Compliments of the Author 
EXTRACTION 
OF A GLOSSO-EPIGLOTTIC MYXO-SARCOMA, BY 
MEANS OF THE FINGERS 
TO WHICH ARE ADDED 
TWO CASES OF PALATO-PHARYNGEAL TUMOR AND A BIBLI- 
OGRAPHY OF PHARYNGEAL GROWTHS 
Paper read before the American Laryngological Association at its meeting held 
in the Academy of Medicine, New York, May 23, 1883 
BY 
ETHELBERT CARROLL MORGAN, A.B., M.D. 
WASHINGTON, D. C. 
Reprinted with the discussion from the Transactions of the Association, Vol, 
iv., 1883 
PRESS OF 
G. P. PUTNAM’S SONS 
27 Sc 29 WEST 23D STREET, NEW YORK 
1884 EXTRACTION 
OF A GLOSSO-EPIGLOTTIC MYXO-SARCOMA, BY 
MEANS OF THE FINGERS 
TO WHICH ARE ADDED 
TWO CASES OF PALATO-PHARYNGEAL TUMOR AND A BIBLI- 
OGRAPHY OF PPIARYNGEAL GROWTHS 
Paper read before the American Laryngological Association at its meeting held 
in the Academy of Medicine, New York, May 23, 1883 
BY 
ETHELBERT CARROLL MORGAN, A.B., M.D. 
WASHINGTON, 1). C. 
Reprinted with the discussion from the Transactions of the Association, Vol. 
iv., 1883 
G. P. PUTNAM'S SONS 
27 & 29 WEST 23D STREET, NEW YORK 
1884 
PRESS OF A CASE OF GLOSSO-EPIGLOTTIC MYXO- 
SARCOMA; AND A BIBLIOGRAPHY 
OF PHARYNGEAL TUMORS. 
By ETHELBERT CARROLL MORGAN, A.B., M.D., 
WASHINGTON, D.C. 
IN calling attention to the present instance of what 
may be denominated a laryngo-pharyngeal tumor, I 
have two motives: first, to record an interesting variety of 
neoplasm ; and second, to describe the method employed for 
its removal, which, to say the least, was primitive. 
Accurate drawings are herewith presented of two other 
pharyngeal tumors which have come under my observation, 
being the cases operated upon at the Providence Hospital, 
by my friend, Prof. Johnson Eliot, M.D.1 
In connection with the present undertaking my desire 
was to tabulate all reported cases of pharyngeal or laryngo- 
pharyngeal tumors, with reference to their nature, dimen- 
sions, seat, symptoms, treatment, and recurrence. 
I find, however, that these morbid growths have frequent- 
ly been vaguely named, and oftener no reliable microscopic 
data were obtainable. 
Compelled, then, to limit myself to recording the most 
instructive and complete of these reports, I append what, 
with my present knowledge, may be regarded as the most 
complete bibliography on this subject extant. 
The preparation of this bibliography has been laborious, 
and my thanks are expressed to Drs. Billings and Fletcher, 
1 The tumor and life-sized drawings of the writer’s case were also presented 
to the Association. 4 
Transactions of the A merican Laryngological Association. 
of the library of the Surgeon-General’s Office, Washington, 
D. C., for valuable assistance. 
The following is a concise history of my case, corrected 
up to the date when he was last examined by me, May 15, 
1883 :— 
Mr. John C , aged forty-nine, had complained for the 
past eighteen months of cough, dysphagia, dysphonia, and occa- 
sionally of complete aphonia. The above symptoms were increas- 
ing from week to week, and being associated with suffocative 
attacks at night, on several occasions nearly resulted fatally. He 
experienced a constant inclination to swallow, had no real pain, 
and reclining in some positions was absolutely impossible. The 
man was strongly and compactly built, had a well-developed chest, 
and gave no history of syphilis, though there was slight enlarge- 
ment of the cervical lymphatics at the left angle of the inferior 
maxilla. 
Direct examination revealed the presence of an enormous 
growth springing from below, and occupying nearly the entire oro- 
pharynx. 
