A case of tracheotomy for multiple neoplasms of the larynx : clinical lecture delivered at Jefferson Medical College Hospital / by J. Solis-Cohen.

  • Solis-Cohen, Jacob da Silva, 1838-1927.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: A case of tracheotomy for multiple neoplasms of the larynx : clinical lecture delivered at Jefferson Medical College Hospital / by J. Solis-Cohen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    small conjunctival forceps, giving one pair to an assistant and taking the other myself. Now, lifting up the fascia between us, I divide it layer by layer between the two instruments, I like this method better than using the grooved director, and we shall so continue dividing the fascia layer by layer until we see the white line between the pairs of sterno-hyoid and sterno-thyroid muscles. A few strokes bring the knife between these muscles, and we continue down until we get to the trachea. After separating these muscles by retractors in the hands of two of our assistants, we shall arrest the bleeding, if there be any, before incising the trachea. Ordinary bleeding is stopped with pressure from pieces of ice in a cloth, as we are doing here, or with hot water. Should these fail, we would use ligatures or the forceps. The slight bleeding being restrained, you see here distinctly the isthmus of the thyroid gland in the upper portion of the Avound, and below it the trachea, recognizable by its cartilaginous rings. Before incising the trachea, you see that I take a small sharp spoon and scrape away the connective tissue in the middle line to the width of an eighth of an inch on each feide of the proposed line of incision. This will prevent emphysema being caused by coughing. Any air escaping by the sides of the tube will not be driven under the connective tissue and skin ; for it is in tliat way that the skin becomes puffed up, and the trache- otomy-tube displaced. If you take away the connective tissue there is no place for the air to accumulate, and that which escapes will get away by the side of the tube. Having freed the trachea from the superimposed connective tissue in the middle line, I penetrate it with the point of the same knife I have used all through, inserting it with the cutting-edge upward through the lowest interspace accessible; and now, as it penetrates the trachea, you hear the air escape along the grove in its back. With a sawing movement I continue the incision upward until I have divided three interspaces and two cartilaginous rings. I now withdraw the knife and lay it aside, and at the same time place the nail of my left forefinger between the edges of the incision in the trachea. Drawing the right lip of the incision a little aside, I am able, without the slightest impediment, to introduce the greased silver canula armed with its catheter-like tube-conductor. You feel the expiratory current of air escaping from the orifice of the pilot-tube, showing you that the tube is in the windpipe. The patient is now raised, and an assistant ties the canula around the neck, in such a manner that the knot shall be at one side. Meanwhile I remove the pilot-tube and insert the inner tube; and now the operation, save for the dressing, is complete.