. The diseases of children : medical and surgical. A case has been re-ported in a child as young as14 months ; it is possible thesegrowths may be congenital in someinstances. In a case of our own,in a girl of 3^ years there was a his-tory of laryngeal stridor from modes of treatment arepossible—removal of the growthsby endolaryngeal operation, amethod applicable only to latechildhood and adults ; the secondis tracheotomy, with or without anattempt to remove the growthsfrom the tracheotomy wound ; andthe third is thyrotomy, with ex-cision of the warts when fullyexposed. The last pla
. The diseases of children : medical and surgical. A case has been re-ported in a child as young as14 months ; it is possible thesegrowths may be congenital in someinstances. In a case of our own,in a girl of 3^ years there was a his-tory of laryngeal stridor from modes of treatment arepossible—removal of the growthsby endolaryngeal operation, amethod applicable only to latechildhood and adults ; the secondis tracheotomy, with or without anattempt to remove the growthsfrom the tracheotomy wound ; andthe third is thyrotomy, with ex-cision of the warts when fullyexposed. The last plan, which is the simplest, is open to the objectionthat injury is likely to be done to the vocal cords and permanent aphoniamay result. Several successful cases by Parker, Davies-CoUey, and others,have, however, been recorded. On the whole, in this disease, it is probablybest to perform tracheotomy and trust to spontaneous disappearance of thegrowths, leaving resort to thyrotomy for cases in which long use of thetracheotomy tube is Fig. 66.—Papilloma of the laryn.\. Girl aged 5years. The growths are seen attached to thevocal cords, and are also present in the neighbour-hood of the tracheotomy wound. One or twocaseous glands are seen at the bifurcation of thetrachea. See case. (From a photograph byF. H. Westmacott.) 350 Diseases of tJie Respwatory Apparatus In two cases under treatment at the Childrens Hospital by our colleaguesDr. Hutton and Mr. Collier, and by ourselves, repeated operations wererequired both in the shape of thyrotomy and of scraping out the growthsthrough the laryngeal apeiture. The tendency to recurrence was verymarked indeed, and more than once the windpipe had to be reopened toprevent suffocation after the children had appeared to be convalescent. Inboth cases it was found impossible to dispense with a tube. The growthssprang from all parts of the interior of the larynx and upper portion of thetrachea. Hutton^ points out that cases of spon
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