Laryngoscopic examination was difficult on account of the ex- 
tent of the tumor, but showed that it was pedunculated and at- 
tached by a broad base in the left glosso-epiglottic fossa, and to 
a small portion of the lateral pharyngeal wall. 
Further digital exploration confirmed the above, and I found 
that the pedicle of the growth could be included beween the tips 
of the index and middle fingers, so that an dcraseur could readily 
have been employed in its extraction. 
I could not, however, resist the inclination to operate at once. 
Telling my patient to remain seated, I inserted the index and mid- 
dle fingers, seized the pedicle, and, using considerable torsion and 
force, removed the tumor. 
My assistant, Dr. G. Byrd Harrison, tells me that there was 
only slight hemorrhage, and subsequent odynphagia, and that the 
patient spoke in a clear unobstructed voice immediately after the 
operation. 
The tumor measured two and one fourth inches in its lesser, 
and two and three fourths in its greater, circumference ; it was of 
firm consistence and ovoid shape, having a pedicle one-fourth inch 
long. Laryngoscopic examination, practised after the extraction, 
showed that the left ventricular band was implicated, and that a Morgan on Glosso-Epiglottic Myxo-Sarcoma. 
5 
large nodule occupied the anterior portion of the right arytenoid 
region. 
My after-treatment comprised the employment of a sedative 
gargarism and spray. The patient, at this date, is doing remark- 
ably well. 
The microscopic examination and drawings of the tumor 
in my case, which are herewith submitted, were executed 
by Dr. J. C. McConnell, of the Army Medical Museum, 
Washington, D. C. 
His report reads as follows : 
“ARMY MEDICAL MUSEUM, 
“ Washington, d. c., May IO, 1883. 
“ My dear Dr. Morgan : 
“ Microscopically, the tumor presents the characters of a myxo- 
sarcoma. It is very vascular ; so vascular that it might properly 
be called myxo-sarcoma telangiectodes. The epithelial covering 
is that of the region in which the tumor had its origin ; it is 
sharply defined, and in no portion of the growth has it burrowed. 
The stroma in diffused areas, particularly just beneath the epithe- 
lial covering, has undergone a mucoid change. In all other situa- 
tions the tumor presents the ordinary appearances of a spindle- 
celled sarcoma. The vessels have in large numbers undergone 
amyloid degeneration of their walls. 
“ Very respectfully, 
“ Your obedient servant, 
“ J. C. McConnell, M.D.” 
ABSTRACT OF DR. ELIOT’S CASES. 
“ Some nine years ago I was requested by Prof. Robert Reyburn 
to see Captain B., aged 29. The Captain’s history was excellent ; 
he had never suffered from constitutional disease of any descrip- 
tion, was physically well developed, and presented a specimen of 
perfect health. 
I. 
“ Upon examination the right tonsil was found enlarged, with a 
tumor occupying one-fifth of the hard palate ; the palatine swell- 
ing was smooth, symmetrical, with the mucous covering apparently 
thickened ; there was also congestion of the surrounding tissues. 
The tumor was painless, firm, but slightly resilient on pressure, 6 
Transactions of the American Laryngological Association. 
We came to the conclusion that it was either fibrous or cartilagi- 
nous. There was no glandular implication in the cervical or 
submaxillary regions. He informed us that the tumor had grown 
slowly ; it had not as yet interfered with respiration or degluti- 
tion. He sought relief, and expressed a willingness to have it 
removed, insisting on the administration of ether. We reluctantly 
acceded to his wishes. A few inspirations of the anaesthetic satis- 
fied us of the danger attending its administration ; it was im- 
mediately withdrawn. A second attempt to etherize him was 
made, but discontinued at the approach of asphyxia. After the 
removal of a small portion of the tumor the case was abandoned, 
he refusing to submit to the operation without anaesthetics, which 
we declined to administer. 
“ Early in December last he placed himself under the charge of 
Dr. Ralph Walsh of our city, and by that gentleman I was invited 
to see him. Dr. Reyburn was added to the consultation. We 
found the patient in a truly deplorable condition. The tumor 
had extended over three-fourths of the hard palate, the uvula and 
half arches were forced back and obscured from view, the tongue 
was depressed, with scarcely space to pass the finger between that 
organ and the tumor. The corresponding sides of the face and 
neck were enlarged by the external protrusion of the tumor. The 
connection of the growth between the palatine and submaxillary 
region was readily diagnosed ; pressure on the palatine aspect 
increased the fulness in the submaxillary region. His respiration 
was so embarrassed and stridulous that it was painful to be in his 
company. The recumbent position was painful and suffocating. 
