20 



THE TOXER LECTURES. 



sloughing tissue on which blood coagulates, may form a sort 

 of polyp which sullbeates the patient even in spite of trache- 

 otomy. 



Fig. 2. 



Laryngeal Ulcer after Typhoid. Polypoid Hrematoma hanging from it and 

 causing death by suffocation after Tracheotomy, a, upper end of incision. The 

 smaller cut, b, is a section of the Htcraatoma showing its two layers ; the centre 

 consisting of shreds of dead tissue hanging from the ulcer, and the outer layer of 

 clotted blood. Hoffmann, Verand der Organ, beim Abdom. Typhus, Taf. v. Fig. 16. 



The seat of the stenosis is threefold. Most frequently (25 

 cases) it is supra-glottic, that is, in the epiglottis and arj'-epi- 

 glottidean folds, especially where the oedema is primaiy, or 

 where it is caused by ulceration, or arytenoid perichondritis. 

 The next most frequent site is subglottic, i. e., about the cricoid 

 (22 cases). This is always, I believe, the result of cricoid 

 necrosis or perichondritis. Russell reports 2 cases following 

 typhus, which he regards as examples of Gibb's " subglottic 

 oedema." That the second was a case of ulceration and peri- 

 chondritis, is quite certain from the history, and most likely 

 the other was too. The larynx was normal down to the chords, 

 tracheotomy rescued both wlien suffocation was imminent, and 

 both were followed by stricture, requiring the permanent use 

 of the canula. The least frequent site of the osdema is in the 



