Conclusions based on treatment of 100 cases of laryngeal diphtheria with anti toxin in conjunction with intubation: Antitoxin should be administered early, without waiting for a bacteriological diagnosis. Tonsillar exudate attended by a croupy cough or partial aphonia is an indication for a full dose of 1500 to 2000 units of antitoxin. Antitoxin adminis tered twelve hours or more prior to oper ative interference will reduce the mor tality of intubated cases at least 50 per cent. Early operation urged. Results are sunnnarized as follows: Number of operations, 100; recoveries, 69; deaths, 31; tuortality under 3 years, 49 per cent.; mortality over 3 years, 19 per cent.; com plicating measles, cases, 5 deaths. Shurly (jour. Amer. Med. Assoc., May 19, 1900).
Intubation has become more common since the introduction of antitoxin, for cas-es are less severe and tracheotomy does not so often become necessary. Primary tracheotomy is indicated in children under 1 1/2 years with out spoken rickets, serious collapse, wide spread pharyngeal ulceration, severe clyspncea and (edema of the larynx. spas modic or mechanical obstruction in the larynx, large (edematous swellings (such as subcutaneous emphysema of the neck), bronchial stenosis, or continued tlyspncea after intubation. Secondary tracheotomy is indicated when the tube has been in several days and dyspntea continues after the fourth iutubation, when membranes close the tube, when laryngeal abscess occurs, when the thy mus or bronchial glands are enlarged, when frequently changing the tube gives no relief, when the child cannot swallow sufficient food, and when dyspncea fol low.s intnbation twice. five or six days
after intubation, in children under 2 years. Intubation should be performed early, all indications for tracheotomy must be overcome, everything must be prepared for a possible tracheotomy, patients must be kept in a well-steamed atmosphere, the smallest tube should be introduced but once, bromides should be given before extubation, and all should be ready for a new intubation when ex tubation is done. In children under 2 years the tube is left in on an average of 2 to 4 days; from 2 to 4 years, 3 to 6 days; over 5 years, 3 to 4 days. In tubatiou may be done experimentally, preliminary to tracheotomy or during tracheotomy, and before or after clos ing the tracheotomy wound. In private practice intubation is only justified when the physician has had experience, anti toxin has been given, and a, good nurse secured. It is only indicated, then, when no bronchial stenosis exists, the larynx is not swollen or ulcerated, and no indi cations for tracheotomy are noted. The tube is left in as long as no indication for secondary tracheotomy appears and the child bears it well. Rahn (Jahrbuch f. Kinderh., Feb., 1902).
The results of intubation after the ad ministration of antitoxin have been most brilliant. -Whereas two-thirds of such cases died before the use of antitoxin, with it about two-thirds recover. The indications and technique of the opera tion are described in the article on IN