To separate the operative surgery of a region from its general surgery is not perhaps so natural and convenient nowadays as it was formerly and a t a time when anatomical practicability was not only the primary but also the predominant characteri5tiv of a satisfactory operation. At that time many operations were designed so as to have for their object the removal of a definite part or organ. In these circumstances the surgeon could justifiably describe as perfectly well defined and formal procedures such operations as excision of half the tongue, of the upper jaw, and of the larynx for malignant disease. Thus it was possible for operative surgery to exist as a quasiindependent art having no very close reIation t o pathological requirements.
To-day, however, we are no longer restricted to these simplified and so to say diagrammatic procedures, and thereby much ineffective treatment and iiselcss mutilation are avoided. Thc modern operation for cancer is primarily designed to remove a disease rather than to remove an organ. It is no longer evohed. a5 it were, in an anatomical vacuum. but in close relation with an environment of pathological and clinical fact. These considerations apply especially to the surgery of the nasal cavity, the mouth, the pharynx, and the larynx. Operations for malignant disease in these parts depend for success on full familiarity with the pathological conditions and on very exact diagnosis of the individual case, quite as much as they do on operative technique.
In the parts of the pharynx with which we are here concerned the only form of malignant disease that is found, with the rarest exceptions, is the squamous-celled epithelioma. This tumour shows even in this small area wide variations in its amenability to treatment, and any operation must be planned in relation to these. To estimate the task before him in a given case the surgeon must know the exact point of origin of the growth, the clinical type it conforms to, and the extent to which i t has spread. No method of examination can a t present provide these data infallibly, or can yet take the place of a judgement trained by the patient study of cases.
The region of the pharynx we are to consider corresponds roughly with that described by anatomists as the laryngeal part, and extends from the tip VOL. XV1.-NO.