His countenance livid, articulation indistinct, mastication painful, 
and deglutition difficult. He informed me that within the last 
month the tumor had increased rapidly ; he could almost mark 
its daily growth. He was despondent, anxious, and apprehensive 
of the result ; he felt a cord daily tightening around his neck, that 
must eventually suffocate him. His affliction was so terrible that 
life had ceased to be a boon. He was now willing to submit to 
surgical interference. 
“ On the 3d of January, 1879, assisted by Prof. J. Ford 
Thompson, of the hospital staff, Profs. Reyburn, Ashford, and 
Walsh, a semilunar incision was made on the posterior margin of 
the hard palate, another was made on its anterior portion, con- 
necting the latter with the first, leaving an ellipse of two inches in 
width. The circumscribed part was seized with a strong vulsellum, Morgan on Glosso-Epiglottic Myxo-Sarcoma. 
and traction made. The dissection was necessarily slow from 
frequent interruption by the patient freeing his mouth and throat 
from blood. An hour elapsed before the cervical portion of the 
tumor was raised from its bed. The hemorrhage was consider- 
able. No vessels were tied ; no haemostatic used ; the bleeding 
ceased on the completion of the operation ; the mass was removed 
in detached pieces. 
“ Upon superficial examination it appeared to be sarcomatous 
in character. A portion of it was preserved for microscopic 
examination, but by some accident was mislaid.” 
I would say that the above case has been recently ex- 
amined by me, and there are no evidences of a recurrence 
of the growth, the patient being in perfect health. 
II. 
“ In the summer of 1880, Miss F. V., aged twenty-three, white, 
was brought to the Providence Hospital for examination. Her 
general appearance indicated impaired health, she being anaemic, 
feeble, and emaciated. Examination revealed a tumor the size of 
an English walnut, situated upon the left side of the velum pen- 
dulum palati, extending to the pharynx and tonsil of the same 
side. Her voice was husky, deglutition painful, and respiration 
slightly embarrassed. The lymphatics of the left side were 
enlarged and sensitive. The tumor was elastic on pressure, 
painful to the touch, and several deeply ulcerated points were 
noticed on its surface. As the growth was regarded malignant, 
surgical interference was not deemed advisable, and she was 
counselled to go home. 
“In November, 1881, one year after her first examination, she 
again entered the hospital. The tumor was larger, respiration 
difficult, and it was impossible to close the mouth. Finding the 
ulcerations cicatrized, the surface smooth, the lymphatic glands 
less swollen, and her general condition improved, it was deemed 
advisable to operate. On November 22, 1882, in the presence of 
Drs. E. C. Morgan, Ashford, Magruder, Bayne, and Malian, the 
operation was performed. The patient was seated in a chair. 
No anaesthetics were employed. We anticipated great hemor- 
rhage, and had the thermo-cautery, haemostatics, and tracheotomy 
tubes at hand. 
“An incision was made in the long diameter of the tumor, and 
its contents rapidly enucleated, several small pieces of bone coming 8 
Transactions of the A merican Laryngological Association. 
away with it. Little hemorrhage followed, no haemostatics were 
required, and bleeding ceased with the conclusion of the operation. 
On the second day hemorrhage occurred, but was quickly con- 
trolled. The patient convalesced slowly, and after several weeks 
left the hospital. 
“ On March 12th she returned with a small swelling at the side 
of the cicatrix, and was anxious to have it removed. On the day 
fixed for the operation, while conversing with a patient in the 
ward, without premonition, violent hemorrhage took place, and 
death followed immediately. 
“ No autopsy was made. A large vessel had evidently been 
opened by the softening of the tissue and had yielded to arterial 
pressure. Microscopic examination demonstrated the tumor to 
be a spindle-celled sarcoma.” 
REMARKS. 
It is generally believed and stated by authors that 
pharyngeal growths are rare, and that few cases have 
been recorded. 
