SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 27 



on by some form of broncliotomy, 28 recovered and 42 died, a 

 mortality of 60 per cent. And when it is remembered that in 

 two of the fatal cases the larvnx was not opened, thongli 

 tracheotomy was apparently performed ; and a third, in full 

 recovery thirteen da^^s after the operation, on the removal of 

 the canula, was suddenly suffocated before it cculd be replaced ; 

 and in another, the canula got dispjaced in front of the tra- 

 chea ; that in many, if not in most of the cases, the operation 

 was deferred till the last possible — that is the most unfavor- 

 able — moment ; that many cases that might have been rescued 

 were plainly allowed to die from exhaustion, or even from 

 positive suffocation, by timid doctors, in which the result could 

 not have been worse had an operation been performed, the 

 question of operation would seem to be decided. 



Yet I would not be understood as an advocate of rash and 

 indiscriminate broncliotomy. Its dangers are great, and not 

 to be undervalued. The question, however, is often between a 

 dangerous operation and a more dangerous refusal. In case 

 the attack is sudden and severe, so that life is in immediate 

 and positive peril, no question can arise as to the propriety of 

 an operation, wanting which, the patient perishes on the s))ot, 

 nor any question tliat crico-thyroid larjMigotomy is the easiest, 

 safest, speediest operation. Delay here means death. Of 14 

 such operations, 8, orST per cent., recovered, and in such cases 

 as are recorded by Emmet and Anderson, no words can add 

 force to the fact, that after life was apparently extinct, larj-n- 

 gotomy and artificial respiration saved 5, the delay of a few 

 minutes resulting fatally in the 6th case. A cut throat here is 

 not over-dangerous, and the operation is so simple, and may 

 be so Imperative that every medical man, as well as surgeon, 

 should stand ready to do it in case of impending death. 



But it is in the less suddenly threatening cases that judg- 

 ments may differ, and here I hope to be able to assist in form- 

 ing a decision. The moment, in a case of typhus or typhoid, 



