Apart from a few brilliant but unhappily isolated cases of radical excisioIn, it is generally recognized that the successful extirpation of carcinoma of the thoracic oesophagus by operative measures is a virtual impossibility, and that the operative mortality is in the region of 100 per cent. It would be expected that these growths, being in the rmain typical squamous epitheliomata, would respond as well to radium treatment, as do growths of the tonigue and lip; but this hope of cure has been in -no way justified, although recent results from deep x-ray therapy have been very encouraging. It therefore remains to decide which of the various palliative measures will, with the minimum amnount of discomfort, give the uInfortunate patient the greatest relief from his symptoms for the longest period, and at the same time hold out a hope, however slight, of cure.
USE OF RADONThe first applications of radium in cases of carcinoma of the oesophagus were made with the help of containers, with the appropriate dose of radium, lowered into position in the lumen of the gullet and subsequently removed. More lately, methods of thoracotomy and trans-or extrapleural application of radium or radon to the outer surface of the oesophagus have been tried, with the obvious disadvantage of requiring a serious major operation in a debIlitated patient, in order that access may be had to the growth. The method about to be described is simplicity itself-direct implantation of-radon seeds into the growth through an oesophagoscope. This necessitates a loing seed introducer which will not interfere with the limited field of vision allowed by the oosophagoscope, and such an instrument -has been designed by one of us (T. B. J.). It consists of an elongated trocar and cannula, with the handle conveniently attached to the side, the knob of the trocar being levelled off flush with the barrel of the cannula. The proximal end of the cannula is inarked in alternate centimetre lengths of black and white, as an indication of the depth to which the point of the instrument has penetrated after contact with the growth, the distance being checked against the level of the proximal end of the oesophagoscope. There is no magazine for seeds, as this is unnecessary on account of the small average number of seeds used and would only complicate the instrument. The introducer can be made in any length, but we find that it is most convenient to have three, sizes, long enough to protrude 5 cm. beyond the mouth of (1) the long, (2) the medium oesophagoscope, and (3) the direct laryngoscope, respectively. A bluntended plunger with which to push home the seeds accompanies each introducer.If the patient is in a really serious condition as a result of starvation, a preliminary gastrostomy is performed under local anaesthesia in order to feed him up and render hiin fit for the oesophagoscopy. If he is reasonably well the gastrostomy is omitted. After x-ray examination of a barium swallow has been made to ascertain the level and extent of the growth, and to exclude condit...