Patient investigation has convinced me beyond a doubt 
of the incorrectness of the above statement, for in working 
upon this paper I have succeeded in collecting at least one 
hundred and thirty examples, sixty-one well authenticated, 
embracing a period of seventy-one years, extending from 
1812 1 to 1883, inclusive. 
I desire to especially explain that my statistics deal 
solely with tumors originating in, or tumors extending 
into, the inferior pharynx, having purposely omitted all 
reference to the exhaustive tables of Cervesato3 and 
Moure3 on cystic tumors of the epiglottis. 
Sarcoma is the most common growth occurring in the 
pharynx, fibroma being next in frequency. 
The following tabular statement shows in detail the rela- 
tive frequency of the different morbid growths among the 
sixty-one cases specially examined : 
1 Winter, A., Chiron. Sulzbach., i8i2-’i3, iii, 315-331., pi. I. 
3 Lo Sperimentale, January and February, 1881. 
3 Rev. mens, de laryngol., etc., Nos. 4, 5, 1880, and Nos. 6, 7, 8, 9, 1881. Morgan on Glosso-Epiglottic Myxo-Sarcoma. 
9 
Sarcomata ........ 14 
Fibromata ........ 10 
Fibro-sarcomata ....... 1 
Myxo-sarcomata ....... 4 
Albuminous-sarcomata 2 
Lipomata......... 3 
Papillomata ........ 3 
Lymphomata ........ 5 
Osteomata . 1 
Fibro-plastic tumors ...... 1 
Dermoid tumors 3 
Congenital tumors ....... 1 
Adenomata, cystic ....... 1 
Growth bearing pilose skin 1 
Nature not mentioned, unknown, or doubtful . . n 
Total . . . . . . . .61 
It is my pleasant duty to say that an essay read before 
this Association at its first annual meeting by Dr. Frederick 
I. Knight,1 as also the article of Dr. G. A. Peters,2 present 
the subject-literature of pharyngeal tumors more satisfac- 
torily than any English papers with which I am acquainted. 
I shall not now undertake to describe Dr. Knight’s inter- 
esting case—we are all familiar with it. The four cases re- 
ported by Peters were myxo-sarcomata; two of them were 
operated by himself, one by Dr. H. B. Sands, and one by 
Dr. M. J. Asch. 
Arnott3 gives rather an indefinite description of a pedun- 
culated tumor, the nature of which he does not mention, 
situated at the base of the tongue, on the pharyngeal wall, 
and being as large as a green walnut. He says, “ the 
growth was ligated at its pedicle and twisted off.” The 
natural inference from the text is that Arnott made use of 
his fingers in the twisting process, for no instrument is 
alluded to. As far as I can judge, the above case is the 
counterpart of the one reported by me to-day, being the 
1 Trans. Am. Laryngol. Assoc., 1879, p. 204. 
3 Med. Rec., N. Y., 1880, xviii., p. 565-568. 
8 Lond. Med. Gaz., N. S., 1845, vol. 1., p. 530. 10 
Transactions of the American Laryngological Association. 
sole example of a similar operative procedure to be found 
in the medical literature at my command. 
Barton 1 reports a congenital growth, nature not stated, 
which he extracted from the pharynx of a woman by means 
of an £craseur and scissors. 
Abraham 9 describes a rare growth, bearing pilose skin, 
of which he presents a drawing. After removal with 
6craseur there was no recurrence. Interesting cases of 
dermoid tumors are also recorded by Clinton Wagner,3 
Hale White,4 and Kidd.6 
Holt6 reports a unique case of a “fatty pendulous tumor 
of the pharynx and larynx,” which, on one occasion, dur- 
ing vomiting, protruded in such a manner as to occlude the 
larynx, and suffocation would have resulted had the tumor 
not been pushed aside. The patient died suddenly while 
smoking his pipe; and it is conjectured that the tobacco- 
fumes produced sudden cough and displacement of the 
growth, causing suffocation. On post-mortem examination 
of the pharynx, a large pendulous tumor was detected, fill- 
ing the pharynx, and extending downward toward the 
oesophagus to the extent of nine inches. 
