DOES EXCISION OF THE LARYNX TEND 
TO. THE PROLONGATION OF LIFE ? 
A PAPER REAP BEFORE THE COLLEGE OF PHYSICIANS OP PHILADELPHIA, 
APRIL 4, 1883. 
BY 
J. SOLIS-COHEK, M.D., 
HONORARY PROFESSOR OF LARYNGOLOGY IN JEFFERSON MEDICAL COLLEGE ; 
AND PROFESSOR IN DISEASES OF THE THROAT AND NOSE, IN THE 
PHILADELPHIA POLYCLINIC AND COLLEGE FOR 
GRADUATES IN MEDICINE. 
THE TRANSACTIONS OF THE COLLEGE OF PHYSICIANS, VOL. VI 
EXTRACTED FROM 
COLLINS, PRINTER, 705 JAYNE STREET 
PHILADELPHIA: 
1883. DOES EXCISION OF THE LARYNX TEND TO THE 
PROLONGATION OF LIFE I 
That complete laryngectomy can be performed 
without sacrifice of life, there is now accumulative 
evidence. 
That every operation involving the removal of the 
larynx imperils the immediate existence of the patient, 
the records of the procedure abundantly attest. 
That a very large proportion of the subjects 
operated upon, say nearly fifty per cent, of them, 
succumb within so brief a period that their deaths 
may be justly attributed to the operation, an exami- 
nation into its statistics renders only too obvious. 
The writer owns to a prejudice against the opera- 
tion; he has never witnessed a laryngectomy, nor 
seen a patient upon whom it had been performed. It 
may seem rather an assumption on his part, there- 
fore, to criticize an operation of the technical pro- 
cedure and after-management of which he is prac- 
tically ignorant. 
Let us consult the statistics of the operation, and 
contrast the average life of those who have been 
subjected to it with the average life of patients in 
similar condition intrusted to palliative treatment. 4 
I have before me, as I write, more or less detailed 
records of sixty-five operations of complete “ extir- 
pation of the larynx,” as it is termed. 
There are a number of partial excisions, which have 
not been brought into the subjoined table because 
the partial operation is not included in the scope of 
this paper. 6 
TABLE I.- 
—LIST 
OF COMPLETE LARYNGECTOMIES, INCLUDING AND SUPPLEMENTING THE TABLES OF 
MACKENZIE, FOULIS, BLUM, AND BUROW. 
No. 
Operator. 
Date. 
Age. 
Sex. 
Disease. 
Parts removed. 
Result. 
Reference. 
Remarks. 
1 
Watson, Pat- 
rick Heron 
(of Edin- 
burgh). 
1866 
36 
M. 
Stenosis from sy- 
philis. 
Larynx and one 
ring of trachea. 
Death in 3 weeks 
from pneumonia. 
Foulis; Transactions 
International Med- 
ical Congress, Aug. 
1881, vol. iii. p. 355. 
Pneumonia was 
suspected be- 
fore the opera- 
tion. 
3 
Billroth 
(Vienna). 
1873 
Dec, 31 
36 
M, 
Carcinoma of the 
larynx. 
Larynx, lower third 
of epiglottis, part 
of the upper two 
rings of the tra- 
chea. 
Death from recur- 
rence 7 months after 
the operation. 
Archiv f. klin. Chir- 
urgie, Bd. xvii. H. 
ii. p. 343. 
Recurrence noted 
at end of four 
months. 
3 
Heine 
(Prague). 
1874 
Apl, 28 
50 
M. 
Carcinoma of the 
larynx. 
Entire larynx. 
Death from recur- 
rence 6 months af- 
ter operation. 
Arch. f. klin. Chir., 
Bd. xix. p. 584; 
Bohm Corresp. Bl. 
1874. 
4 
Schmidt, M. 
(Frankfort). 
1874 
4ug. 13 
56 
M. 
Epithelioma of 
the larynx. 
Thyroid, cricoid, 
and both aryte- 
noid cartilages. 
Death on the fourth 
day from collapse. 
Arch. f. klin. Chir., 
Bd, xviii. H. i. p. 
189. 
5 
Maas 
(Breslau). 
1874 
June 1 
57 
M. 
“ Adeno -fibroma 
carcinomato- 
sum.” 
Entire larynx. 
Death from pneumo- 
nia 2 weeks after 
operation, “ On 
fourth day,” Blum. 
Arch. f. klin. Chir., 
Bd. xix. p. 507. 
6 
Watson, P. 
H. (Edin- 
burgh) . 
1874 
60 
M. 
Epithelioma of 
larynx extend- 
ing to left vocal 
band. 
Larynx. 
Death from pneumo- 
nia in 3 weeks. 
Foulis, Trans. Int. 
Medical Congress, 
1881. 
7 
8 
Schonborn 
(Kouigs- 
berg). 
1875 
Jan. 33 
73 
M. 
Carcinoma of the 
larynx. 
Entire larynx. 
Death on the fourth 
day. 
Berliner klin.Woch., 
Sept. 20, 1875, p. 
525. 
Bottini 
(Turin). 
1875 
Feb. 6 
34 
M. 
Sarcoma (partly 
round - celled, 
partly spindle- 
celled) of the 
larynx. 
Entire larynx. 
Well April 19,1881, 
probably still alive. 
