e--Carcinoma of the Gullet.#--This is met with in
two forms which present widely different pathological and clinical
features.

Cancer of the _cervical_ portion affects the gullet at its junction
with the pharynx, and for some unexplained reason is much more common
in women, and at the comparatively early age of between thirty and
fifty. Cancer of the _thoracic_ portion affects the extreme lower end
of the gullet, and is met with almost exclusively in men over fifty.

#Cancer of the Cervical Portion.#--Difficulty of swallowing may arise
suddenly; more often it is slow and progressive over a period of
months and, in some cases, even of years. Pain on swallowing is not a
constant or prominent feature; it may be referred to the site of the
lesion or to one or both ears. In a considerable number of cases, the
complaints of the patient are referred to the larynx; coughing, with
abundant mucous expectoration disturbing the night's rest, hoarseness,
or even loss of voice, which symptoms are due either to direct
invasion of the larynx or to implication of one or other recurrent
nerve; for the same cause, difficulty of breathing may supervene,
sometimes of such a nature as to render tracheotomy imperative. A
gurgling noise on swallowing, and regurgitation of food are
occasionally observed.

Palpation of the neck, and particularly of the larynx and trachea,
should be carried out in all cases presenting the symptoms described;
and as bearing on the question of operation, enlargement of the
cervical lymph glands and of the thyreoid should be looked for; cancer
of the thyreoid is sometimes secondary to disease at the
pharyngo-oesophageal junction.

Direct and indirect laryngoscopic examination is then made; if the
laryngeal mirror fails to reveal anything abnormal, suspension
laryngoscopy, which gives a more extensive view of that part of the
pharynx lying behind the larynx, may be employed, or the
oesophagoscope may be preferred. A portion of the growth may be
removed for microscopical examination.

The use of the oesophageal bougie as a diagnostic agent must be
deprecated; it gives no satisfactory explanation of the cause of the
obstruction, and its employment when malignant ulceration is present,
is not free from serious risk to the patient (Logan Turner).

_Treatment._--The surgeon is dependent on the help of the
laryngologist not only for the diagnosis of the disease at the
earliest stage possible, but also for informat