Taylor7 mentions his case of fatty tumor behind the 
pharynx, presenting all the evidences of a post-pharyngeal 
abscess ; but which, on incision, proved to be a lipoma. 
Death resulted from suffocation, although tracheotomy was 
performed. 
Vidal8 says that Vimont had a patient in whom a large 
pharyngeal tumor was detached and ejected during 
vomiting. 
Pedunculated sarcomata are, according to my researches, 
rare ; the most instructive case has been recorded by Billroth.9 
1 Med. Press and Circ., Lond., 1881, N. S. xxxi., io. 
3 Jour. Anat. and Physiol., Lond., i8So-’8i, xv., 244-248. 
3 Med. Rec., N. Y., 1881, xx., 76. 
4Lancet, Lond., April 9, 1881, p. 581. 
8 No reference given. 
6 Trans. Pathol. Soc. of London, l853~’54, v., pp. 123-125, pi. 1. 
7 Tr. Path. Soc., l876-’77, Lond., 1877, xxviii., pp. 216-218. 
8 Traite depathologic externe, t. iii., p. 605 and 657. 
8 Ehrendorfer, E.: Archiv f. klin. Chirg., Berl., 1881, xxvi., p. 578, pi. 1. Morgan on Glosso-Epiglottic Myxo-Sarcoma. 
11 
McLeod’s1 pharyngeal sarcoma was as large as an 
orange; laryngotomy was performed prior to its extraction, 
and the case was cured. 
Having given the clinical history, mode of operation, 
termination, and microscopic data, of my own case, as also 
abstracts of Dr. Eliot’s interesting operations—with one of 
which I was associated ; and having briefly mentioned a few 
of the reports that have come under my notice, I wish simply 
to add that attention has been called to this tumor: 
First, Because of the rarity of pedunculated myxo- 
sarcomata in this particular situation. 
Second, Because of the size this tumor attained. 
Third, To demonstrate that our fingers may sometimes 
effectually supplant instruments; and 
Fourth, In order to ascertain what degree of urgent 
symptoms warrant operative interference in a pharyngeal 
neoplasm whose benign or malignant character is un- 
known. 
BIBLIOGRAPHY OF TUMORS OF THE INFERIOR PHARYNX. 
Abraham, P, S. An anomalous growth, bearing pilose skin, in the pharynx 
of a young woman, y. Ancit. and Physiol., Lond. 1880-81. xv., pp. 244-248. 
Arnott, J. Broad-based tumor of the pharynx. Lond. Med. Gaz., N. S., 
1845, vol. 1., p. 530. 
Barton. Congenital tumor of the pharynx. Med. Press and Circ., 
Lond. 1881, n. s. xxxi., p. 10. 
Billroth, Th. Chirurgischer, Erfahrungen, “Medullary Lymphoma,” 
“ Fibrous Sarcoma.” Langenbeck's Archiv. f. klinisch. Chirurgie, 1869, Bd. x., 
S. 107 and 105. 
Borelli, G. Tumor fibro-plastico (?). Rac. di osserv. clin-patol., Torino, 
1867, ii., pp. 380-384. 
Broca. Lymphadenoma of tonsil; removal. Mouvement mid., Par., 1879, 
xvii., p. 91. 
Busch, W. Ueber Retropharyngealgeschwiilste. Ann. d. Charite-Kran- 
kenhaus zu Berlin, 1857, viii., 1, pp. 89-1x5 ; 1858, viii., 2, pp. 16-21. Also, 
Lond. M. Rec., Oct. 15, 1877. 
Cabaret, P. J. H. Polype du pharynx ; arrachement ; guerison. Revue 
de therapeutique medico-chirurg., Paris, 1866, pp. 509-512. 
Carreno J. Observacion de cuatro polipos situados en el centro de la 
faringe. Decadas de Med. y Cir. prdct., Madrid, 1828, vol. xvii., p, 217. 
Chapman, S. H. Sarcoma of the inferior constrictor of the pharynx and 
inlet of the oesophagus. Am. J. M. Sc., Phila., Oct., 1877, p. 432. 
Chiari O. Ueber retropharyngeale Strumen. Allg. Wien. med. Ztg., 1881, 
xxiv., p. 201. 