Communicazione 
letta Junanzi, la 
R. Academia di 
Medicina di Torino, 
April 30,1875. Let- 
ter from Prof. Bot- 
tini to Dr. Foulis. 
The operation en- 
tailed copious 
hemorrhage, 
and was fol- 
lowed by se- 
vere erysipelas. 6 
table I—continued. 
Wo. 
Operator. 
Date. 
Age 
Sex. 
Disease. 
Parts removed. 
Eesult. 
Reference. 
Remarks. 
9 
Langenbeck 
1875 
57 
M. 
Carcinoma of up- 
Entire larynx, hy- 
oid bone, part of 
Death from recur- 
Berlin, klin. Woch. 
j 
(Berlin). 
July 21 
per part of lar- 
rence in cervical 
1875, No. 33, p. 453 
ynx, of the epi- 
glottis, and of 
the tongue, pha- 
lymphatic glands, 
Arch. f. klin. Chir., 
rynx, and oeso- 
phagus. 
4 months after. 
Bd. xxi. Supplem 
10 
Multanow- 
ski (St. Pe- 
tersburgh). 
1875 
July 27 
the hyoid bone. 
p. 136. 
Centbl. f. Chir., 1883, 
No. 25, and letter 
59 
M. 
Carcinoma. 
Entire larynx. 
Death from croupous 
pneumonia 3 mos. 
I 
after operation. 
from Dr. A. Schmidt 
to Prof. Burow 
(Arch. Laryng., 
N.Y., April, 1888). 
As above. 
11 
Multanow- 
ski (St. Pe- 
1875 
Aug. 9 
47 
M. 
Carcinoma. 
Entire larynx. 
Death from recur- 
rence 3 months 
13 
tersburgh). 
Billroth 
(Vienna). 
1875 
Nov. 11 
54 
M, 
Diffuse carcino- 
ma of the lar- 
ynx. 
Entire larynx. 
after operation. 
Death on the fourth 
day from extensive 
broncho - pneumo- 
Billroth’s Clinical 
Surgery, London, 
1881, p. 133. 
Had not been pre- 
ceded by trach- 
eotomy; wound 
nia. 
did well, with 
butlittlefebrile 
13 
Maas 
( Freiburg). 
1876 
Feb. 5 
50 
M. 
Epithelioma of 
the larynx. 
Entire larynx, with 
exception of the 
Death from recur- 
rence 6 months 
Arch. f. klin. Chir., 
Bd. xx. p.535. Pri- 
reaction. 
Recurrence in 
posterior por- 
tion of tongue 
epiglottis and of 
after the operation. 
vate communica- 
a small piece of 
the cricoid cartil- 
tion from operator 
to Dr. Foulis, 
about 3 months 
after operat’n. 
age. 
Trans. Int. Med. 
C., London, 1881. 
Death by he- 
morrhage from 
the ulcerated 
14 
Gerdes 
(Jeyer). 
1876 
Mar. 30 
76 
M. 
Carcinoma. 
Entire larynx. 
Death on the fourth 
day from collapse. 
Arch. f. klin. Chir., 
Bd. xxi. H. ii. p. 
mass. 
15 
Reyher 
1876 
60 
M. 
Carcinoma of the 
Entire larynx, with 
Death on the eleventh 
473. 
St. Petersburgher 
med. Woch., 1877, 
Nos. 17 and 18. 
(Dorpat). 
May 
1 
vocal bands. 
exception of epi- 
glottis. 
day from hyposta- 
tic pneumonia. 7 
table i—continued. 
No. 
Operator. 
Date. 
Age. 
Sex. 
Disease. 
■ Parts removed. 
Result. 
Reference. 
Remarks. 
16 
Watson, P. 
H. (Edin- 
burgh). 
1876 
60 
F. 
Epithelioma of 
larynx, with en- 
largement of 
some adjacent 
glands. 
Larynx and en- 
larged glands. 
Death in one week 
from pulmonary 
embolism. 
Letter from operator 
to Dr. Foulis. 
The lingual and 
facial veins 
were cut in the 
operation. 
17 
Kosmski 
(Warsaw). 
1877 
Mar. 15 
36 
F. 
Epithelioma of 
the larynx, with 
perforation of 
the skin. 
Entire larynx. 
Death from recur- 
rence 9 months 
after operation. 
Centbl. f. Chir.,1877, 
No. xxvi. p. 401. 
Private communi- 
cation from opera- 
tor to Dr. Foulis. 
18 
Fonlis 
(Glasgow). 
1877 
Sept. 10 
38 
M. 
Sarcoma, “ part- 
ly papilloma, 
partly spindle- 
celled sarco- 
ma.” 
Entire larynx, with 
exception of su- 
perior cornua of 
thyroid cartilage 
and half the ary- 
tenoid cartilages. 
Death from tracheal 
and pulmonary 
phthisis, March 1. 
1879. 
Lancet, Oct. 13,1877, 
and Mar. 29, 1879. 
19 
Wegner 
(Berlin). 
1877 
Sept. 16 
52 
F. 
Carcinoma of the 
larynx, size of 
walnut, origin- 
ating from right 
ventricle. 
Entire larynx, with 
epiglottis, but 
leaving lower half 
of the cricoid car- 
tilage. 
Well April 13, 1878. 
Verb, der Deutsche 
Gesellsch. f. Chir., 
1878. Private com- 
munication from 
operator to Dr. 
