ter of the
malignant strictured area and this can be done only by visual control
through the esophagoscope (Fig. 95)

Drs. Henry K. Pancoast, George E. Pfahler and William S. Newcomet have
obtained very satisfactory palliative effects from the use of radium
in esophageal cancer.

[221] CHAPTER XXVIII--DIRECT LARYNGOSCOPY IN DISEASES OF THE LARYNX

The diagnosis of laryngeal disease in young children, impossible with
the mirror, has been made easy and precise by the development of
direct laryngoscopy. No anesthetic, local or general, should be used,
for the practised endoscopist can complete the examination within a
minute of time and without pain to the patient. The technic for doing
this should be acquired by every laryngologist. Anesthesia is
absolutely contraindicated because of the possibility of the presence
of diphtheria, and especially because of the dyspnea so frequently
present in laryngeal disease. To attempt general anesthesia in a
dyspneic case is to invite disaster (see Tracheotomy). It is to be
remembered that coughing and straining produce an engorgement of the
laryngeal mucosa, so that the first glance should include an
estimation of the color of the mucosa, which, as a result of the
engorgement, deepens with the prolongation of the direct laryngoscopy.

_Chronic subglottic edema_, often the result of perichondritis, may
require linear cauterization at various times, to reduce its bulk,
after the underlying cause has been removed.

_Perichondritis and abscess_, and their sequelae are to be treated on
the accepted surgical precepts. They may be due to trauma, lues,
tuberculosis, enteric fever, pneumonia, influenza, etc.

_Tuberculosis of the larynx_ calls for conservatism in the application
of surgery. Ulceration limited to the epiglottis may justify
amputation of the projecting portion or excision of only the ulcerated
area. In either case, rapid healing may be expected, and relief from
the odynphagia is sometimes prompt. Amputation of the epiglottis is,
however, not to be done if ulceration in other portions of the larynx
coexist. The removal of tuberculomata is sometimes indicated, and the
excision of limited ulcerative lesions situated elsewhere than on the
epiglottis may be curative. These measures as well as the
galvanocautery are easily executed by the facile operator; but their
advisability should always be considered from a conservative
viewpoint. They are rarely justifiable until afte