist of tube about four and one half
inches in length and little less than inch in
diameter. The upper part of this channel p pc
culiarly arranged and narrowed; this is called
the larynx. 1t is in the larynx that by the vi
bration of two slender chords sounds pro-
duced. The framework oe the rrachea and
larynx consists of rings of cartilage or gristle,
clothed upon the inside by a. delicate skin or
mucous membrane. Since the trachea IS of
larger caliber than the larynx. that is above 1t.
the difficulty in breathing, which would follow
obstruction of any kind in the larynx above
can be remedied at least temporarily by opening
the trachea wind-pipe below the seat Of
obstruction. This operation is called tracheoto-
my. and the conditions calling for it may be
foreign body, tumor. Inflammation OF the
gristle, or tho presence of membrane in the
larynx the latter is the condition in diphthertic
Group, the disease most frequently calling for
this operation. Probably 80 per cent of all
tracheotornis made in children and for this
disease, which so often Appeara In epidemic
form. In the case of the Crown Prince the con-
dition calling for tracheosomy has been either q
cancerous tumor or an inflammation of the
cartiages of the larynx with thicksning OF its
lining membrane to degree greatly interfering
with the free entrance OF air to the lungs.
Which of these conditions exists has not been
ositively determined, although from the opin-
ions of Sir Morel Mackenzie aud Virchow the
disease is probably . pericondriiis with
thickening and liberation of the mucous
membrane. Whatever be the disease trache-
otony was indicated TO alleviate the most pro-
nounced and DANGEROUS symptom. the difficulty
in breathing. When made for this purpose,
tracheotomy is not dangerous operation In
deed, it was known and practiced hundred
years before the Christian The operation
itself will not be fatal in more than 10 per cent.
of cases, and when the fatality is greater it de-
pends upon the condition for which the opera
tion is made. If, for example, tracheotomy be
made for the removal Of a foreign body only 20
per cent of the cases operated upon will die,
whereas when the operation is made in cases OF
diphtheritlc Group only 30 per cent. recover.
ton, but to the disease, which extends down the
lungs kills the patient by affecting his blood.
In the of the Crown Prince the tracheoto-
eventually followed by one contemplating the re-
moval of more or less of the diseased larnyx
above the tracheotomy wound. The operation
Is SuLAclehEiy sIHp1o III INC minus VI Cooi Sur
geon. The patient is placed upon his back,
with pillow placed under the neck and an
nasthetized.
"A fold of skin lie raised and transfxed with
knife, and wound from one to two inches in
length is thus made in tho central line of the
neck from the prominent portion OF the larnyx
toward the upper portion of the breast-plate.
The knife is then laid aside, and with small
pair of forceps the soft parts are slowly torn
asunder until the wind-pipe is reached Tbs
bleeding, which is generally most feared, can be
entirely obviated by tearing through the soft
parts after the skin has been divided. When
the trachea is reached it is opened in rhe central
line by incision half an inch or less in length.
Through this incision IN the trachea silver,
aluminium hard rubber tube is inserted,
through which the patient breathes. The opera
tion itself does not take long, and usually the
tube can be placed in the trachea within two
minutes of the time tho cut is first made. This
tube remains In the trachea until the obstruction
TO breathing disappears. Sometimes. in cases
of cancer or OF Inflammation OF the carriages OF
the laruyx. the tube must be worn during the
remainder of life. Where the operation has
been made successfully for the removal of for
eign bodies, in cases of diphtheritic Group. it
can often DO removed after the lapse OF from one
day to q week. J"
s.And what effect will this operation havsup-
on the Crown prince7n
.sThs operation is not curative. 1t will prob
ably prolong life. and that is all Here, as In
other cases, tracheotomy Is merely intended TO
relieve one symptom, the difficulty in breath
ing
HAS the operation often performed in
this city7'
.svery frequently. and almost always for the
relief Of Group. For this disease the operation