An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    1155/1336 (page 1113)
    2. Partial Excision of the Larynx. Cases reported prior to January, 1892 77 Died as result of operation (8 weeks) 26 Died in first three years (3 from recurrence) 5 Recurrence in first year, either dead or living when reported 17 Recurrence after 1 year (13 months, 16 months, 17 months) 3 Reported in first year, free 13 Reported in second year, free 4 Reported in third year, free 2 Reported after 3 years, free 7 After what has been said of the course of laryngeal cancer left to itself, it will be admitted that the many cases who died as a result of operation are not to be looked upon as necessarily an argument against the procedure ; nor are the cases of complete recovery to be looked upon as unqualified successes. The loss of a larynx is a terrible mutilation of the human organism, and the after-life of the patient, with or without an artificial vocal apparatus, is not an enjoyable existence. Gussenbauer and AVolf have invented mechanisms which permit these patients to produce articulate speech ; but many cases have been reported in whom some fold of tissue has been formed by nature to serve as a vibrating membrane in the production of sound and its modifi- cation by the lips and tongue into speech. Cohen's well-known case of adeno-carcinoma, in which the larynx and upper part of the trachea being removed, the remaining tracheal orifice was stitched to the skin above the episternal notch, is still alive (November, 1896) —nearly five years after operation—and he speaks hoarsely, but distinctly, by means of swallowed air which he holds in a kind of a pouch in his pharynx and expels past some vibrating fold of mucous membrane in the neighborhood of the pillars of the fauces. He breathes without cannula through the cervical opening. Excision of the larynx is an operation which, in fairness to the patient, should only be performed by a surgeon skilled in all the technic of modern surgical methods and equipped by previous surgical experience with the ability and presence of mind to meet grave aud often unexpected problems which may arise during its performance. Cohen and especially Semon l are the laryngologists who have had the most gratifying results in these opera- tions ; but, as a rule, it is not a task to be undertaken by even the experienced laryngologist. In many cases the tumor has spread, either by direct growth or by metas- tasis, beyond the larynx. The inclusion of these in the tables given is what makes the percentages of recurrence and death so high. In each case, as it is met, a decision as to a radical operation or a palliative treatment is to be decided on its merits and according to the wishes of the patient, when the conditions are explained to him. Tracheotomy for the passage of air is always indicated, and even gastrotomy for the introduction of food may be a means of prolonging a miserable existence. Sarcoma of the I,arynx.—Bergeat'2 has presented the most complete and exhaustive review of the reports of sarcoma of the larynx yet published. His list is as follows : Laryngeal sarcoma, primary 85 Laryngeal sarcoma, secondary, by continuity 10 Laryngeal sarcoma, secondary, by metas- tasis 2 Doubtful 17 Tracheal and bronchial sarcoma, primary . 7 Tracheal and bronchial sarcoma, secondary in man 9 Tracheal and bronchial sarcoma, secondary in animal (dog) 1 114 17 1 Semon (Lancet, Dec. 15, 1894, et seq.), in a series of private cases, has attained the best results hitherto published. 2 Monatschrift fur Ohrenheilkunde, 1895, Nos. 8 and 12.