the pleural cavity_ should be immediately removed.
The esophageal speculum inserted through a small intercostal incision
makes an excellent pleuroscope, its spatular tip being of particular
value in moving the lung out of the way. This otherwise dark cavity is
thus brilliantly illuminated without the necessity of making a large
flap resection, an important factor in those cases in which there is
no infection present. The pleura and wound may be immediately closed
without drainage, if the pleura is not infected. Excessive plus
pressure or pus may require reopening. In one case in which the author
removed a foreign body by pleuroscopy, healing was by first intention
and the lung filled in a few days. Drainage tubes that have slipped up
into the empyemic cavity are foreign bodies. They are readily removed
with the retrograde esophagoscope even through the smallest fistula.
The aspirating canal keeps a clear field while searching for the
drain.

_Pleuroscopy for Disease_.--Most pleural diseases require a large
external opening for drainage, and even here the pleuroscope may be of
some use in exploring the cavities. Usually there are many adhesions
and careful ray study may reveal one or more the breaking up of which
will improve drainage to such an extent as to cure an empyema of long
standing. Repeated severing of adhesions, aspiration and sometimes
incision of the thickened visceral pleura may be necessary. The author
is so strongly imbued with the idea that local examination under full
illumination has so revolutionized the surgery of every region of the
body to which it has been applied, that every accessible region should
be thus studied. The pleural cavity is quite accessible with or
without rib-resection, and there is practically no risk in careful
pleuroscopy.

[201] CHAPTER XXI--BENIGN GROWTHS IN THE LARYNX

Benign growths in the larynx are easily and accurately removable by
direct laryngoscopy; but perhaps no method has been more often misused
and followed by most unfortunate results. It should always be
remembered that benign growths are benign, and that hence they do not
justify the radical work demanded in dealing with malignancy. The
larynx should be worked upon with the same delicacy and respect for
the normal tissues that are customary in dealing with the eye.

_Granulomata in the larynx_, while not true neoplasms, require
extirpation in some instances.

_Vocal nodules_, when other methods of cure