SUllGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 29 



that perichondritis is recognized and serious dyspnoea sets in, 

 without waiting for repeated attacks to exhaust the slight store 

 of strength, all of which will be needed during the subsequent 

 separation of the necrosed cartilage, and the sloughing of the 

 soft parts. 



In other cases than those of perichondritis such haste will 

 not be necessary : }■ et if the respiratory murmur be progres- 

 sively enfeebled ; if pulmonary congestion set in; if the parox- 

 ysms of dyspnoea increase in frequency and severity, especially 

 if orthopnoea arise ; if the local disease be extensive or rapidly 

 increasing ; or if the general feebleness be so great that a little 

 further interference with the respiration will destroy life; then 

 no time is to be lost. Doubt is certain death. 



What operation shall be performed ? If an instant operation 

 be needful, cricothyroid larj-ngotomj^ is the best ; if time allow, 

 tracheotom}-. But if the cricoid be involved, with Beck, I 

 w^ould advise laryngo-ti-acheotomy, i. f., tracheotomy pi'olonged 

 through the cricoid ; since it would allow readier access to the 

 seat of the disease for the discharge of pus, the removal of any 

 loose piece of cartilage, and the treatment of any ulcers or 

 granulations. These I regard as greater advantages than the 

 danger of possible collapse of the lateral halves of the cricoid, 

 which is prevented in part by the canula, and would not imi)ede 

 the respiration even if it occurred. Unless necessary, it is 

 liest not to operate during a paroxjj-sra ; since the mechanical 

 difficulties of the operation are then largely increased, and tlie 

 danger of entrance of air into the veins is apparentlj"^ mucli 

 greater- In 36 operations for larjmgeal angina, tvvo such 

 accidents occurred ; whereas, in 245 non-anginose cases, not a 

 single similar accident arose (Sestier). 



Hemorrhage, as would be supposed from the condition of 

 the blood, is sometimes a serious complication, both at the 

 operation and subsequent!}', and caused death in three cases. 



A curious and unexpected complication arose in two cases 