Foulis. 
20 
Bottini 
(Turin). 
1877 
Aug. 39 
48 
M. 
Epithelioma of 
the larynx. 
Entire larynx and 
portion of oeso- 
phagus. 
Death on the third 
day from double 
pneumonia. 
Annales des maladies 
de Poreille et du 
larynx, July 1, 
1878; ' Centbl. f. 
Chir., 1878. 
Performed 
“ bloodlessly,” 
with galvano- 
cautery blade. 
21 
Bruns, Vic- 
tor von 
(Tubingen). 
1878 
Jan. 29 
54 
M. 
Epithelioma of 
the larynx (of 
5 years’ dura- 
tion). 
Entire larynx. 
Death from recur- 
rence 9 months 
after operation. 
• 
Wien. med. Presse, 
Nov. 17,1878. Com- 
munication from 
Prof. Paul Bruns to 
Dr. Foulis. 
1 
Preliminary 
tracheotomy 
not performed. 
Collapse after 
operation, and 
hyperpyrexia 
for a week. 
Voice tube em- 
ployed in five 
weeks. 8 
table I—continued. 
• 
No. 
Operator. 
Date. 
Age. 
Sex. 
Disease. 
Parts removed. 
Result. 
Reference. 
Remarks. 
33 
Rubio 
(Madrid). 
1878 
May 11 
41 
M. 
Perichondritis of 
the thyroid car- 
tilage, with ne- 
crosis. 
Entire larynx. 
Death on the fifth 
day from maras- 
mus. 
Observacion clinica, 
etc. Real Academia 
de Med., Madrid, 
1878. 
33 
Czerny 
(Heidel- 
berg) . 
1878 
Aug, 34 
46 
M. 
Sarcoma in and 
under vocal 
bands, and per- 
forating the 
thyroid cartil- 
age ; also in- 
volving the 
neighboring 
glands. 
Entire larynx, and 
the diseased 
glands. 
Death 15 months 
after operation (as 
the result of a new 
operation ?). 
Letter from operator 
to Dr, Foulis. Schid- 
ler, die Tracheoto- 
mie, Billroth und 
Liicke’s Deutsche 
Chirurgie, 1880, p. 
300. 
Repeated remov- 
als of recurring 
masses. 
34 
Billroth 
(Vienna). 
1879 
Peb. 37 
43 
F. 
Epithelioma of 
pharynx, lar- 
ynx, and thy- 
oid gland. 
Entire larynx, with 
part of pharynx 
and oesophagus. 
Death during seventh 
week from passage 
of bougie into me- 
diastinum. 
Private communica- 
tion from operator 
to Dr. Foulis. 
25 
Gussenbauer 
(Prague). 
1879 
May 34 
34 
M. 
Carcinoma. 
Entire larynx. 
Death 3 months after 
operation from tu- 
berculosis pulmo- 
num. 
Letter from operator 
to Prof. Burow. 
Arch. Lar., April, 
1883. 
26 
Macewen, 
Wm. (Glas- 
gow). 
1879 
July 31 
56 
M. 
Carcinoma of lar- 
ynx and upper 
end of gullet; 
also a glandu- 
lar mass at left 
side of neck. 
Larynx, part of gul- 
let, and the glan- 
dular mass. 
Death in 3 days from 
pneumonia. 
Foulis, Trans. Int. 
Med. Con., Lon- 
don, 1881. 
37 
Caselli Azzio 
(Reggio-Em- 
ilia). 
1879 
Sept. 30 
19 
F. 
Sarcoma of lar- 
ynx, pharynx, 
palate, and base 
of tongue. 
Entire larynx, pha- 
rynx, base of 
tongue, soft pa- 
late, and tonsils. 
Well August, 1881 
(probably still liv- 
ing). 
Bui. del Scien. Med., 
Bologna, 1880, vol. 
v.; Centbl. f. Chir., 
1880; CasellPs Re- 
print, Bologna, 
1880. CasellPs 
statement at meet- 
ing Int. Med. Con., 
London, 1881. 
Operation occu- 
pied more than 
3 hours, was 
largely done 
with the gal- 
vano - caustic 
blade, and was 
attended with 
but little he- 
morrhage. 9 
table I—continued. 
No. 
Operator. 
Date. 
Age. 
Sex. 
Disease. 
Parts removed. 
Result. 
Reference. 
Remarks. 
28 
Lange, F. 
1879 
74 
M. 
Sarcoma of lar- 
Larynx, right cor- 
Death from asthenia 
Archives of Laryngo- 
(New York) 
Oct. 12 
ynx involving 
the gullet. 
nua of hyoid bone, 
part of gullet. 
nearly seven months 
after operation. Re- 
logy, N. Y., 1879, 
p. 36. 
29 
Multanow- 
currence. 
1879 
60 
M. 
Carcinoma. 
Entire larynx. 
Death on fifth day 
Centralbl. f. Chir., 
ski (St. Pe- 
tersburgh). 
Dec. 4 
from pneumonia. 
1882, No. 25. Let- 
ter from Dr. A. 
Schmidt to Prof. 
Burow, Arch. Lar., 
80 
Langenbuch 
1879 
An aged 
female. 
Death on third day 
from collapse. 
April, 1883. 
Verh. der Deutsche 
Ges. f. Chir., Bd. x. 