1 Indian Med. Gaz., Calcutta, 1881, xvi, p. 146, 12 
Transactions of the A merican Laryngological Association. 
Cohen, J. S. Diseases of the throat, etc., 2d ed., N. Y., 1879, p. 252. 
Cohen, J. S. Case of cystic adenoma of base of tongue with retro-pharyn- 
geal adenoma. Archiv. Laryngol., N. Y., 1880, 1., p. 274. 
CoRRADl, G. Fibroma della sotto-muccosa faringea. Sperimentale, Firenze, 
1879, xliii., pp. 369-371. 
Deazeley, C. Tumor of the pharynx. London Med. Gaz., 1843, vol. xxii., 
pp. 868, 869. 
Delafield, F. Sarcoma of tongue and pharynx simulating epithelioma, 
New York Med. your., 1876, xxiii., pp. 623, 624. 
Desgranges, A. Tumeurs de la langue et du pharynx. Lemons de clin. 
chirp., Paris, 1868, pp. 109-144. 
Dugas, L. A. Extirpation of pharyngeal tumors, Southern Med. Surg. 
Jour., n. s., Augusta, 1853, ix., pp. 264-268. 
Ehrendorfer, E. Seltener Geschwtilstformen am Larynx und Pharynx. 
Archiv. f. klin. Chirg., Berl., 1881, xxvi., p. 578, pi. 1. 
Eliot, Johnson. Palato-pharyngeal sarcoma. Illust. Med. and Surg., vol. 
ii., No. 1, p. 107, 1 pi. Also: Palato-pharyngeal tumor. Am. y. M. Sc., 
Phila., 1879, n. s. lxxviii., pp. 124-126. 
Fenwick, B. Case of carcinomatous tumor between the pharynx and la- 
rynx. Brit. Med. y., Lond., 1878, i., p 154. 
Fischer, Jos. Beitrag zur Ausrottung der Geschwulste durch Elektrapunk- 
tur nach Nelaton. Wien. med. Wchnschr., 1865, No. 61. 
Gorecki, X. Lymphadenoma, fibrous, of tonsil and posterior pharynx. 
Praticien, Par., 1879, ii., 177-80. 
Goschler. Rachenpolyp intrauterinalen Bildung. Allg. Wien. Med. Ztg., 
1865, p. 344. 
Hahn, I. Verfahren bei der Exstirpation von Tumoren im Pharynx und 
CEsophagus. 8°, Stuttgart, 1878. 
Hallin, O. F. Tumor fibrosas pharyngo-nasalis. Hygiea, Stockholm, 
1868, xxx., pp. 255, 256. 
Hamilton, J. On a bony tumor of the pharynx. Dub. Med. Press, 1850, 
xxiii., pp. 277-278. 
Hartley, D. Tumor of the pharynx ; laryngotomy. Med. Times and 
Gaz., Lond., 1863, i., p. 640. 
Holt. Fatty pendulous tumor of the pharynx and larynx. Trans. Pathol. 
Soc., Lond., 1853-54, v., pp. 123-125, pi. i. 
PIuguier. Tumeur fibreuse de la gorge. Bull. soc. chirg. de Par., 1852, 
ii., pp. 49i~494- 
Knight, F. I. Retro-pharyngeal sarcoma. Trans. Am. Laryngol. Assoc., 
1879, p. 204. 
Larondelle. Observation d’ un polype pharyngien, etc. Bull, de T acad. 
roy. de mdd. de Belg., 1870, iv., pp. 183-189. 
Legrange. Sarcome primatif des ganglions lateraux gauches du pharynx. 
Progres mid., Par., 1882, x., pp. 53-55. 
Little. Tumor of the pharynx removed by the ecraseur. Med. Times 
and Gaz., Lond., 1863, i. n. s., p. 507. 
Lloyd, T. Papilloma of the fauces : removal. Lancet, Lond., 1881, i., 
p. 865. 
Luschka, H. v. Virchow’s Archiv, 1870 L., pp. 161-164, 1 pi- 
Macleod. Tumor of the pharynx ; operation ; death. Glasgow M. y., 
1880, xiii., pp. 240-242. 
