hema illustrating the lateral method of exposing a growth
in the ventricle of Morgagni, by bending the patient's head to the
opposite side, while the second assistant externally fixes the larynx
with his hand. M, Patient's mouth; T, thyroid cartilage; R, right
side; L, left. V, B, ventricular band. C, C, vocal cord. The circular
drawing indicates the endoscopic view obtainable by this method. The
tube, E, is dropped to the corner of the mouth, B, and the tube is
inserted down to R. The lip of the spatula can then be used to lift
the ventricular band so as to expose more of the ventricle. The
drawing shows an unusually shallow ventricle.]

_Taking a Laryngeal Specimen for Diagnosis_.--The diagnosis of
carcinoma, sarcoma, and some other conditions can be made certain only
by microscopic study of tissue removed from the growth. The specimen
should be ample but will necessarily be small. If the suspected growth
be small it should be removed entire, together with some of the basal
tissues. If it is a large growth, and there are objections to its
entire removal, the edge of the growth, including apparently normal as
well as neoplastic tissue, is necessary. If it is a diffuse
infiltrative process, a specimen should be taken from at least two
locations. Tissue for biopsy is to be taken with the punch forceps
shown in Fig. 28 or that in Fig. 33. The forceps may be inserted
through the tube or from the angle of the mouth; the "extubal" method
(see Fig. 58).

[FIG. 58.--Schema illustrating removal of a tumor from the upper part
of the larynx by the author's "extubal" method for large tumors. The
large alligator basket punch forceps, F, is inserted from the right
corner of the mouth and the jaws are placed over the tumor, T, under
guidance of the eye looking through the laryngoscope, L. This method
is not used for small tumors. It is excellent for amputation of the
epiglottis with these same punch forceps or with the heavy snare.]

_Removal of large benign tumors above the cords_ may be done with the
snare or with the large laryngeal punch forceps. Both are used in the
extubal method.

_Amputation of the epiglottis_ for palliation of odynophagia or
dysphagia in tuberculous or malignant disease, is of benefit when the
ulceration is confined to this region; though as to tuberculosis the
author feels rather conservatingly inclined. Early malignancy of the
extreme tip can be cured by such means. The function of the epiglottis
seem