Only met by com- 
piler in Blum’s 
list, Arch. Gen. 
de med., 1882, 
31 
Reyher, Carl 
1880 
48 
M. 
Carcinoma. 
Larynx. 
Death on seventh day 
Wolner’s Med. Jour., 
ii. p. 79. 
(St. Peters- 
burgh). 
from septic bron- 
1880. H. i. Letter 
cho-pneumonia. 
from operator to 
32 
Thiersch 
(Leipsic). 
1880 
Feb. 26 
36 
M. 
Carcinoma, 
Entire larynx and 
two rings of tra- 
chea. 
Well 18 months 
AFTER OPERATION. 
Dr. Foulis. 
Deutsch. Ztschr. f. 
Chir., 1881, xvi. p. 
149. Centbl. f. 
med, Wiss., Sept. 
23, 1882. Revue 
mens, de Laryn., 
No. 82, p. 350, but 
accredited to Lan- 
Tracheotomy, 
Sept, 27, 1879. 
Laryngotomy 
for access to 
growths, Feb. 
3, 1880. 
33 
Thiersch 
(Leipsic). 
1880 
April 15 
52 
M. 
Carcinoma. 
Entire larynx. 
Were 17 months 
AFTER OPERATION, 
derer. 
As above. 
Tracheotomy, 
Mar. 2,1880. 
34 
Czerny 
1880 
47 
M. 
Epithelioma of 
Larynx and soft 
Death from exhaus- 
Letter from operator 
(Heidel- 
Oct. 11 
larynx and su- 
tissues in front of 
tion and hemor- 
to Dr. Foulis. 
berg). 
perjacent soft 
parts. 
it. 
rhage 5 months 
(March 25, 1881) 
after. 10 
table i—continued. 
No. 
! Operator. 
Date. 
Age 
Sex 
Disease. 
Parts removed. 
Result. 
Reference. 
Remarks. 
35 
Hahn 
(Berlin). 
1880 
Oct. 23 
67 
M. 
Carcinoma. 
Larynx, all except 
a portion of the 
thyroid cartilage. 
Free from recur- 
rence 3 YEARS 
after operation. 
Letter from operatoi 
to Prof. Burow. 
Archives of Laryn- 
36 
Thiersch 
(Leipsic). 
1880 
Nov. 10 
45 
1 
F. 
Carcinoma of 
pharynx and 
larynx. 
Larynx and part of 
pharynx. 
Death from recur- 
rence in 4 months 
(March 16,1881). 
gology, April, 1883. 
Deutsch. Ztsch. f. 
Chir., 1881, xvi. p. 
149. 
Tracheotomy, 
Oct. 17, 1880. 
Recurrence 
noted within 6 
weeks after 
37 
Bircher, H. 
(Aarau). 
1880 
49 
F. 
Scirrhus of the 
Thyroid gland ex- 
Death in 16 days 
Letter from operator 
to Dr. Foulis. Trans. 
Int. Med. Congress, 
operation. 
Dec. 3 
thyroid gland, 
involving the 
cised; 6 months 
later the cancer 
from pneumonia 
and gangrene of 
larynx. 
recurred, and the 
the lung. 
1881. 
larynx was ex- 
cised with part of 
38 
Pick 
(London). 
1881 
Jan. 16 
39 
M. 
Epithelioma of 
larynx (preced- 
the gullet. 
Larynx and epiglot- 
tis. 
Death in 5 days from 
pleurisy and peri- 
Lancet, April 3,1881, 
p. 541, Brit. Med. 
ed by papillo- 
mata). 
Carcinoma of 
pharynx and 
carditis. 
Journ., April 9, 
39 
Thiersch 
(Leipsic). 
1881 
Jan.17 
57 
F. 
Entire larynx and 
part of pharynx. 
Death on seventh day 
from secondary in- 
1881, p. 563. 
Deutsch. Ztsch. f. 
Chir., 1881, Bd. 
Tracheotomy, 
Dec. 9, 1880. 
40 
Toro 
(Cadiz). 
1881 
March 9 
larynx. 
Epithelioma of 
laryrwx. 
Hyoid hone, base 
of tongue, and 
fectious pneumonia 
Death on fourth day 
from pulmonary 
xvi. p. 149. 
Med. Record, N.Y., 
August 6, 1881, p. 
41 
Winiwarter 
(Liege). 
1881 
April 
55 
F. 
Carcinoma, 
larynx. 
Entire larynx. 
emphysema. 
NO RECURRENCE 11 
167. 
Clinique Chir. Univ. 
MONTHS AFTER OPE- 
RATION. 
Liege ; Monatschr. 
f. Ohrenheilk, 1882, 
No. 9. Burow’s 
43 
Poulis 
(Glasgow). 
1881 
April 30 
50 
M. 
Epithelioma of 
larynx (preced- 
ed by papillo- 
mata). 
Larynx. 
Well and strong Au- 
gust, 1881. 
list. 
Brit. Med. Jour., May 1 
7, June 11, 1881; 
Trans. Int. Med. 
Congress, London, 
1881, 11 
table I—continued. 
No. 
Operator. 
Date. 
Age 
Sex 
Disease. 
| Parts removed. 
Result. 
Reference. 
Remarks. 
43 
Czerny 
(Heidel-) 
berg). 
1881 
May 13 
47 
M. 
Epithelioma. 
Larynx and upper 
two rings of tra- 
chea. 
