Laryngectomy : exhibited May 25, 1892.

  • Solis-Cohen, Jacob da Silva, 1838-1927.
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: Laryngectomy : exhibited May 25, 1892. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    respiration by the use of tubes, etc. They assert that the air of respiration becomes fully saturated with moisture in the nose, and that consequently, being saturated when it enters the lung, it can receive no moisture from the lung. Therefore, they say, physiologists are wrong in stating that moisture is exhaled from the lung. In this case there is no connection whatever between nose and lung; and if you take a mirror and hold it over the tracheal opening you will see that it becomes covered with moisture. In this case the lungs do exhale moisture. Of course, here the conditions are different from the normal. I only wish to call attention to this point, as it seems to show that the older physiologists were right. There is still a small fistula above, which I think will close without difficulty, but it has no connection whatever with the trachea. From the history of this case, I took it for granted at first that it was a papilloma recurring upon the seat of a former growth ; but when a portion of it was examined by a microscopist it wa's pronounced sarcoma. After extirpation of the larynx the growth was pronounced to be a cj'lindrical epithelioma, or a destructive adenoma or adeno-carcinoma invading the ary- tenoid and thyroid cartilages as well as the soft parts. You see it here in the specimen, nearly fiUing the cavity of the larynx, proceeding from the left side mainly but extending slightly to the right side and penetrating necrotic portions of both wings of the thyroid cartilage so as to present externally and involve the cutaneous surface likewise. Whatever it may be, there is no doubt of its malignancy. The question whether benign growths are ever transformed into malignant ones, is important. It is the generally received opinion that benign growths are sometimes, by further irritation, converted into malignant tumors. A col- lective investigation into the subject by Semon, of London, has shown the fallacy of this opinion so far as it refers to laryngeal neoplasms. Certainly there was in this case no conversion of a papilloma into a malignant growth. The malignant growth became developed many years later upon the site from which a benign growth had been removed. There is one clinical point that has been a revelation to me; and that is the freedom from pain, freedom from cough, and freedom from dysphagia. Should there be no recurrence in this case we have every reason to be satisfied with the result. Should recurrence ensue, the patient will have been relieved from suffering for some time. A number of years ago, when I investigated this subject, I was opposed to the operation in the main, as I am still. This is an exceptional case ; and it is only in exceptional cases that laryngectomy should be performed. At that time Dr. Czerny, of Heidelberg, wrote to me that if I could only see some of his patients and witness how free from pain they were, I would believe that the operation was a justifiable one. This case verifies his remark. The patient is now happy; whereas for many months before the operation he had been miserable. The man is wearing a single rectangular-like tube with as little parapher- nalia about it as possible.