er most unfortunate cases I have
seen perichondritis of the laryngeal cartilages with subsequent
stenosis occurring after the roentgenotherapy. Possibly the disastrous
results were due to overdosage; but I feel it a duty to state the
unfavorable experience, and to call attention to the difference
between cancer and papillomata. Multiple papillomata involve no danger
to life other than that of easily obviated asphyxia, and it is
moreover a benign self-limited disease that repullulates on the
surface. In cancer we have an infiltrating process that has no limits
short of life itself.

_Endolaryngeal extirpation_ of papillomata in children requires no
anesthetic, general or local; the growths are devoid of sensibility.
If, for any reason, a general anesthetic is used it should be only in
tracheotomized cases, because the growths obstruct the airway.
Obstructed respiration introduces into general anesthesia an enormous
element of danger. Concerning the treatment of multiple papillomata it
has been my experience in hundreds of cases that have come to the
Bronchoscopic Clinic, that repeated superficial removals with blunt
non-cutting forceps (see Chapter I) will so modify the soil as to make
it unfavorable for repullulation. The removals are superficial and do
not include the subjacent normal tissue. Radical removal of a
papilloma situated, for instance, on the left ventricular band or
cord, can in no way prevent the subsequent occurrence of a similar
growth at a different site, as upon the epiglottis, or even in the
fauces. Furthermore, radical removal of the basal tissues is certain
to impair the phonatory function. Excellent results as to voice and
freedom from recurrence have always followed repeated superficial
removal. The time required has been months or a year or two. Only
rarely has a cure followed a single extirpation.

If the child is but slightly dyspneic, the obstructing part of the
growth is first removed without anesthesia, general or local; the
remaining fungations are extirpated subsequently at a number of brief
seances. The child is thus not terrified, soon loses dread of the
removals, and appreciates the relief. Should the child be very
dyspneic when first seen, a low tracheotomy is immediately done, and
after an interim of ten days, laryngoscopic removal of the growth is
begun. Tracheotomy probably has a beneficial effect on the disease.
Tracheal growths require the insertion of the bronchoscope for their