gh a tube; some surgeons look upon the
operation with disfavour because they doubt whether it even prolongs
life, and it is often followed by a pneumonia which rapidly proves
fatal. Variation in the results of gastrostomy observed by different
surgeons is partly due to differences in the stage of the disease at
which the operation is performed, and probably to a greater extent to
the confusion between cases of slowly growing squamous epithelioma of
the lower end of the gullet and cases of glandular carcinoma of the
cardiac end of the stomach, these being grouped together under the
clinical heading of "malignant stricture of the lower end of the
gullet." In our experience cases of epithelioma of the gullet (in the
strict sense of the term) benefit greatly if subjected to gastrostomy
as soon as the condition is recognised. In a case operated upon by
Thomas Annandale the patient survived the operation for three years
and some months.

_Radiation._--The introduction of a tube of radium into the stricture
and its retention there, the silk thread attached to the tube being
secured to the cheek by a strip of plaster, is described by Hill and
Finzi as the most valuable palliative measure that has so far been
employed in cancer of the gullet; the capacity of swallowing may be
regained to a considerable extent. The employment of radium is
rendered easier and more efficient if it is preceded by gastrostomy.

_The Roux-operation._--This consists in making a new gullet to replace
that which is obstructed; the abdomen is opened and a loop of jejunum
is isolated; its lower end is anastomosed--end to side--to the
stomach; the intestine is brought upwards through a tunnel made for it
between the skin and the sternum, and the upper end is brought out and
fixed to the skin, in the supra-sternal notch. It has scarcely passed
beyond the experimental stage.

CHAPTER XXIX

THE LARYNX, TRACHEA, AND BRONCHI[7]

Examination of the larynx--CARDINAL SYMPTOMS OF LARYNGEAL AFFECTIONS:
(1) Interference with the voice: _Hoarseness_; _Aphonia_--(2)
Dysphagia--(3) Interference with respiration: _Diphtheritic
laryngitis_; _Acute oedema of the larynx_; _Intubation of the
larynx_; _Tracheotomy_; _Bilateral abductor paralysis_;
_Syphilitic affections_; _Tuberculosis_--Tumours: _Papilloma_;
_Epithelioma_; _Sarcoma_--Foreign bodies in the air-passages: _In
the pharynx_, _larynx_, _trachea_, _bronchi_.

[7] Revised b