Well and strong Au- 
gust, 1881. 
Letter from operatoi 
to Dr. Foulis. Ver- 
bal report to Int. 
Med. Cong,, Lon- 
44 
Beyher, Carl 
(St. Peters- 
1881 
May 14 
57 
M. 
Carcinoma. 
Larynx. 
Death on fifth day 
don,1881. 
Letter from operator 
burgh). 
• 
from septic bron- 
to Dr. Foulis. Trans. 
cho-pneumonia. 
Int. Med. Congress, 
45 
Kocher 
(Berne). 
1881 
May 16 
59 
M. 
Carcinoma. 
Entire larynx, ex- 
No RECURRENCE 16 
1881. 
Letter from operator 
Patient wears a 
cept a piece oi 
the cricoid car- 
tilage. 
MONTHS AFTER OPE- 
RATION. 
to Prof. Burow. 
Arch. Laryn., N.Y. 
April, 1883. 
self-made arti- 
ficial epiglottis 
to overcome 
choking in de- 
glutition, re- 
sult of excision 
46 
47 
Tilanus (Am- 
sterdam ). 
Gussenbauer 
(Prague). 
1881 
May 
1881 
May 19 
51 
48 
M. 
M. 
Epithelioma. 
Carcinoma, 
Entire larynx. 
Entire larynx. 
Death in 36 hours 
from collapse. 
Well 19 months 
Centbl.f. Chir., 1882, 
.No. 34. 
Letter from operator 
of epiglottis. 
AFTER OPERATION J 
doing duty as a 
to Prof. Burow. 
Arch. Laryn., N.Y. 
48 
Volker 
(Bruns- 
wick). 
1881 
May 28 
44 
F. 
Carcinoma epi- 
thelioides. 
Entire larynx. 
riding-master. 
Death from suffoca- 
tion 5 months after 
April, 1883. 
Academisch Proef- 
schrift, Amsterdam, 
Suffocated while 
patient had 
operation. 
1883, pp. 84 and 113. 
withdrawn ca- 
ll ula to cleanse 
49 
Albert 
(Vienna). 
1881 
July 6 
45 
M. 
Carcinoma, al- 
most filling right 
half of larynx. 
Entire larynx, ex- 
cept epiglottis ; 
also small section 
of adherent ceso 
phagus. 
death on eighth day 
from diffuse bron- 
chitis and lobular 
pneumonia. 
Wien med. Presse, 
1881, xxii. p. 1373. 
it. 
On 13th, hemor- 
rhage from in- 
ternal carotid, 
arrested by li- 
gature above 
and below 
point of ero- 
sion. Collapse 
same evening; 
death nextday. 12 
table i—continued. 
No 
Operator. 
Date. 
Age 
Sex. 
Disease. 
Parts removed. 
Result. 
Reference. 
Remarks. 
50 
51 
Hahn 
(Berlin). 
Mare-ary 
(Turin). 
1831 
Aug. i; 
1881 
Sept. 29 
46 
36 
M. 
F. 
Carcinoma. 
Epithelioma o: 
oesophagus and 
larynx. 
Entire larynx. 
Larynx, first ring oi 
trachea, thyroid 
body, part oi 
Death in 25 days from 
putrid bronchitis. 
Letter from operate] 
to Prof. Burow. 
Arch. Ital. di Lar. 
Jan. 15, 1882. 
Recurrence at 
end of 3 mos. 
pharynx, and 
oesophagus. 
Entire larynx. 
52 
Gussenbauei 
(.Prague). 
1881 
Oct. 
63 
M. 
Carcinoma. 
STRONG AND WELL 
Letter from operator 
14 MONTHS AFTER 
to Prof. Burow. 
53. 
Reyher, Carl 
(St. Peters- 
burgh). 
1881 
Oct. 10 
73 
M. 
Carcinoma. 
Larynx and upper 
three rings of 
OPERATION. 
Death from recur- 
rence, 9 months 
St. Petersburg!! med. 
Ztschr., 1883, No 
trachea. 
after operation. 
28. Letter from 
• operator to Prof. 
54 
Reyher, Carl 
(St. Peters- 
15 urgh). 
1881 
Oct. 10 
65 
M. 
Carcinoma. 
Larynx. 
Death on seventh day 
from septic pneu- 
monia. 
Recurrence in four 
months. Excision 
of right lobe of 
thyroid gland and 
Burow. 
As above. 
55 
Novaro. 
1881 
63 
M. 
Carcinoma. 
Entire larynx. 
Giorn. di R. Acad, di 
med. di Torino,vol. 
xxxix. 1881, p. 39 ; 
Arch. Ital. di Lar., 
part of pharynx. 
July 15, 1882. 
Death from hem- 
orrhage on 11th 
66 
Schede. 
1881 
54 
M. 
Cancroid. 
Larynx, hyoid 
day. 
Two months later 
Deutsche med. 
bone, and thy- 
roid gland. 
the patient was 
Woch., 1883, No. 
fitted with an arti- 
33, p. 45. 
57 
Reyher, Carl 
(St. Peters- 
burgh). 
Kocher 
(Berne). 
1882 
April 7 
55 
M. 
Carcinoma epi- 
thelioides. 
Entire larynx, pha- 
rynx, and parts 
of oesophagus. 
Entire larynx and 
carcinomatous * 
glands. 
ficial larynx. 
