a degree of fear that it
may properly be called panic, when attempts at decannulation are made.
Crying and possibly glottic spasm increase the difficulties.

_Spasmodic stenosis_ may be associated with panic, or may be excited
by subglottic inflammation. Prolonged wearing of an intubation tube,
by disturbing the normal reciprocal equilibrium of the abductors and
adductors, is one of the chief causes. The treatment for spasmodic
stenosis and panic is similar. The use of a special intubation tube
having a long antero-posterior lumen and a narrow neck, which form
allows greater action of the musculature, has been successful in some
cases. Repeated removal and replacement of the intubation tube when
dyspnea requires it may prove sufficient in the milder cases. Very
rarely a tracheotomy may be required; if so, it should be done low.
The wearing of a tracheotomic cannula permits a restoration of the
muscle balance and a subsidence of the subglottic inflammation.
Corking the cannula with a slotted cork (Fig. 111) will now restore
laryngeal breathing, after which the tracheotomic cannula may be
removed.

[PLATE V--PHOTOPROCESS REPRODUCTIONS OF THE AUTHOR'S OIL-COLOR
DRAWINGS FROM LIFE--LARYNGEAL AND TRACHEAL STENOSES:

1, Indirect view, sitting position; postdiphtheric cicatricial
stenosis permanently cured by endoscopic evisceration. (See Fig. 5.)
2, Indirect view, sitting position; posttyphoid cicatricial stenosis.
Mucosa was very cyanotic because cannula was re-moved for laryngoscopy
and bronchoscopy. Cured by laryngostomy. (See Fig. 6.) 3, Indirect
view, sitting position; posttyphoid infiltrative stenosis, left
arytenoid destroyed by necrosis. Cured by laryngostomy; failure to
form adventitious band (Fig. 7) because of lack of arytenoid activity.
4, Indirect view, recumbent position; posttyphoid cicatricial
stenosis. Cured of stenosis by endoscopic evisceration with sliding
punch forceps. Anterior commissure twice afterward cleared of
cicatricial tissue as in the other case shown in Fig. 15. Ultimate
result shown in Fig. 8. 5, Same patient as Fig. 1; sketch made two
years after decannulation and plastic. 6, Same patient as Fig. 2;
sketch made four years after decannulation and plastic. 7, Same
patient as Fig. 3; sketch made three years after decannulation and
plastic. 8, Same patient as Fig. 4; sketch made one year after
decannulation, fourteen months after clearing of the anterior
commissure to form adventitious cords