Sacramento daily record-union. [volume] (Sacramento [Calif.]) 1875-1891, 1888-02-25
TRACHEOTOMY.
THE OPERATION PERFORMED
UPON THE CROWN PRINCE.
is Re- rted To, and
Its Effects.


prominent physicians and surgeons in the
city, gave Cincinnati Enquirer reporter a
description of the operation to which the
Crown Prince was recently subjected Said
the doctor:
Tracheotomy is an operation resorted
TO when from any cause there is an OBJ
struction to the free entrance of air to the
lungs through the upper part of the air
passages. These air passages consist of a
tube about four and one half inches in
length and little less than an inch in di-
ameter. The upper part of this channel
is peculiarly arranged and narrowed this
is called the larynx. 1t is in the larynx
that by the vibration of two slender cords
sounds are produced. The framework OF
the trachea or larynx consists of rings Of
cartilage or gristle, clothed upon the in
side by a delicate skin, or mucous MEM
brane. Since the trachea is of larger cali
Der than the larynx that is above ii, the
difficulty in breathing, which would follow
an obstruction of any kind In the larynx
above, can be remedied, at least Temporal
rily, by opening the trachea or wind-pipe
below the seat of obstruction. This opera
ton is called tracheotomy, and the condi-
tions calling for it may be foreign body,
a tumor, an inflammation of the gristle, or
the presence of a membrane in the larynx
The latter is the condition in diphtheritic
Group, the disease most often calling for this
cheotomies are made in children and for this
disease, which so often appears in epidemic
form. In the case of the Crown Prince
the condition calling for tracheotomy has
been either cancerous tumor or an in
fiammation of the cartridges of the larynx,
with thickening of its lining membrane to
a degree greatly interfering with the free
entrance of air to the lungs. Which of
the conditions exists has not been posi-
lively determined, although from the opin-
ions of Sir Morel Mackenzie and Virchow,
the disease is probably pericondritis with
thickening liberation of the mucous men,
brane. Whatever be the disease, tracheot-
omy was indicated to alleviate the most
pronounced and dangerous symptom, the
difficulty of breathing. When made for
this purpose tracheotomy is not danger
Gus operation. Indeed, it was known and
practiced a hundred years before the
Christian era. The operation itself will
not be fatal in more than 10 per cent. of
cases, and when the fatality is greater it
depends upon the condition for which the
operation is made. If for example, trache-
otomy be made for the removal of for
eign body only 20 per cent. of the cases
operated upon will die, whereas, when the
operation is made in cases of diphtheritic
Group only 80 per cent. recover. This fa-
tality must be ascribed, not to the opera
ton, but to the disease, which extends
down the lungs or kills the patient by af-
fecting his blood. In the case of the Crown
Prince the tracheotomy may be but pre-
liminary operation, to be eventually fol-
lowed by one contemplating the removal
of more or less of the diseased larynx
above the tracheotomy wound
"The operation is sufficiently simple in
the hands of a good surgeon. The patient
is placed upon his back, with pillow
placed under the neck, and anasthetized.
A fold of skin is raised and transfxed with
knife, and a wound from one to two
inches in length is thus made in the cen
trail line of the neck from the prominent
portion of the larynx 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 windpipe is reached.
The 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 the central line
by an incision half an inch or less in
length. Through this incision in the
trachea a silver, albumen or hard rubber
tube is inserted, through which the patient
breathes. The operation itself does not
take long, and usually the tube can be
placed in the trachea within two minutes
of the time the cut is first made. This
tube remains in the trachea until the OBJ
struction to breathing disappears. Some
times, in cases of cancer or Inflammation
of the cartridges of the larynx, the tube
must be worn during the remainder of life.
Where the operation has been made sue
cessfully for the removal of foreign bodies,
or in cases Of diphtheric Group, it can often
be removed after the lapse of from one day
to week."
"And what effect will this operation
have upon the Crown Prince?'
'The operation is not curative. 1t will
probably prolong life, and that is ALL
Here, as in other cases, tracheotomy is
merely intended to relieve one symptom
the difficulty in breathing"
'Has the operation been often performed
in this city p
Every frequently, and almost always for
the relief of Group For this disease the
operation is a comparatively recent one,
and has been established particularly by
the French physicians, Brettoneau and
Trousseau, who were the leading lights of
Paris during the first half of the present
century. There is among the laity an abb
horrence for tracheotomy in Group, because
| fully seventy per cent. died notwithstand
the operation. Without it, however, for
its more recent substitute, intubation, all
| thus afflicted succumb In intubation the
tube is inserted into the larynx through
| the mouth, without an incision. This, in
the case of the Crown Prince, was in no
| way practicable. | do not think he has
much chance for recovery in case it is ne
| cessary to remove the diseased larynx"