x,
dyspnoea becomes a prominent and grave symptom. The patient may
rapidly become cyanosed, the inspirations assume a noisy, stridulous
character, and great distress and imminent suffocation supervene. If
laryngoscopic examination is possible, the ary-epiglottic folds may be
found greatly swollen and the upper aperture of the larynx partly
occluded. Digital examination may reveal the swollen condition of the
parts. The urine should be examined for albumin and tube casts.

[Illustration: FIG. 287.--Larynx from case of sudden death, due to
oedema of ary-epiglottic folds, _a_, _a_.

(From drawing lent by Dr. Logan Turner.)]

_Treatment._--In the milder forms, the sucking of ice, the inhalation
of medicated steam, or spraying with a solution of adrenalin, and the
application of poultices to the neck, may suffice to relieve the
condition. Scarification of the epiglottis and ary-epiglottic folds
with a knife, followed by free bleeding, may give complete relief.
Diaphoretic and purgative treatment should not be neglected. If
suffocation is imminent, tracheotomy or intubation is called for.

In performing #tracheotomy#, a roller pillow is placed beneath the
neck to put the parts on the stretch, and an incision is carried from
the lower margin of the cricoid cartilage downwards for about 2
inches. The sterno-hyoids and sterno-thyreoids are separated; the
cross branch between the anterior jugular veins, and any other veins
met with, secured with forceps before being divided; and the trachea
exposed by dividing transversely the layer of deep fascia which passes
from the cricoid to the isthmus of the thyreoid. If the isthmus cannot
be pulled downwards sufficiently, it may be divided in the middle
line. All active bleeding having been arrested, the larynx is steadied
by inserting a sharp hook into the lower edge of the cricoid
cartilage, and the trachea is opened by thrusting a short,
broad-bladed knife through the exposed rings. The back of the knife
should be directed downwards, and the opening in the trachea enlarged
upwards sufficiently to admit the tracheotomy tube. In children it is
sometimes found necessary to divide the cricoid for this purpose
(_laryngo-tracheotomy_). The slit in the trachea is then opened up
with a tracheal dilator, and the outer tube inserted and fixed in
position with tapes. The inner tube is not fixed, so that it may be
coughed out if it becomes blocked, and that it may be frequently
removed and cl