eaned by the nurse. The tube should be discarded as
soon as the patient is able to breathe by the natural channel.

_Intubation of the Larynx._--This procedure is employed as a
substitute for tracheotomy, especially in children suffering from
membranous and oedematous forms of laryngitis. As experience is
required to carry out the manipulations successfully, and as its use
is attended with certain risks which necessitate that the surgeon
should be constantly within call, the operation is more adapted to
hospital than to private practice. O'Dwyer's apparatus is that most
generally employed. The operation consists in introducing through the
glottis, by means of a specially constructed guide, a small metal or
vulcanite tube furnished with a shoulder which rests against the false
vocal cords. The part of the tube which passes beyond the true vocal
cords is bulged to prevent it being coughed out.

In an emergency a gum-elastic catheter with a terminal aperture may be
passed, as recommended by Macewen and Annandale.

#Bilateral Abductor Paralysis.#--Both recurrent nerves may be
interfered with by such conditions as enlargement of the thyreoid,
tumour of the oesophagus, or intra-thoracic tumour, or by injury in
the course of operations for goitre. A gradually increasing
inspiratory dyspnoea is developed, which at first is only noticed on
exertion, when the desire for air is increased; later it becomes
permanent, and even during sleep the stridor may be marked.
Suffocation may become imminent. When the larynx is examined with the
mirror, the vocal cords are seen to lie near each other, and on
inspiration their approximation is still greater.

The _treatment_ is directed to removing the cause of pressure on the
nerves. In the majority of cases tracheotomy is called for and the
tube must be worn permanently.

#Syphilitic Affections of the Larynx.#--_Secondary syphilitic_
manifestations in the form of congestion of the mucous membrane,
mucous patches, or condylomata, are occasionally met with, and give
rise to a huskiness of the voice. These conditions usually disappear
rapidly under anti-syphilitic treatment.

In _tertiary syphilis_, whether inherited or acquired, the most common
lesion is a diffuse gummatous infiltration, which tends to go on to
ulceration and to lead to widespread destruction of tissue. It usually
attacks the epiglottis, the arytenoids, and the ary-epiglottic folds,
but may spread and implicate all the s