s of a small trocar and
cannula. For all of these procedures direct laryngoscopy affords a
ready means of accurate application. Tracheotomy is necessary however,
because of the reactionary swelling, which may be so great as to close
completely the narrowed glottic chink. Where this is the case, the
endolaryngeal application of the radium may be made by inserting the
container through the tracheotomic wound, and anchoring it to the
cannula.

The author is much impressed with Freer's method of radiation from the
pyriform sinus in such cases as those in which external radiation
alone is deemed insufficient.

The work of Drs. D. Bryson Delavan and Douglass M. Quick forms one of
the most important contributions to the subject of the treatment of
radium by cancer. (See Proceedings of the American Laryngological
Association, 1922; also Proceedings of the Tenth International
Otological Congress, Paris, 1922.)

[214] CHAPTER XXVI--BRONCHOSCOPY IN MALIGNANT GROWTHS OF THE TRACHEA

The trachea is often secondarily invaded by malignancy of the
esophagus, thyroid gland, peritracheal or peribronchial glands.
Primary malignant neoplasms of the trachea or bronchus have not
infrequently been diagnosticated by bronchoscopy. Peritracheal or
peribronchial malignancy may produce a compressive stenosis covered
with normal mucosa. Endoscopically, the wall is seen to bulge in from
one side causing a crescentic picture, or compression of opposite
walls may cause a "scabbard" or pear shaped lumen. Endotracheal and
endobronchial malignancy ulcerate early, and are characterized by the
bronchoscopic view of a bleeding mass of fungating tissue bathed in
pus and secretion, usually foul. The diagnosis in these cases rests
upon the exclusion of lues, and is rendered certain by the removal of
a specimen for biopsy. Sarcoma and carcinoma of the thyroid when
perforating the trachea may become pedunculated. In such cases
aberrant non-pathologic thyroid must be excluded by biopsy.
Endothelioma of the trachea or bronchus may also assume a pedunculated
form, but is more often sessile.

_Treatment_.--Pedunculated malignant growths are readily removed with
snare or punch forceps. Cure has resulted in one case of the author
following bronchoscopic removal of an endothelioma from the bronchus;
and a limited carcinoma of the bronchus has been reported cured by
bronchoscopic removal, with cauterization of the base. Most of the
cases, however, will be sub