either the hypertrophic or cicatricial forms. Only too frequently the
stenosis should be called posttracheotomic rather than
postdiphtheritic, since decannulation after the subsidence of the
acute stenosis would have been easy had it not been for the sequelae
of the faulty tracheotomy. Prolonged intubation may induce either a
supraglottic or subglottic tissue hyperplasia. _The supraglottic type_
consists in an edematous thickening around the base of the epiglottis,
sometimes involving also the glossoepiglottic folds and the
ventricular bands. An improperly shaped or fitted tube is the usual
cause of this condition, and a change to a correct form of intubation
tube may be all that is required. Excessive polypoid tissue
hypertrophy should be excised. The less redundant cases subside under
galvanocaustic treatment, which may be preceded by tracheotomy and
extubation, or the intubation tube may be replaced after the
application of the cautery. The former method is preferable since the
patient is far safer with a tracheotomic cannula and, further, the
constant irritation of the intubation tube is avoided. _Subglottic
hypertrophic stenosis_ consists in symmetrical turbinal-like swellings
encroaching on the lumen from either side. Cautious galvanocauterant
treatment accurately applied by the direct method will practically
always cure this condition. Preliminary tracheotomy is required in
those cases in which it has not already been done, and in the cases in
which a high tracheotomy has been done, a low tracheotomy must be the
first step in the cure. Cicatricial types of postdiphtheritic stenosis
may be seen as webs, annular cicatrices of funnel shape, or masses of
fibrous tissue causing fixation of the arytenoids as well as
encroachment on the glottic lumen. (See color plates.)

As a rule, when a convalescent diphtheritic patient cannot be
extubated two weeks after three negative cultures have been obtained
the advisability of a low tracheotomy should be considered. If a
convalescent intubated patient cough up a tube and become dyspneic a
low tracheotomy is usually preferable to forcing in an oversized
intubation tube.

_Typhoid Fever_.--Ulcerative lesions in the larynx during typhoid
fever are almost always the result of mixed infection, though
thrombosis of a small vessel, with subsequent necrosis is also seen.
If the ulceration reaches the cartilage, cicatricial stenosis is
almost certain to follow.

_Trauma_.--The ch