Sagittal pictures of the larynx, taken by means of a therapeutic roentgen apparatus in 40 patients with laryngeal cancer, were compared with the indirect laryngoscopical pictures of the same area in the same cases and with the findings prepared from 36 larynges totally removed.
The following technique used was one described in Dr. Kanda's work.
Bulk-focus distance: 90-100cm or so
Intensity of current: 3 milli amperes
Voltage: 140 kilovolts
Exposure: 0.7-1 second
Position of subject: Flat on face, with neck fully extended and vocal organs kept issuing the sound “Uh”
The following was the result of the radiographical examination.
1. Any laryngeal cancer sufficiently developed to be diagnosed pathohistologically and with the direct laryngoscope was identifiable radiographically.
2. Radiography was found valuable as used in the diagnosis for the cancerous lesion produced not only in the two lateral walls of the hypopharynx, the larynx, the subglottic area and the trachea, and in the inner wall of the pyriform sinus, but also in the anterior and posterior walls of the larynx and trachea.
3. Radiography proved of greater use than indirect laryngoscopy in that it made visible the changes produced in the subglottic area, the cordar paralysis, and those various ohter laryngeal disturbances which neither direct nor indirect laryngoscopy could disclose.
4. Radiography was found
(1) to serve the purpose of confirming and amplifying the findings reached by direct and indirect laryngoscopy;
(2) to give an everlastingly visible pictures of laryngeal lesions;
(3) to denote how far the tumor is extended into the subglottic area.
5. Radiography proved adapted for wide everyday application, needing no complicated technique and no special apparatus difficult to handle.
6. It is to be noted, however, that radiography as it is today needs to be improved, because the pharyngeal picture it gives is somtimes obscured by the presence of the vertebrae (particularly by the process caudalis) and calcified laryngeal cartilages and by the thickness of the cervical soft tissue.

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The patients with chronic febricular palatine tonsillitis (so-called tonsillar febricula) who were subjected to surgical treatment as in-patients at the Clinic of Otorhinolaryngology, Kyushu University Hospital, during the period of 1937 to 1951 amounted to 109 in number, including 52 male and 57 female. Palatine tonsillectomy crued the febricula in 78.9% of cases. The incidence of the condition was highest among 11 to 25-year-old persons. The subjective and objective symptoms, not much varied from those of chronic palatine tonsillitis, were marked and advanced. The diagnosis of the disease still remains difficult in many respects. The author is of the opinion that the hemographical findings may serve as an important criterion in the differentiation of this disease from chronic palatine tonsillitis. The disease is characterized by a slight increase in sedimentation rate, a decrease in the number of erythrocytes, an increase in that of leucocytes, a decrease in the amount of hemoglobin, an increase in the number of polynuclears, shift to the left of stab cells, an increase in the number of lymphocytes, an increase in that of basophils. The presence of one or more of these hemographical changes may safely be taken as an indication of the development of the disease. The subsidiary means of the diagnosis may comprise, among others, electrocardiographic search for myocardiac disturbance, alternate massaging of the right and the left palatine tonsil (for provocation of the focus), and confirmation of the presence or absence of fever type peculiar to the disease. Pathohistological examination of palatine tonsillitis in 80 tonsils in 40 of the above-mentioned 109 patients showed that this disease is attended, not only by the hitherto reported pathologic picture of chronic palatine tonsillitis, but also by some other conditions: pus accumulates and forms a pustuous cyst in the tonsillar fossa on one or either side: bust of the cyst produces inflammatory lesion in the lymphoid reticular tissue ; inflammation of epithelium in the fossa ; eosinophilic infiltration and reactive inflammation in the lymph follicles, and formation in the fossa of actinomycotic druse accompanied by remarkable wandering of neutrophils are seen as signs of systemic reaction. Such pictures of acute and subacute symptoms are to be seen at sametime. It thus appears that this disease is a condition of focal infection developing with the above-des-cribed inflammatory lesions as its primary foci and that the fibrila is a condition of mere secondary occurrence. In other words, this disease is caused by the absorption of the bacteria or bacterial toxin brought from the site of the inflammatory lesion and, possibly, also by the allergic reaction elecited by the bacteria or bacterial toxin acting as antigen. It therefore follow that the best treatment of this disease is total palatine tonsillectomy by which the original focus can be completely removed.

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The therapeutic and preventive effects of Vitamin B₁ for auditory impairment after the subcutaneous injection of quinine hydrochloride were observed by means of the microphonic response of the cochlear.
In these studies, Kittens of two or three months after birth were used as experimental animals and they were divided into four groups of experimental series. And the procedures for observing the response based upon cochlear potential were as follows: The maximum output, the intensity of the stimulating pure tone to produce 100 micro volts, and the equal loudness curve were measured for the forced vibration and the logarithmic decrement was measured for the free vibration with tuning forks.
The cats which were given daily injections of quinine hydrochloride alone subcutaneously showed an additional decrement of response.
When larger doses of Vitamin B₁ were administered to the cats with auditory impairment due to quinine injection, a little improvement of the response was observed.
The radium therapy upon the cervical sympathetic ganglion of the cats with cochlear impairment was not as effective as the Vitamin B₁ injection. When Vitamin B₁ was injected simultaneously with quinine for a preventive purpose, they showed a favorable tendency to increase the response, for instance the decline of response of the group that had 10 injections of quinine together with Vitamin B₁ was equal to that of the group that had two injections of quinine alone.