McLeod, K. Sarcomatous tumor of the pharynx. Lndian Med. Gaz., Cal- 
cutta, 1881, xvi., p. 146. 
Monfalcon. Polype du pharynx et de 1’ cesophage. Diet, des sciences mid., 
Par., 1820, xliv., pp. 225-227. Discussion on Paper of Dr. Morgan 
13 
Paci, A. Su di un raro palipo faringeo. Gior. internaz. d. Sc. med., Napoli., 
1879, n. s., i., p. 596. 
Peters, G. A. Notes on four cases of pharyngeal tumors. Med. Rec., N. Y., 
1880, xviii., pp. 565-568. 
Pick, T. P. Naso-pharyngeal polypi. St. George’s Hospital Reports, 
Lond., vol. ii., 1867, p. 151. 
PlL, P. K. Lipoma pharyngis et laryngis. Nedrl. Tijdschr. v. Geneesk., 
Amst., 1879, xv., pp. 89-92. 
Roe, J. O. A large recurrent papilloma of the pharynx. Illust. Quart. Med. 
and Surg., N. Y., 1882, i., p. 69, 1 pi. 
Rosenbach, J. Ein Fall van Rundzellsarkom, etc. Berl. klin, Wchnschr., 
p. 519. 1875. 
Roser. Schlund-polypen, etc. Medicin Correspondenz-Blatt des Wur- 
temburgischen aerzlitchen Vereins, Bd. 29, S. 161, 1859. 
Schuh. Einiges liber Rachenpolypen und ihre Behandlung. Wien. med. 
Wchnschr., 1865, pp. 1,777-1,780, 1,793-1,795, 1,813-1,816. 
Skeys. Fibrous tumor of the fauces. Lancet, London, 1857, vol. i., p. 242. 
Smith, H. Removal of a large fibrous polypus from the pharynx. Lancet, 
Lond., 1872, i., pp. 147, 148. 
Sommerbrodt, J. Ueber eine Papillargeschwulst im Pharynx. Virchow's 
Archiv, 1870, li., pp. 136, 137. 
Syme, J. Fibrous tumor of the fauces. Lancet, Lond., 1856, vol. i., p. 51. 
Tatum. Fibrous tumor of the pharynx, etc. Lancet, Lond., 1858, vol. i., 
pp. 138, 139. 
Taylor, T. Fatty tumor behind the pharynx. Tr. Path. Soc., 1876-77, 
Lond., 1877, xxviii., pp. 216-218. 
Venturini, E. Sarcoma midollare della faringe. L’ Ippocratico, 1871, 
vol. xix., 3 ser., p. 89. 
Vibert. Tumeur fibreuse du pharynx. Bull et m6m. soc. de chirg. de Par., 
1879, n. s., v., pp. 615-617. 
Vidal. Traite de pathologie externe, t. iii., p. 605, 657. 
Voltolini, R. Die Anwendung der Galvanokaustik, etc. Wien, 1871, 
p. 226. 
Wagner. Sarcoma retropharyngeale. Deutsche Klinik, 1861, p. 61. 
Wagner, C. Dermoid tumor of the pharynx. Med. Rec., N. Y., 1881, 
xx., p. 76. 
Weil, C. Grosse Rachengeschwulst, etc. Ztschr. f. Heilk., Prag., 1881, 
ii., pp. 6-15, 1 pi. 
Wesh, S. Sarcoma of the right tonsil. Tr. Path. Soc,, Lond., 1881-2, 
xxxiii., pp. 331-334- 
Winter, A. v. Geschichte eines atisserst grassen. Rachen-Polypen. 
Chiron., Sulzbach, 1812-13, iii., pp. 315-331, 1 pi. 
Wunsche, Reinhold Theordor. (?) Ueber retropharyngealgeschwtilste. 
Inaug. Diss., 23 pp., 2 1., 8°, Leipzig, 1864. 
Dr. DeBlois said that at least one useful suggestion might be 
drawn from the very interesting paper of Dr. Morgan, and that 
was the proper use of our fingers. 
