If both tonsils are enlarged they should both be operated on at the same sitting, and the pain is so slight that even children frequently make little objection to the second operation. Bleeding is rarely troublesome if the portion be at once fairly removed, but if in the patient's struggles the hook should slip before the cut is complete, the partially detached portion will irritate the fauces, cause coughing and attempts to vomit, and sometimes a troublesome hæmorrhage. The plentiful use of cold water will generally be sufficient to stop the bleeding, though cases are on record in which the use of styptics, or even the temporary closure of a bleeding point by pressure, has been necessary. M. Guersant has operated on more than one thousand children, with only three cases of any trouble from hæmorrhage, while four or five out of fifteen adults required either the actual cautery or the sesqui-chloride of iron.[126] FOOTNOTES: [114] Rough diagram of operation for salivary fistula:--A, section of cheek close to buccal orifice; B, section of zygoma, muscles, etc.; C, the duct of the parotid; D, the fistulous opening of the cheek; E E, the thread knotted inside the mouth; F, the palate. [115] _Lancet_, Feb. 4, 1865. [116] _Med. Times and Gazette_ for Feb. 10, 1866. [117] _Lancet_, April 20, 1872. [118] _Transactions International Medical Congress_, 1881, vol. ii. p. 460. [119] Gross's _Surgery_, vol. ii. p. 472. [120] Langenbeck, _Archiv_, ii. p. 657. [121] _Med. Chir. Trans._ for 1867-8. [122] Diagram of staphyloraphy, chiefly to illustrate the passing of the threads:--_a_, the first thread; _b_, the second. The dotted line at edge of fissure shows amount to be removed; the other dotted lines showing size and position of the incision through the mucous membrane above. [123] Holmes's _Surgery_, vol. ii. pp. 504-513. [124] _Edinburgh Medical Journal_ for Jan. 1865, Mr. Annandale's instructive paper on "Cleft Palate." [125] Diagram of fissure of hard palate:--_a_, anterior palatine foramina; _b_, posterior palatine foramina with groove for artery; _c_, incisions requisite to free the soft structures. [126] Holmes's _Diseases of Children_, p. 555. CHAPTER IX. OPERATIONS ON AIR PASSAGES. OPERATIONS ON THE LARYNX AND TRACHEA.--The great air passage may be opened at three different situations, and to the operations at these different places the following names have been given:-- _Laryngotomy_, when the opening is made in the interval between the cricoid and thyroid cartilages, through the crico-thyroid membrane. _Laryngo-tracheotomy_, when the cricoid cartilage and the upper ring of the trachea are divided. _Tracheotomy_, when the trachea itself is opened by the division of two, three, or more rings.