ium iodid is given, lest its
reaction upon the larynx cause an edema necessitating tracheotomy. If
no improvement is noticed lues is excluded. If the Wassermann is
positive, malignancy and the other possibilities are not considered as
excluded until the patient has been completely cured by mercury,
because, for instance, a leutic or tuberculous patient may have
cancer; a tuberculous patient may have lues; or a leutic patient,
tuberculosis.
2. Pulmonary tuberculosis is excluded by the usual means. If present
the laryngeal lesion may or may not be tuberculous; if the
laryngoscopic appearances are doubtful a specimen is taken. Lupoid
laryngeal tuberculosis so much resembles lues that both the
therapeutic test and biopsy may be required for certainty.
3. In all cases in which the diagnosis is not clear a specimen
is taken. This is readily accomplished by direct laryngoscopy under
local anesthesia, using the regular laryngoscope or the anterior
commissure laryngoscope. The best forceps in case of large growths are
the alligator punch forceps (Fig. 33). Smaller growths require tissue
forceps (Fig. 28). In case of small growths, it is best to remove the
entire growth; but without any attempt at radical extirpation of the
base; because, if the growth prove benign it is unnecessary; if
malignant, it is insufficient.

_Inspection of the Party Wall in Cases of Suspected Laryngeal
Malignancy_.--When taking a specimen the party wall should be
inspected by passing a laryngoscope or, if necessary, an esophageal
speculum down through the laryngopharynx and beyond the
cricopharyngeus. If this region shows infiltration, all hope of cure
by operation, however radical, should be abandoned.

_Radium and the therapeutic roentgenray_ have given good results, but
not such as would warrant their exclusive use in any case of
malignancy in the larynx operable by laryngofissure. With inoperable
cases, excellent palliative results are obtained. In some cases an
almost complete disappearance of the growth has occurred, but
ultimately there has been recurrence. The method of application of the
radium, dosage, and its screening, are best determined by the
radiologist in consultation with the laryngologist. Radium may be
applied externally to the neck, or suspended in the larynx;
radium-containing needles may be buried in the growth, or the
emanations, imprisoned in glass pearls or capillary tubes, may be
inserted deeply into the growth by mean