A manual of operative surgery . thither and thither in search of the slit-like opening, which isvery easily lost. The depth of the wound, the quantity of bloodand mucus which may fill it, and the movements of the trachea i$4 OPERATIONS ON HEAD AND NECK [part hi may readily cause the site of the opening to be lost, especiallyif the trachea has not been well exposed and the fascia freelydivided. Provided that the trachea has been incised and thesharp hook is still in place, dressing forceps or the special curveddilator with separating blades will readily enable the tubeto be introduced in case o
A manual of operative surgery . thither and thither in search of the slit-like opening, which isvery easily lost. The depth of the wound, the quantity of bloodand mucus which may fill it, and the movements of the trachea i$4 OPERATIONS ON HEAD AND NECK [part hi may readily cause the site of the opening to be lost, especiallyif the trachea has not been well exposed and the fascia freelydivided. Provided that the trachea has been incised and thesharp hook is still in place, dressing forceps or the special curveddilator with separating blades will readily enable the tubeto be introduced in case of difficulty. This is, of course, sup-posing the vertical incision in the tracheal wall has been madelong enough. It is most important not to incise the trachea in two separateplaces. It will usually be found more convenient to restore thechilds head to the erect position before the tube is the tube is in place—and not before—the sharp hook isremoved. The tube is secured in place by tape, and the wound below. FIG. 287.—PARKERS TRACHEAL ASPIRATOR. the tube is brought together by a suture or two of silkwormgut. A piece of lint properly shaped and smeared with boricacid or carbolic oil is placed under the shield of the tube, andis made to cover and protect the wound. Each end of the wound will probably require one or twosilkworm-gut sutures to approximate the edges. Rapid and efficient sponging with small pieces of fine Turkeysponge is of great service throughout the operation. 5. Detachment of Diphtheritic Membrane.—Before the tubeis inserted an attempt may be made in all cases of diphtheriato rid the trachea of false membranes and retained secretions. A moistened feather is passed into the windpipe and rotatedso as to detach any false membrane and to draw it out. As arule, however, the urgent necessity of introducing the tube makesit advisable to effect this clearing with feathers passed through chap, v] BOSES TRACHEOTOMY 185 the latter. Harm may be done
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