Sir.—The excellent article by Battaglia and Lockhart in the March issue of the Journal (129:334, 1975) leaves little room for debate that acute epiglottitis, almost certainly the most frightening emergency in pediatric practice, requires treatment in the well-equipped hospital where endotracheal intubation can be performed routinely. Until very recently,1 tracheostomy was believed to be obligatory. Berenberg and Kevy2 state "... in epiglottitis tracheostomy is often the cornerstone of conservative management."
Battaglia and Lockhart present a convincing case for endotracheal intubation when adequate skill and equipment are available. However, this leaves unanswered the problem for the pediatrician who may not have adequate skill or equipment to deal with this situation in his office or in the home. Forewarned, he can meet the patient in the hospital, but he may encounter the patient with respiratory arrest or may provoke this in his attempt to examine the child. (Most pediatricians will