Death 14 days after 
operation from ex- 
setter from operator 
58 
1883 
May 13 
54 
M. 
Carcinoma. 
haustion. 
Letter from operator 
to Prof. Burow. 
Recurrence seven 
months, after 
operation. 13 
table I—concluded. 
No. 
Operator. 
Date. 
Age. 
Sex. 
Disease. 
Parts removed. 
Result. 
Reference. 
Remarks. 
69 
Whitehead, 
Wm, (Man- 
1883 
46 
M. 
Epithelioma ol 
Thyroid and cricolc 
Well January 31, 
Lancet, Nov. 4, 1883 
May 27 
right vocal band 
cartilages and two 
1883. Probably 
p. 741. Letter from 
Chester). 
and parts sub- 
rings of trachea, 
leaving epiglottis 
still alive. 
operator to com- 
jacent (as far 
piler, dated Jan.31, 
down as upper 
intact. 
1883. 
portion of tra- 
60 
1883 
June 13 
54 
chea). 
Bergmann, 
von (Wurz- 
burg) . 
M. 
Carcinoma. 
(Adeno-sarco- 
Entire larynx. 
Speaks well with 
artificial (Bruns) 
Sitzungsb. Wurzburg 
Phys. Grcsell., 1882, 
ma ?). 
LARYNX SOME MOS. 
AFTER OPERATION. 
47 - 56. Deutsche 
med. Woch., 1883, 
No. 35.; Centbl. f. 
Chir., Aug. 19, 
61 
Burow 
1883 
44 
M. 
Carcinoma. 
Entire larynx with- 
Death from sudden 
1883. 
Archives of Laryn- 
63 
(Konigs- 
berg). 
Kocher 
(Berne). 
July 7 
1883 
Sept. 38 
43 
M. 
Carcinoma. 
out epiglottis. 
Entire larynx and 
a portion of oeso- 
suffocation mos. 
after operation. 
gology, April, 1883. 
Sammlung klin. Vor- 
trage v. Volkmann, 
63 
Maydl 
(Vienna). 
1883 
50 
M. 
Carcinoma. 
Larynx, except cri- 
coid cartilage. 
Excision of a 
gland, size of a 
dove’s egg. 
No recurrences mos. 
after operation. 
No. 334, p. 1944. 
Wien med. Presse, 
1883, xxiii. 1673; 
Wien med. Woch., 
1883, No. 44. Let- 
ter from operator 
64 
Ruggi. 
1883 
10 
M. 
Polypi of the la- 
Entire larynx. 
to Prof. Burow. 
Centbl. f. Chir., 1883, 
No. 45; Raccogli- 
tore med.-, 1883, 
“Recovery in 88 
days.” Burow’s 
list. 
65 
I 
McLeod 
(Calcutta). 
1883 
35 
M. 
Papilloma of la- 
rynx. 
Entire larynx and 
thyroid gland. 
In good condition 
one month later. 
xviii. p. 36. 
Ind. Med. Gaz., 1883, 
xviii., 34-86. 14 
Of the above complete operations, four 
were performed in non-malignant cases; one for 
cicatricial syphilitic stenosis, with death “ some weeks 
after from pneumonia” (Case 1) [Watson] ; one for 
necrosis, the case terminating fatally by marasmus 
five days after the operation (Case 22) [Rubio] ; one 
tor polypi of the larynx (Case 64) [Ruggi] ; and one 
for papilloma of the larynx (Case 65) [McLeod]. 
Of the sixty-one operations remaining in this list, 
five were performed for sarcoma; in two of which the 
results were so remarkably exceptional, that attention 
should be especially directed to them. 
I. Bottini, of Turin, on Feb. 6, 1875, removed the 
entire larynx from a male subject twenty-four years 
of age, with a laryngeal sarcoma, partly round-celled, 
partly spindle-celled. Notwithstanding copious 
hemoi i ha&e and severe erysipelas, the patient re- 
covered. He was reported well in August, 1881, or 
more than six years after the operation, and I have 
seen no notice of his death. He had been perform- 
ing the duties of a postman, and walking eight miles 
a day. This is the most successful case on record. 
11. Caselli, of Reggio-Emilia, on Sept. 20, 1879, 
removed the larynx, pharynx, base of the tongue, 
soft palate and tonsils, from a female subject nineteen 
years of age, lor a sarcoma of the larynx, pharynx, 
palate, and base ol tongue. The patient was reported 
well in August, 1881, practically two years after the 
operation, and I have seen no notice of her death. 
This is the second best case on record. 
The remaining three patients operated upon for 
sarcoma died at the periods of seven, fifteen, and 
seventeen-and-a-half months, respectively. 15 
TABLE lI.—CASES OF SARCOMA. 
1 (Lange) lived nearly 7 months. 
1 (Czerny) “ “ 15 u 
1 (Foulis) “ “ 171 u 
} was alive Aug.’lSSl, nearly 2 years after operation. 
1 (Bottom) was alive and well Aug. 1881, years after operation. 
Taking for granted, as we are bound to do, that 
death Avas imminent in these five cases of sarcoma 
when the operation was resorted to, we have a con- 
siderable prolongation of life in every instance, and 
a remarkable prolongation in two, or in forty per cent. 
A,s fai as these limited statistics go, therefore, the 
operation of excision of the larynx in hopeless cases 
of sarcoma is worthy the serious consideration of the 
surgeon. 