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The author who had studied on the apparatus of myringo-photography for a long time improved the lightsource of it by use of a ring-form strobo-flash-lamp, which was very small and gave an intensive illumination, for obtaining the sufficient photograph or cinematograph, even in the colour photography. The clinical experiments on the acoustic reflex of human tympanic muscle were carried out by the photography of tympanic membrane with use of this new apparatus, expecially to the phenomenon which was discovered by Prof. Kawata recently i. e. the retraction degree of the tympanic membrane dependent upon the location of malleus, when the object was exposed to the intense sound of various intensities, was continuously recorded. Therefore the author was able to measure exactly the above mentioned degree with aid of the enlarged figure of photograph taken by the procedure described above.
In intact tympanic membrane the increase of intensity of applied pure tone resulted in the increase of concavity with a certain characteristic. This response to the frequency of used pure tones was most sensitive in the middle tone area as 1024 cps and 2048 cps. In general the less the degree of retraction of tympanic membrane in silent state the more intene response expected.
In the experiments in which five kinds of sound were used, the retraction was augmented by increasing the phone in every sound frequency, and the responsive retraction was most sensitive to the sound of which chief component was C⁵ (4096 cps) and then to the higher tone area (above 4000 cps).
Besides these observations in normal persons, the experiments of the same acoustic reflex were also carried out in the cases of deafness. The retraction shifting of conductive deafness was in general very slightly in comparison with that of intact tympanic membrane, and the most sensitive response observed on the aspect of frequency in 120 phone was revealed in 4096 cps.
The retraction of tympanic membrane in the perceptive deafness, when these patients were applied the pure tones, was very slightly in contrast to that of intact one, but was generally a little larger then that of the ear of conductive deafness. This result is similar to that of normal ear of which responsive retraction is significant in the middle tone area.
The change in the deaf ear which was exposed to intensive loudness was poorer than in the normal ear, and being in the same phone intensity the response by applying the pure tones is more remarkable than that by noises. By the noise distinction the reaction was markedly recognized by the white noise and the sound of which chief component was C⁵ (4096cps).
The author supposes that these colour-photograpic figures of normal and pathological tympanic membrane, obtained by the new designed apparatus of myringo-photogaphy, are those which could not find out in the textbooks or references of otology up to the present.

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In the past, the area with a predilection for recurrence after total laryngectomy under the diagnosis of cancer of the larynx was the cervical lymph node.
The author has examined the feature of the metastases to the cervical lymph nodes and has clarified pathohistologically the significance of radical neck dissection as the method of preventing and treating the metastases to the cervical lymph nodes.
In addition, the author has described the operation-technique of radical neck dissection, problems of postoperative illeffects and postoperative cure rate, that is,
(1) In patient without clinically palpable cervical lymph nodes, microscopically positive nodes were found in 12 out of 41 cases of prophylactic neck dissection (29.2%). Accordingly, in order to prevent the recurrences in the cervical lymph nodes, even in the absence of palpable nodes, prophylactic neck dissection with laryngetomy must be performed in all advanced laryngeal cancer.(not in cluding the cordal cancer)
(2) In patient with clinically palpable cervical lymph nodes, microscopically negative nodes were found in mere one out of 15 cases of therapeutic neck dissection (6.7%). Add to this, metastases frequently occured not only in the main node, but also in the several daughter lymph nodes, and they frequently perforated the capsule of the lymph node, invaded the great vessels in the neck (mainly the internal jugular vein), adipose tissue around the lymph node and sternocleid muscle. Lymphatic and blood-vessel permeating forms were sometimes seen in the areolar tissue.
Therefore, in order to prevent the recurrences in the cervical lymph nodes, combined radical neck dissection with laryngectomy must be performed in all patient with clinically palpa-ble cervical lymph node, because extirpation of lymph node only is insufficient.
(3) When combined radical neck dissection & laryngectomy is performed, operation is possible by mere elongation of T-type incision (Gluck), usually layngectomy are first performed and extirpate “en bloc” larynx & tissue of neck.
(4) Radical neck dissection is a safe procedure, its most illeffects are
1) the elevation of the arm is hindered by injury of accessory nerve.
2) severe facial edema resulting from removal of bilateral internal jugular veins.
3) chylus retention caused by injury the thoracic duct.
but, they can be prevented by careful procedure.
(5) Out of 80 patients subjected to combined radical neck dissection and hyopreepiglolarygectomy (Iwamoto) under the diagnosis of cancer of the larynx,
only 11 cases (13.8%) had a postoperative recurrence of cancer.
3 cases (3.8%) resulted in death
curability of laryngeal cancer is being improved than the past.

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