. Minor and operative surgery, including bandaging . thetrachea in the median line of the neck, and after the tracheahas been exposed it is opened by dividing two or three ofthe tracheal rings. Under certain circumstances the operation may be per-formed with very few instruments ; but if the surgeon hasthe choice, he will find it convenient to have at hand twosmall scalpels, one short grooved director, a tenaculum,two aneurism needles (which may be used as retractors),one pair of artery forceps, haemostatic forceps, two pairsof dissecting-forceps, a pair of scissors, a sharp-pointedtenotome, a
. Minor and operative surgery, including bandaging . thetrachea in the median line of the neck, and after the tracheahas been exposed it is opened by dividing two or three ofthe tracheal rings. Under certain circumstances the operation may be per-formed with very few instruments ; but if the surgeon hasthe choice, he will find it convenient to have at hand twosmall scalpels, one short grooved director, a tenaculum,two aneurism needles (which may be used as retractors),one pair of artery forceps, haemostatic forceps, two pairsof dissecting-forceps, a pair of scissors, a sharp-pointedtenotome, a pair of tracheal forceps, a tracheal dilator,tracheotomy tubes, tapes, ligatures, sponges, a flexiblecatheter, and feathers. The director should be short; theordinary grooved director is too long to use with satisfac-tion in operating upon the short necks of children ; sothat I use a shorter and somewhat broader one, having abevelled extremity, which allows it to be passed with easebetween the different layers of the tissues (Fig. 485). Fig. Authors tracheotomy director. Haemostatic forceps are also useful in controlling hem-orrhage during the operation in case of the division of 576 TRACHEOTOMY. vessels which bleed freely, when the operator from theurgency of the case does not think it justifiable to ligatethem at the time of their division. They may also beemployed under similar circumstances to clamp the isth-mus of the thyroid gland on either side of the tracheawhen it becomes necessary to divide it to expose thetrachea. A sharp-pointed tenotome is the instrument I prefer toemploy in opening the trachea, as its sharp point enablesit to be easily thrust into the trachea. Tracheal dilators of various kinds are employed, butthe most satisfactory tracheal dilator which I have em-ployed is that of Golding-Bird (Fig. 486), which is aself-retaining instrument; the blades are slipped throughthe tracheal incision and are then expanded by turningthe screw to which they are att
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