The history of the remaining fifty-six operations 
presents a much more gloomy account. They were 
all for carcinoma, if we may include under that head 
Schede’s case (56) of “ cancroid.” 
Let me read the list of deaths as far as reported:—- 
TABLE 111. RECORDED DEATHS AFTER LARYNGECTOMY FOR 
CARCINOMA. 
1. 
2. 
3. 
Tilanus, 
Macewen, 
Bottini, 
Case 46. 
“ 26. 
“ 20. 
Death in 36 hours from collapse. 
3 days “ pneumonia. 
“ 3 “ “ 
4. 
5. 
Langenbuch, 
Schmidt, 
“ 30. 
“ 4. 
4 4 
44 
3 
4 
4 4 
4 4 
4 4 
4 4 
collapse. 
44 
6. 
Gerdes, 
“ 14. 
4 4 
4 
4 4 
4 4 
4 4 
7. 
Q 
Billroth, 
Toro, 
Schbnborn, 
“ 12. 
4 4 
4 
4 4 
4 4 
pneumonia. 
O. 
9. 
“ 40. 
“ 7. 
i 4 
4 4 
4 
4 
44 
4 4 
<4 
4 4 
pulmonary emphysema. 
? 
pneumonia, 
septic broncho-pneumonia. 
10. 
11. 
12. 
Multanowski, 
Reyher, 
Pick, 
Reyher, 
Reyher, 
Watson, 
Thiersch, 
“ 29. 
“ 44. 
4 4 
4 4 
5 
6 
4 4 
4 4 
44 
4 4 
13. 
14. 
15. 
1G. 
“ 38. 
“ 31. 
“ 54. 
“ 16. 
“ 39. 
4 4 
4 4 
4 4 
4 4 
5 
7 
7 
7 
7 
44 
4 4 
4 4 
44 
4 4 
44 
4 4 
4 4 
4 4 
pleurisy and pericarditis, 
septic broncho-pneumonia, 
septic pneumonia, 
pulmonary embolism, 
“secondary infectious” 
17. 
Albert, 
“ 49. 
4 4 
8 
4 4 
4 4 
pneumonia. 
“diffuse bronchitis and 
lobular” pneumonia. 16 
lg. Reyher, 
19. Reyher, 
Case 15. 
“ 57. 
Heath 
t 6 
in 11 days from “hypostatic” pneumonia. 
14 “ “ exhaustion. 
20. 
21, 
Maas, 
Watson, 
“ 5. 
“ 6. 
4 4 
44 
2 weeks 
2 “ 
44 
44 
pneumonia. 
11 
22. 
Bircher, 
“ 37. 
44 
16 days 
44 
pneumonia and ‘£ pulmo- 
23. 
Hahn, 
Billroth, 
“ 50. 
44 
25 
4 4 
44 
nary gangrene.” 
putrid bronchitis. 
24. 
“ 24. 
44 
6 weeks 
44 
passage of bougie into 
25. 
Multanowski, 
“ 11. 
44 
2 
mos. 
44 
mediastinum. 
recurrence. 
26. 
Gnssenbauer, 
“ 25. 
44 
2 
4 4 
44 
tuberculosis pulraonum. 
‘ ‘ croupous’ ’ pneumonia, 
recurrence. 
27. 
28. 
Multanowski, 
Langenbeck, 
“ 10. 
“ 9. 
44 
4 4 
3 
4 
4 4 
44 
4 4 
4 4 
29. 
Thiersch, 
“ 36. 
4 4 
4 
44 
4 4 
44 
30. 
Novaro, 
“ 55. 
44 
4 
44 
44 
recurrence and hemorrhage 
consequent upon addi- 
tional operative proced- 
31. 
von Burow, 
ures. 
“ 61. 
4 4 
U 
. 44 
44 
sudden suffocation. 
32, 
Czerny, 
“ 34. 
4 4 
5~ 
44 
4 4 
recurrence. 
33. 
V olker, 
“ 48. 
44 
5 
44 
44 
suffocation. 
34. 
Heine, 
“ 3. 
44 
6 
4 4 
44 
recurrence. 
35. 
Maas, 
“ 13. 
4 4 
6 
44 
44 
44 
36. 
Billroth, 
“ 2. 
44 
7 
44 
44 
44 
37. 
Bruns, 
“ 21. 
44 
9 
4 4 
4 4 
4 4 
38. 
Kosinski, 
“ 17. 
44 
9 
44 
44 
44 
39. Reyher, 
“ 53. 
44 
9 
4 4 
4 4 
44 
40. 
Czerny, 
“ 23. 
44 
15 
4 4 
4 4 
4 4 
table in.—continued. 
To this list may be added the cases of— 
Margary, Case 51, in which recurrence was reported at 3 months. 
Ivocher, “ 58, “ “ “ 7 u 
In the following cases neither death nor recurrence has been reported: 
1. 
F oulis, 
case 42, alive 5 weeks after operation. 
2. 
Czerny, 
44 
43, “ 6 “ “ 
56, artificial larynx adjusted 2 months after operation. 
3. 
4. 
Schede, 
Mayal, 
44 
u 
5. 
von Bergmann. 
u 
1 
iikj i ccuiit/iiGty o mourns alter operation. 
60, alive “some” “ “ 
6. 
