TRACHEOTOMY 343 



gives the practitioner more indications for tracheotomy than 

 all other diseases combined. This disease, besides its ab- 

 scesses which bulge across the lumen of the air passages, is 

 also accompanied with more or less inflammatory tumefac- 

 tion of the aerial mucous membrane. These two conditions 

 combined produce the most formidable temporary obstruc- 

 tion imaginable. Frequently the abscess alone will extend 

 across the entire lumen, or even meet a similar abscess from 

 the opposite side, and totally obstruct the passage of air. At 

 other times the abscesses are wanting and the tumefied mu- 

 cosa alone obstructs the passage. In this latter event, pallia- 

 tive means of dealing with the disease should first be tried, for 

 very often a very threatening dyspnoea due to nothing more 

 than oedema of the pharyngeal and laryngeal mucosa will 

 subside promptly without tracheotomy; and besides, the la- 

 bored respirations, by forcing air through the swollen pas- 

 sage, tend to preserve a capacity that would soon be totally 

 and persistently obstructed after the operation had been per- 

 formed. Tracheotomy is more harmful than beneficial to the 

 disease process. It favors encroachment. In these cases the 

 operation should be postponed until a crisis definitely indi- 

 cates that the life of the patient is in imminent danger from 

 suffocation. "When abscesses constitute the obstruction mat- 

 ters are somewhat different, because the passage of air will 

 have little influence in preventing them from bul-ging inward. 

 They are formidable obstructions and can only be dimin- 

 ished by evacuating their contents when they have matured. 

 During the period of- their development nothing but trache- 

 otomy will preserve the respirations. In short, serious dysp- 

 noea due to abscess, should be promptly met by intubation 

 of the trachea, whilst that due to oedema of the mucous mem- 

 brane should be treated expectantly until suffocation be- 

 comes imminent. 



Acute uncomplicated pharyngoiaryngitis (sore throat) 

 occasionally threatens to occlude the glottis but as in the 

 laryngitis of influenza, tracheotomy should be postponed to 

 the last, in view of the frequency with which the obstruction 

 disappears under medical treatment. 



Spasm of the glottis sometimes provokes a serious dysp- 

 noea of short duration that only tracheotomy will relieve, 

 but these seizures usually prove fatal or else are relieved 

 spontaneously before arrival of the practitioner. They can 

 also be cured by simply limiting the passage of air into the an- 

 terior nares. This disease is, judging from its manifestation, 

 more of an inco-ordinate action of the vagus, than a spasm. 



