CHAPTER XXXVI ACUTE STENOSIS OF THE LARYNX 277 CHAPTER XXXVII TRACHEOTOMY 279 CHAPTER XXXVIII CHRONIC STENOSIS OF THE LARYNX AND TRACHEA 300 CHAPTER XXXIX DECANNULATION AFTER CURE OF LARYNGEAL STENOSIS 309 BIBLIOGRAPHY 311 INDEX 315 [17] CHAPTER I--INSTRUMENTARIUM Direct laryngoscopy, bronchoscopy, esophagoscopy and gastroscopy are procedures in which the lower air and food passages are inspected and treated by the aid of electrically lighted tubes which serve as specula to manipulate obstructing tissues out of the way and to bring others into the line of direct vision. Illumination is supplied by a small tungsten-filamented, electric, "cold" lamp situated at the distal extremity of the instrument in a special groove which protects it from any possible injury during the introduction of instruments through the tube. The bronchi and the esophagus will not allow dilatation beyond their normal caliber; therefore, it is necessary to have tubes of the sizes to fit these passages at various developmental ages. Rupture or even over-distention of a bronchus or of the thoracic esophagus is almost invariably fatal. The armamentarium of the endoscopist must be complete, for it is rarely possible to substitute, or to improvise makeshifts, while the bronchoscope is in situ. Furthermore, the instruments must be of the proper model and well made; otherwise difficulties and dangers will attend attempts to see them.