. Les maladies de l'enfance : services médicaux et chirurgicaux. t assez pour ne pas pousser la membrane trachéale downthe, pourtant assez longtemps pour reachbelow la sténose cricoïde et suffisamment grande pour topermit masses à les traverser. De temps en temps un long tube ameublit le upperattachment d'une fonte de la trachée et froisse un wad ci-dessous format RIF dans l'extrémité du tube. Theusual raison est, comme on pouvait s'y attendre, apncea.suppression immédiate du tube est commonlyfollowed par l'expulsion de l'otherdisposal ou en fonte de la masse dans le largetrachea. À ce stade, lorsque le longs tubes n'ont pas réussi à donner du relief, l'shortcyl

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. The diseases of children : medical and surgical. t enough not to push downthe tracheal membrane, yet long enough to reachbelow the cricoid stenosis and large enough topermit masses to pass through them. Occasionally a long tube loosens the upperattachment of a tracheal cast and crumples itinto a wad below the end of the tube. Theusual result is, as would be expected, apncea.Immediate removal of the tube is commonlyfollowed by either expulsion of the cast or otherdisposal of the mass in the comparatively largetrachea. At this point, when the long tubes have failed to give relief, the shortcylindrics become of temporary service. These tubes are of various sizes, seven in number. Since they have no reten-tion swell it is necessary to use the largest size possible, wedging it into the larynx, and for obvious reasons in the line of pressure, not leaving them more than a fewhours in place. They require a special introducer with long curve in order to carrythe short tube well through the cricoid constriction before withdrawing theobcurator.. Figf. 215.—Short large calibre tubes(loose membrane or foreign-bodytubes). 834 Diseases of Childreji In short, to allow the expulsion of loose membrane from the trachea, the largestpossible hollow cylinder is passed through the narrowed larynx, allowed to remainfor a little, and removed as soon as the resulting cough has expelled the foreignbody requiring its insertion. 2. Ulceration from too large a tube making pressure within the cricoid ring, and ulceration at the lower end of the tube. The former can be of a seriousnature, destroying the cartilage ; the latter is superficial and of little import. Ul-ceration within the cricoid is due to improper size ; ulceration below to improperconstruction of tube. Properly constructed tubes are difficult to describe, more difficult to secure froma maker, even if a most faithful and conscientious servant. But one maker inthis world has succeeded in making tubes that embody all the ideas of the

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