as
much as it would be, with the same degree of cough, in any patient not
subject to asthma. The secretions were removed and the attack quickly
subsided; but no influence on the recurrence of attacks was observed.
It is essential that the bronchoscopic studies be made, as were these,
without anesthesia, local or general, for it is known that the
application of cocain or adrenalin to the larynx, or even in the nose,
will, with some patients, stop the attack. When done without local
anesthesia, allowance must be made for the reaction to the presence of
the tube. In those cases in which other means have failed to give
relief, the endobronchial application of novocain and adrenalin,
orthoform, propaesin or anesthesin emulsion may be tried. Cures have
been reported by this treatment. Argentic nitrate applied at weekly
intervals has proven very efficient in some cases. Associated
infective disease of the bronchial mucosa brings with it the questions
of immunity, allergy, anaphylaxis, and vaccine therapy; and the often
present defective metabolism has to be considered.

_Autodrownage_.--Autodrownage is the name given by the author to the
drowning of the patient in his own secretions. Tracheobronchial
secretions in excess of the amount required to moisten the inspired
air, become, in certain cases, a mechanical menace to life, unless
removed. The cough reflex, forced expiration, and ciliary action,
normally remove the excess. When these mechanisms are impaired, as in
profound asthenia, laryngeal paralysis, laryngeal or tracheal
stenosis, etc.; and especially when in addition to a mild degree of
glottic stenosis or impaired laryngeal mobility, the secretions become
excessive, the accumulation may literally drown the patient in his own
secretions. This is illustrated frequently in influenza and arachidic
bronchitis. Infants cannot expectorate, and their cough reflex is
exceedingly ineffective in raising secretion to the pharynx;
furthermore they are easily exhausted by bechic efforts; so that age
may be cited as one of the most frequent etiologic factors in the
condition of autodrownage. Bronchoscopic sponge-pumping (_q.v._) and
bronchoscopic aspiration are quite efficient and can save any patient
not afflicted with conditions that are fatal by other pathologic
processes.

_Lues of the Tracheobronchial Tree_.--Compared to laryngeal
involvement, syphilis of the tracheobronchial tree is relatively rare.
The lesions may be gummat