gnant nature of the growth.

Intrinsic cancer may spread over the upper boundaries of the larynx
and become _extrinsic_, or the disease may be extrinsic from the
outset.

In cases of _extrinsic_ cancer the early symptoms are much more
marked, pain and difficulty in swallowing, and the secretion of
frothy, blood-stained mucus being among the earliest manifestations.
The cervical glands are infected early, sometimes even before there
are any symptoms of laryngeal disease. Difficulty of breathing is also
an early symptom on account of the growth obstructing the entrance of
air. Tracheotomy may therefore be called for. In other respects the
course and terminations are similar to those of intrinsic cancer.

When the growth spreads into the tissues of the neck the patient's
sufferings are greatly increased. The oesophagus may be invaded with
resulting dysphagia; the nerve-trunks may be pressed upon, causing
intense neuralgic pains; the lymph glands become infected and break
down, and the growth fungates through the skin. The general health
deteriorates and death results, usually from septic pneumonia set up
by the passage of food particles into the air-passages, from
absorption of toxins, or from haemorrhage. The duration of this form of
the disease varies from one to three years.

The _treatment_ consists in removing the growth. In early and limited
forms of intrinsic cancer laryngo-fissure (thyreotomy) gives good
results; in more advanced cases the entire larynx must be
removed--_complete laryngectomy_--and at the same time, or after an
interval, the associated lymph glands are removed from the anterior
triangle of the neck on both sides.

In cases in which excision is impracticable, the sufferings of the
patient may be alleviated by performing low tracheotomy, and by
feeding with the stomach tube or by nutrient enemata. In some cases
the difficulty of feeding the patient may make it necessary to perform
gastrostomy.

#Sarcoma# of the larynx gives rise to the same symptoms as cancer, and
can seldom be diagnosed from it before operation.

#Foreign Bodies in the Air-Passages.#--Foreign bodies impacted _in the
pharynx_ usually consist of unmasticated pieces of meat or large
tooth-plates, and they occlude both the food and the air-passages,
frequently causing sudden death. They are considered with affections
of the pharynx.

The bodies most frequently impacted _in the larynx_ are small
tooth-plates in the case of adu