When medical treatment has been thoroughly tested and it is evident that the patient must die from asphyxia unless relieved, then we must meet the emergency by surgical measures.
A nice question of judgment often arises as to the proper time for interfering surgically. When shall we abandon all hope of saving the patient by medical means, and when shall we know that the child will perish unless given prompt relief? In answer to these queries I would say that when the voice becomes whispering, when the cough becomes suppressed, when in addition the dyspnœa becomes urgent, and the loud stridor heard both on inspiration and expiration, and when there is marked recession at the base of the sternum and above the clavicles—when all these symptoms are present and continuous, and not relieved by the use of emetics, it is certainly time to operate.
I do not advise and do