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instance only (Case III.) did the patient require urging. 2d. 

 As this disease sometimes supervenes in the progress of phlegmonous 

 inflammation affecting the parotid or submaxillary regions, and 

 attended with rigidity of the lower jaw, the difficulty of separating 

 the jaw might be insurmountable. In this case tracheotomy would 

 be the only resource. The most suitable means of overcoming the 

 obstacle in such a case, would be the cautious use of wooden wedges 

 to pry apart the jaws. 



The difficulties on the part of the operator, where the requisite 

 knowledge of the anatomical relations of the parts and the necessary 

 skill are possessed, are by no means formidable. The accompanying- 

 plate (Plate I.), together with the description already given of the 

 operation, it is believed will render the subject sufficiently plain. 



The dangers of the operation are either of producing suffocation 

 by exciting spasm, or of inflicting injury with the knife on neigh- 

 bouring parts. In regard to the first, more extensive experience 

 alone can decide the question. In Cases III. and IV. it was sub- 

 mitted to a severe test; at all events the danger from this source 

 can scarcely be equal to that of the disease itself. 



In regard to the danger of wounding neighbouring parts, the 

 action of the knife is limited on either side by the sides of the thy- 

 roid cartilage, which shut in the glottis and render access to the 

 great vessels impracticable. In the swollen state of the lining mem- 

 brane, the scarifications, unless carried to an undue extent, would 

 not be likely to involve anything beyond the membrane itself. 



It will be for future experience to determine in what particular 

 conditions of this disease the operation may be inapplicable. The 

 advantages of its early application are shown in Cases I. and II. ; 

 and in Case III. the patient's obstinate refusal to submit to 

 tracheotomy compelled our sole reliance on scarifications, and that 

 in circumstances of the most imminent danger from impending suf- 

 focation. 



Although oedema of the glottis is a disease confined to adult age, 

 yet an analogous condition of the larynx is accidentally produced in 

 children by their attempting to drink scalding water from the spout 

 of a tea kettle. Numerous cases of this accident have been reported, 

 in which death took place from suffocation, with symptoms of croup, 

 and in which the edges of the glottis and epiglottis were found swol- 

 len and blistered. A few of these cases have been saved by tracheo- 

 tomy. Scarifications would seem to be equally applicable for their 

 relief, and Dr. Marshall Hall, in 1821, {Med. Cliir. Trans., vol. 



