,
may be a delayed result of traumatism to the laryngeal cartilages
during delivery. The symptoms usually develop within four weeks after
birth. Lues and tuberculosis are possible factors to be eliminated by
the usual methods.

_Surgical Treatment of Acute Laryngeal Stenosis_.--Multiple puncture
of acute inflammatory edema, while readily performed with the
laryngeal knife used through the direct laryngoscope, is an uncertain
measure of relief. Tracheotomy, if done low in the neck, will
completely relieve the dyspnea. By its therapeutic effect of rest, it
favors the rapid subsidence of the inflammation in the larynx and is
the treatment to be preferred. Intubation is treacherous and
unreliable except in diphtheritic cases; but in the diphtheritic cases
it is ideal, if constant skilled watching can be had.

[279] CHAPTER XXXVII--TRACHEOTOMY

_Indications_.--Tracheotomy is indicated in dyspnea of laryngotracheal
origin. The cardinal signs of this form of dyspnea are:
1. Indrawing at the suprasternal notch.
2. Indrawing around the clavicles.
3. Indrawing of the intercostal spaces.
4. Restlessness.
5. Choking and waking as soon as the aid of the voluntary
respiratory muscles ceases in falling to sleep.
6. Cyanosis is a dangerously late symptom.

As a therapeutic measure in diseases of the larynx its place has been
thoroughly established. Marked improvement of the laryngeal lesions
has been observed to follow tracheotomy in advanced laryngeal
tuberculosis, and in cancer of the larynx. It has proven, in some
cases, a useful adjunct in the treatment of luetic laryngitis, though
it cannot be regarded as indicated, in the absence of dyspnea.
Perichondritis and other inflammations are benefited by tracheotomy. A
marked therapeutic effect on multiple laryngotracheal papillomata in
children has been noted by the author in hundreds of cases.

_Tracheotomy for foreign body_ is no longer indicated either for the
removal of the intruder, or for the insertion of the bronchoscope.
Tracheotomy may be urgently indicated for foreign body dyspnea, but
not for foreign body removal.

_Subcutaneous rupture of the trachea_ from external trauma may produce
dyspnea and generalized emphysema, both of which will be relieved by
tracheotomy.

[280] _Acromegalic stenosis of the larynx_ is a rare but urgent
indication for tracheotomy.

_Contraindications_.--There are no contraindications to tracheotomy
for dyspnea.

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