Wegner, 
Whitehead, 
Winniwarter, 
u 
19, “ 7 months after operation. 
7. 
8. 
44 
4 4 
59, “no recurrencealive 8 months after operation. 
41, “ “ “ 11 “ u 
9. 
Gussenbauer, 
u 
52, well 14 months after operation. 
10. 
Kocher, 
4 4 
46, no recurrence 16 months after operation. 
11. 
Thiersch, 
4 4 
33, well 17 months after operation. 
32, “ 18 “ “ 
12. 
Thiersch, 
44 
13. 
Gussenbauer, 
4 4 
47, “ 19 “ “ 
14. 
Hahn, 
44 
35, “ 2 years “ “ 
Of the forty reported deaths, seventeen, or forty- 
two-and-a-half per cent., occurred within eight days, 17 
and five more succumbed within the second period of 
eight days. 
The danger during the first few days is from shock 
and from pneumonia. Very few have perished from 
direct shock, very many from pneumonia. The pneu- 
monia has been attributed generally to the ingress of 
blood, aliment, and septic materials into the air-pas- 
sages ; but, if I may form an opinion from what I have 
witnessed in many other operations upon the neck, 
theie is a certain amount of risk of pneumonia in all 
surgical interferences in the cervical region, even 
when the air-passage is not opened. Thus I have 
seen it follow extirpation of the thyroid gland, ex- 
tiipation of cervical neoplasms, and even exploratory 
incision into the region. It may be that the reduc- 
tion of temperature to which the pneumogastric 
nerve is subjected leads to pneumonia, and that the 
manipulations within the wound render it especially 
sensitive. When we reflect that the majority of these 
operations of laryngectomy consume from one to three 
hours in their performance, we can fairly presume 
that the pneumogastric nerve is subjected to sufficient 
ordeal to excite an early pneumonia, quite independ- 
ently of access of foreign matter to the lungs; a sequel 
of the operation against which every available pre- 
caution is taken. 
The danger from pneumonia does not seem to exist 
longer than two weeks, for we have but one record 
of death from this cause after the sixteenth day, and 
that from “croupous pneumonia” (Case 10) at the 
end of three months. This important fortnight safely 
passed, the life of the patient appears comparatively 
secure up to the fourth month. At the fourth month 18 
death begins to be imminent from recurrence, and we 
have, in our table, three at four months; one, and pos- 
sibly several, within five months ; two at six months; 
one at seven months; three at nine months; and one at 
fifteen months. One death from recurrence (Case 11) 
is reported at two months after operation. Nine cases 
are reported living at seven, eight, eleven, fourteen, 
sixteen, seventeen, eighteen, nineteen, and twenty- 
four months, respectively. Thus forty-two-and-one- 
halt per cent, of the forty cases, recorded as termi- 
nating fatally, or more than thirty per cent, of the entire 
number operated upon for carcinoma, perished within 
eight days; and at the end of six months, thirty-five 
of the forty were dead, or eighty-seven-and-one-half 
per cent.; making sixty-two-and-one-half per cent, of 
the entire fifty-six operations for carcinoma; with great 
probability of a still higher percentage had all the 
deaths been reported. 
Let us contrast this record with the average life of 
carcinoma of the larynx not subjected to the radical 
operation of laryngectomy. 
Of a number of cases of carcinoma of the larynx 
under my own care, who agreed to submit to exsec- 
tion of the larynx should I so determine, and in whom 
I performed tracheotomy in preference, one lived six 
months, two lived seven months, one lived thirteen 
months, and one eighteen months, respectively, after 
the tracheotomy. 
Had laryngectomy been practised in these five 
cases, with equal tenure of existence, the result would 
have been accredited to the radical procedure. Had 
the operation been performed, one life might possibly 
have been prolonged; the majority, however, would 
probably have been shortened. At the period a 19 
the end of which eighty-seven-and-a-half per cent, 
of the recorded deaths after laryngectomy had oc- 
curred, i. e., six months, all my tracheotomized cases 
were living ; and hut two of the entire number of 
fifty-six excisions for carcinoma outlived the longest- 
lived instance in my tracheotomized list. It is not 
improbable that a complete series of collated statis- 
tics would present a far better exhibit for the cases 
merely subjected to tracheotomy and palliative pro- 
cedure. It is generally believed that the natural 
history of carcinoma of the larynx comprises an 
average existence of about two years and a half; 
tracheotomy becoming requisite at a period varying 
from nine to eighteen months, according as the dis- 
ease is wholly intra-laryngeal or more parietal. 
In laryngectomy, the initial shock is severe, and sure 
to carry off a large percentage of cases by collapse, 
or by pneumonia. A certain number of lives are 
sacrificed; and the condition of the survivors, with 
their artificial substitutes for the larynx, is often de- 
scribed as pitiable in the extreme. 
In tracheotomy, there is little shock, very slight 
danger of pneumonia, and much less risk of septic 
infection. Life is not likely to be sacrificed in any 
instance; and existence is much more comfortable 
after the operation than after laryngectomy. 
For these reasons, excision of the larynx for carci- 
noma does not, in my opinion, tend to the prolonga- 
tion of life; for the prolonged existence of a very few 
seems purchasable only at the sacrifice of the rem- 
nants of existence of many others. The greatest good 
to the greatest number appears better secured by de- 
pendence on the palliative operation of tracheotomy.