. The diseases of children : medical and surgical. eemed desirable to be within easy call for some hours. I once considered I had on an average four hours leeway, but exceptionallyprompt aid was needed sooner, and a few cases needed reintubation twelve andtwenty-four hours afterwards. Whether, pressure removed, the mucous membranebecomes quickly congested, or whether muscular spasm sets in, or membranereforms, I know not, but I have learned to respect the emergency of the firsttwelve hours after removal of the tube, especially if it be a premature removal. Retained Tubes {Laryngeal Canutes).—R
. The diseases of children : medical and surgical. eemed desirable to be within easy call for some hours. I once considered I had on an average four hours leeway, but exceptionallyprompt aid was needed sooner, and a few cases needed reintubation twelve andtwenty-four hours afterwards. Whether, pressure removed, the mucous membranebecomes quickly congested, or whether muscular spasm sets in, or membranereforms, I know not, but I have learned to respect the emergency of the firsttwelve hours after removal of the tube, especially if it be a premature removal. Retained Tubes {Laryngeal Canutes).—Rarely it is necessary to reinsert a tubemany times. The child may get along half a day or two days and yet require thereintroduction. If the tube is not of proper anatomical conformity it may causegranulations about the head. To relieve this and cure the condition, a specialtube has been devised, naving a prolonged or built-up head. (See Fig. 216.) Itrides above and causes pressure upon the granulations, with consequent absorption. Appendix 835. Fig. 216.—Built-up headfor granulations. Finally, not to recapituhite the literature of the subject, I may mention advan-tages. First of all, parents will consent. It is a bloodless operation ; no cutting, no anaesthetic,and this means much to the friends. It is quickly per-formed, requires no trained assistants or trained attend-ants (it is trained operators that are needed). The airinspired is warmed and moistened through natural pas-sages. Results are equal to or rather better than thoseof tracheotomy under similar circumstances, whether inhospital or outside. Finally, since the successful employment of antitoxintreatment for diphtheria the average duration of laryngealstenosis has been so shortened that there seems no longerany ground for contention as to which is the preferablemethod of tiding past the urgent symptoms of Professor von Ranke, of Munich, proclaimed to theBritish medical profession in London, the time
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