selected for laryngotomy." Supraglottic oedema does not extend to the region of the inter-thyro-cricoid membrane, and the tube may therefore safely be there introduced. Perichondritis and Chondritis of the Larynx. DEFINITION.--Inflammation of the laryngeal perichondrium and cartilage. SYNONYMS.--Phthisis laryngea of the older authors, Laryngitis affecting the cartilages, Deep-seated ulcerative laryngitis, Caries cartilaginum laryngis, Vomica laryngis, Perichondric laryngeal abscess, Necrosis laryngis. (Some of these names refer to the product or terminal stage of the disease.) ETIOLOGY.--Laryngeal perichondritis and chondritis occur either as idiopathic or as symptomatic or secondary affections. Even the former, caused by so-called catching cold or exposure to cold and wet while the system is in a state of lowered vitality, may have a septicæmic basis; it is much more rare than the secondary. Rühle has remarked that arytenoid perichondritis may probably sometimes start in the crico-arytenoid articulation, and in an instance which has come under my observation this certainly seemed to have been the case. Authors state that occasionally the inflammation commences in the cartilaginous tissue itself, instead of in its investment; this is hardly conceivable. Perichondritis must always precede chondritis, but it always causes the cartilage to become involved in the morbid process. Quite often perichondritis and chondritis constitute an extension of a particular ulcerative disease of the mucous and elastic membranes. In the great majority of cases the causes are tuberculosis, syphilis, diphtheria, cancer, lupus, typhus and typhoid fever, small-pox, or else traumatic occurrences, especially suicidal throat-cutting, decubitus or other pressure upon the part--as, for instance, the frequent introduction in an aged subject of the oesophageal sound observed by Ziemssen, and overstrain of the voice alleged by Flormann. At least three cases are reported (viz. by Porter, Lawrence, and Eppinger) in which the disease has been ascribed to the administration of mercury, and Graves and Stokes remark that in broken-down constitutions, {118} where large quantities of mercury have been used, chronic laryngitis is very apt to terminate in ulceration of the cartilages. The disease occurs oftener in men than in women, and oftener between the twentieth and fortieth years than at any other age.