jects for palliative tracheotomy and radium
therapy. It will be found necessary in many of the cases to employ the
author's long, cane-shaped tracheal cannula (Fig. 104, A), in order to
pipe the air down to one or both bronchi past the projecting neoplasm.

It has recently been demonstrated that following the intravenous
injection of a suspension of the insoluble salt, radium sulphate, that
the suspended particles are held in the capillaries of the lung for a
period of one year. Intravenous injections of a watery suspension, and
endobronchial injections of a suspension of radium sulphate in oil,
have had definite beneficial action. While as yet, no relatively
permanent cures of pulmonary malignancy have been obtained, the
amelioration and steady improvement noted in the technic of radium
therapy are so encouraging that every inoperable case should be thus
treated, if the disease is not in a hopelessly advanced stage.

In a case under the care of Dr. Robert M. Lukens at the Bronchoscopic
Clinic, a primary epithelioma of the trachea was retarded for 2 years
by the use of radium applied by Dr. William S. Newcomet,
radium-therapist, and Miss Katherine E. Schaeffer, technician.

[216] CHAPTER XXVII--MALIGNANT DISEASE OF THE ESOPHAGUS

Cancer of the esophagus is a more prevalent disease than is commonly
thought. In the male it usually develops during the fourth and fifth
decades of life. There is in some cases the history of years of more
or less habitual consumption of strong alcoholic liquors. In the
female the condition often occurs at an earlier age than in the male,
and tends to run a more protracted course, preceeded in some cases by
years of precancerous dysphagia.

Squamous-celled epithelioma is the most frequent type of neoplasm. In
the lower third of the esophagus, cylindric cell carcinoma may be
found associated with a like lesion in the stomach. Sarcoma of the
esophagus is relatively rare (Bibliography 1, p. 449).

The sites of the lesion are those of physiologic narrowing of the
esophagus. The middle third is most frequently involved; and the lower
third, near the cardia, comes next in frequency. Cancer of the lower
third of the esophagus preponderates in men, while cancer of the upper
orifice is, curiously, more prevalent in women. The lesion is usually
single, but multiple lesions, resulting from implantation metastases
have been observed (Bibliography 1, p. 391). Bronchoesophageal fistula
from extens