As our practice in laryngology becomes more and more scien- 
tific, so much the more are we addicted to the use of instruments, 
Discussion on Dr. Morgan's Paper. 14 
Transactions of the American Laryngological Association. 
to the exclusion of more natural means. In this connection he 
would suggest the propriety of the use of the finger-nail in the ex- 
tirpation of growths in the larynx. He had the good fortune to 
partially remove, in this way, a growth from the vocal cord, where, 
owing to the hypersesthesia of the parts, the introduction of the 
laryngeal forceps was impossible. 
Although this procedure may seem brutal, it appeared to him 
at least quite as justifiable as introducing the forceps at random 
when the parts cannot be seen. 
With regard to the bibliography of the subject, he thought that 
the Association owed its thanks to Dr. Morgan, the result of whose 
extensive and laborious researches had just been presented. 
Dr. Ingals referred to a case of a very large growth in the naso- 
pharynx, extending into the mouth, which greatly obstructed 
breathing, and which was operated upon by Dr. Moses Gunn, of 
Chicago, who removed it with his finger. He had not been able 
subsequently to discover the point of attachment of the tumor. 
With regard to the brutality of attempting to remove laryngeal 
growths with the finger, he would merely state that it would depend 
upon the size of the operator’s finger. 
Dr. Delavan said that he recalled one of the cases referred to 
in the paper by Dr. Morgan ; he had been present when the opera- 
tion for its removal was performed by Dr. Wagner ; it was in a 
girl of twenty-two years of age, who had not been aware of any 
difficulty in her throat until a few weeks before applying for treat- 
ment. Upon examination a growth one and a quarter inches long 
by three fourths of an inch wide was seen depending from the 
posterior border of the soft palate. It was found to be attached 
near the floor of the posterior nares on the left side. Schrotter’s 
6craseur was used, but it was impossible to remove it in this way, 
and it was finally divided with great difficulty by means of a strong 
knife. Upon microscopic examination the outer surface was found 
to be covered with a thick coating of epithelium, having a horny 
layer and a basement membrane, and under this a thick layer of 
fat. In the centre of the tumor was a large double plate of true 
cartilage, surrounded by a fibrous sheath or perichondrium. The 
point of interest in the case was that the patient had been un- 
conscious of any difficulty in her throat until within a short time, 
although the growth was evidently congenital. It resembled the 
helix of a normal ear. He had, at the time, reported the case at 
a meeting of the New York Pathological Society, and had found Discussion on Paper of Dr. Morgan. 
15 
that up to that time at least six cases had been placed upon record. 
As to the removal of morbid growths in this locality with the 
finger, he thought the method particularly applicable in cases of 
adenoma at the vault of the pharynx. It seemed illogical to ex- 
amine such a case with the finger, and then resort for its removal 
to an instrument, when the examination and the removal might be 
combined in one manipulation. He thought the use of the finger- 
nail, in certain favorable cases, even superior to the use of instru- 
ments. 
Dr. Lincoln said that, in order to illustrate the possibility of 
operating with the fingers through the mouth upon tumors of large 
size, he was prompted to add that in his researches upon the treat- 
ment of naso-pharyngeal tumors, in the paper which he had read 
the day before, he found a report of a case of naso-pharyngeal 
polypus removed by Dr. Whitehead by the fingers, unaided, if he 
remembered correctly, by instruments. 
Dr. Asch said that he would merely suggest that difficulty is 
experienced in introducing the finger behind the palate in many 
cases, especially in women. There are, unquestionably, cases in 
which such a method could be applied, but in others it could not 
be carried out without producing severe laceration. 
Dr. Bosworth said that Meyer reports some three hundred cases 
of examination and diagnosis of the naso-pharynx with the finger. 
Dr. Morgan said that, in resorting to an operative procedure 
essentially pre-laryngoscopic in character, he had placed himself 
beyond the pale of this Association of Laryngologists. 
The relief afforded his patient, the completeness of the extirpa- 
tion, and the failure of recurrence to this date, all appeared to sus- 
tain the wisdom of the method. As stated, the statistics given 
deal with tumors of the inferior pharynx alone; hence the 
example of naso-pharyngeal growth mentioned by Dr. Lincoln 
was not included. g. p. putnam’s sons, printers 
• NEW YORK