ule applying to individuals past middle life,
that benign growths exposed to irritation should be removed, probably
applies to the larynx as well as to any other epithelialized
structure. The facility, accuracy and thoroughness afforded by
skilled, direct, laryngeal operation offers a means of lessening the
incidence of cancer. To a much greater extent the facility, accuracy,
and thoroughness contribute to the cure of cancer by establishing the
necessary early diagnosis. Well-planned, careful, external operation
(laryngofissure) followed by painstaking after-care is the only
absolute cure so far known for malignant neoplasms of the larynx; and
it is a cure only in those intrinsic cases in which the growth is
small, and is located in the anterior two-thirds of the intrinsic
area. By limiting operations strictly to this class of case,
eighty-five per cent of cures may be obtained.* In determining the
nature of the growth and its operability the limits of the usefulness
of direct endoscopy are reached. It is very unwise to attempt the
extirpation of intrinsic laryngeal malignancy by the endoscopic
method, for the reason that the full extent of the growth cannot be
appreciated when viewed only from above, and the necessary radical
removal cannot be accurately or completely accomplished.

* The author's results in laryngofissure have recently fallen to 79
per cent of relative cures by thyrochondrotomy.

_Malignant disease of the epiglottis_, in those rare cases where the
lesion is strictly limited to the tip is, however, an exception. If
amputation of the epiglottis will give a sufficiently wide removal,
this may be done en masse with a heavy snare, and has resulted in
complete cure. Very small growths may be removed sufficiently widely
with the punch forceps (Fig. 33); but piece meal removal of malignancy
is to be avoided.

_Differential Diagnosis of Laryngeal Growths in the Larynx of
Adults_.--Determination of the nature of the lesion in these cases
usually consists in the diagnosis by exclusion of the possibilities,
namely,
1. Lues.
2. Tuberculosis, including lupus.
3. Scleroma.
4. Malignant neoplasm.

In the Bronchoscopic Clinic the following is the routine procedure:
1. A Wassermann test is made. If negative, and there remains a
suspicion of lues, a therapeutic test with mercury protoiodid is
carried out by keeping the patient just under the salivation point for
eight weeks; during which time no potass