tropharyngeal abscess.

[PLATE II--DIRECT AND INDIRECT LARYNGEAL VIEWS FROM AUTHOR'S OIL-COLOR
DRAWINGS FROM LIFE:
1, Epiglottis of child as seen by direct laryngoscopy in the
recumbent position.
2, Normal larynx spasmodically closed, as is usual on first exposure
without anesthesia.
3, Same on inspiration.
4, Supraglottic papillomata as seen on direct laryngoscopy in a
child of two years.
5, Cyst of the larynx in a child of four years, seen on direct
laryngoscopy without anesthesia.
6, Indirect view of larynx eight weeks after thyrotomy for cancer of
the right cord in a man of fifty years.
7, Same after two years. An adventitious band indistinguishable from
the original one has replaced the lost cord.
8, Condition of the larynx three years after hemilaryngectomy for
epithelioma in a patient fifty-one years of age. Thyrotomy revealed
such extensive involvement, with an open ulceration which had reached
the perichondrium, that the entire left wing of the thyroid cartilage
was removed with the left arytenoid. A sufficiently wide removal was
accomplished without removing any part of the esophageal wall below
the level of the crico-arytenoid joint. There is no attempt on the
part of nature to form an adventitious cord on the left side. The
normal arytenoid drew the normal cord over, approximately to the edge
of the cicatricial tissue of the operated side. The voice, at first a
very hoarse whisper, eventually was fairly loud, though slightly husky
and inflexible.
9, The pharynx seen one year after laryngectomy for endothelioma in
a man aged sixty-eight years. The purple papilla; anteriorly are at
the base of the tongue, and from this the mucosa slopes downward and
backward smoothly into the esophagus. There are some slight folds
toward the left and some of these are quite cicatricial. The
epiglottis was removed at operation. The trachea was sutured to the
skin and did not communicate with the pharynx. (Direct view.)]

_Contraindications to Direct Laryngoscopy_.--There are no absolute
contraindications to direct laryngoscopy in any case where direct
laryngoscopy is really needed for diagnosis or treatment. In extremely
dyspneic patients, if the operator is not confident in his ability for
a prompt and sure introduction of a bronchoscope, it may be wise to do
a tracheotomy first.

_Instructions to the Patient_.--Before beginning endoscopy the
patient should be told that he will feel a very disagreea