e obstruction of the airway. Associated with
defective aeration will be the signs of deficient drainage of
secretions. Roentgenray examination may show the shadow of
enchondromata or osteomata, and will also show variations in aeration
should the tumor be in a bronchus.

_Bronchoscopic removal of benign growths_ is readily accomplished with
the endoscopic punch forceps shown in Figs. 28 and 33. Quick action
may be necessary should a large tumor producing great dyspnea be
encountered, for the dyspnea is apt to be increased by the congestion,
cough, and increased respiration and spasm incidental to the presence
of the bronchoscope in the trachea. General anesthesia, as in all
cases showing dyspnea, is contraindicated. The risks of hemorrhage
following removal are very slight, provided fungations on an
aneurismal erosion be not mistaken for a tumor.

Multiple papillomata when very numerous are best removed by the
author's "coring" method. This consists in the insertion of an
aspirating bronchoscope with the mechanical aspirator working at full
negative pressure. The papillomata are removed like coring an apple;
though the rounded edge of the bronchoscope does not even scratch the
tracheal mucosa. Many of the papillomata are taken off by the holes in
the bronchoscope. Aspiration of the detached papillomata into the
lungs is prevented by the corking of the tube-mouth with the mass of
papillomata held by the negative pressure at the canal inlet orifice.

CHAPTER XXIV--BENIGN NEOPLASMS OF THE ESOPHAGUS

As a result of prolonged inflammation edematous polypi and granulomata
are not infrequently seen, but true benign tumors of the esophagus are
rare affections. Keloidal changes in scar tissue may occur. Cases of
retention, epithelial and dermoid cysts have been observed; and there
are isolated reports of the finding of papillomata, fibromata,
lipomata, myomata and adenomata. The removal of these is readily
accomplished with the tissue forceps (Fig. 28), if the growths are
small and projecting into the esophageal lumen. The determination of
the advisability of the removal of keloidal scars would require
careful consideration of the particular case, and the same may be said
of very large growths of any kind. The extreme thinness of the
esophageal walls must be always in the mind of the esophagoscopist if
he would avoid disaster.

[210] CHAPTER XXV--ENDOSCOPY IN MALIGNANT DISEASE OF THE LARYNX

The general surgical r