Tracheotomy is performed for supended anima tion, foreign bodies in the trachea, and oesophagus, chronic laryngitis, and trachitis; but, with the ex ception of the three last of these affections, laryn gotomy is to be preferred. This operation is done by making a longitudinal incision in the mesial line of the trachea, through the integuments, when the operator should feel that there be no artery pulsating, as the innominata and right carotid may come in the way of the knife. He must then pro ceed cautiously, avoiding the isthmus of the thy roid gland,and plunge the trocar and canula through the rings of the trachea obliquely downwards, withdrawing immediately the trocar.
During mastication and deglutition, fish and other bones, pieces of flesh, &c. are sometimes ar rested in their progress to the stomach, either in the pharynx or oesophagus. Fish bones are gene rally found sticking in the fauces or pharynx, so also are needles, pins, and fish-hooks; while bread, bone, flesh, gristle, cheese, coins, and other large bodies, are arrested where the pharynx becomes oesophagus; and when these objects are very large, they often produce instant suffocation; if not, they excite inflammation and suppuration, or gangrene, which ultimately prove fatal. But sometimes an abscess forms in the neck that bursts externally, from which they are discharged; at other times they are spit up, or fall into the stomach, and if in soluble, they are generally arrested in their course along the alimentary canal, and excite inflamma tion, ulceration, gangrene, and death; pins and needles, however, occasionally travel with impu nity over the whole body, when some are expelled per anum, others per urethram, others again through the skin, and some have been known to produce fistula in ano. When they are soluble in the gastric juice, and not sharp-pointed, they should be pushed down by the probang into the stomach; but if otherwise, they ought to be pulled up into the mouth, either with the common polypus forceps, or with a hank of thread doubled; so as to form a number of loops, and fastened to the pro bang, or with the hook end of that instrument. If the object arrested in the pharynx cannot be dislodged, and if it threatens suffocation, the operation of pharyngotomy ought to be performed, which is done by making an incision through the integuments and platysma myoides, on that side of the neck where the body projects most, parallel with the tracheal margin of the sterno-mastoid muscle, avoiding the external and internal jugular veins, the common carotid artery, and the nervus vagus, which ought to be held aside towards the dorsal aspect by an assistant, when the prominent object will appear, which should then be liberated by an incision through the muscular and mucous tunics of the pharynx. The knife should be later
alized with its edge towards the trachea. The ex ternal wound is afterwards approximated by ad hesive plaster, the patient kept extremely quiet, nothing allowed but milk or water for some days, which must be introduced into the stomach by an elastic tube, or the patient supported by injections of nourishing soups, per rectum.
The mammary gland is generally the seat of disease in the female, but rarely in the male. It is subject to phlegmonous and erysipelatous in flammation, to mammary abscess and sinuses, to excoriation and ulceration, to lacteal swelling, to the various species of sarcoma, to hydatid or en cysted swelling, to cartilaginous and ossific tu mour, to hypertrophy, and to simple chronic tu mour of the mamma. Inflammation of this gland is to be treated in the same manner as formerly recommended under inflammation; and the reader is also referred to the Article MIDWIFERY. The treatment ought to be active and prompt, as all glands are easily and rapidly ruined in their func tions by an injury done their structure. Under in flammation it is stated that coagulable lymph was effused, which in glandular texture unites its con glomerate portions in such a manner as to suspend the functions in the first place, and in the second to obstruct too often the secretion ever afterwards. The coagulable lymph lays the foundation for fu ture diseased organization, and forms the substra tum of the diversified variety of tumours, and in those tumours where no acute inflammatory action is present, a chronic state exists, which converts the secretion of the capillary vessels of the affected part from their natural to the diseased condition which they respectively assume, in precisely the same way as acute inflammation disposes these ca pillaries to secrete lymph or pus. This appears a simpler explanation, than Adams's multiplication of hydatids, or Dr. Baron's conversion of encysted hydatids into tubercles. For the phenomena and treatment of mammary abscesses and sinuses, see acute abscess, for in no respect do they differ from those occurring in any other part of the body, with this exception, that sinuses of the mamma should first be tried to be cured by injections of diluted acids. Exfoliation of a rib has supervened to deep abscess of this gland. Mammary inflam mation and abscess occur most frequently within the first three months after parturition. A deep seated abscess is described by Hey, but this is simply a chronic species of it. The excoriation and ulceration which attack the nipple are to be treated like ring-worm, tinea capitis, or noli me tangere, according to their severity. Lacteal swelling of one or more of the lactiferous ducts re quires to be punctured.