Compliments of the Author. 
BENIGN TUMORS OF THE LARYNX. 
WITH REPORT OF CASES. 
A Paper read before the Southwestern Ohio Medical Association, October 3, 1891, 
BY 
MAX THORNER, M.D., 
CINCINNATI. 
Reprint from 
The Cincinnati Lancet- Clinic, 
January 23, 1892. BENIGN TUMORS OF THE LARYNX. 
WITH REPORT OF CASES. 
A Paper read before the Southwestern Ohio Medical Association, October 3, 1891, 
BY 
MAX THORNER, M.D., 
CINCINNATI. 
Mr. President and Gentlemen: 
It has been truly said that it is the 
duty of every specialist to give the pro- 
fession at large the benefit of his studies 
in his special department, to have them 
participate as well in the progress, that 
the different branches of our science 
have made, as he, of necessity, draws 
continually from the common fountain, 
and to thus promote, by exchanging 
ideas, advancement of knowledge every- 
where. On the other hand, complaints 
have been frequently heard that spe- 
cialists are too liable to discuss before 
general medical societies topics of such 
a nature, or going so much into a 
detailed description of operations, that 
only brother specialists could possibly 
have an interest in the proceedings, or 
that their papers were of such an 
elementary character, or the topics so 
threadbare, that they rather belonged 
into a class-room of second-year students 
than into the arena of such a learned 
body 4s a medical society. When, there- 
fore, your worthy Secretary asked me 
to prepare a paper for this meeting, I 
concluded that I had to try to avoid 
either of these objections. 
I selected " Benign Tumors of the 
Larynx" as my subject, because our 
medical weeklies, monthlies and 
archives have, for obvious reasons, for 
the last few years, been so overcrowded 
with reports of, and essays on, malig- 
nant growths of the larynx, that we 
nearly lost sight of the fact that there 
are also such, comparatively harmless, 
neoplasms in the laryx as fibroids, myxo- 
mata, etc.; that, in fact, we became 
nearly used to look upon every innocent 
little growth in or about the throat as-a 
possible, or even probable, source of 
malignant formations. I will not tire 
you with any statistics at all, but the 
fact is, that benign tumors of the larynx 
are by far more common than malignant 
ones. The term benign is used here in 
the generally-accepted sense; they may, 
of course, become dangerous to life on 4 
Benign Tumors of the Larynx-Thorner. 
tracted at random from my case-book 
out of a larger number; however, with 
a view to give some typical illustrations 
to these general remarks. 
CASE II. 
Mr. M. F., aet. twenty-eight, sales- 
man, was referred to me by the late 
Dr. Aub, May 6, 1886. His voice 
had been hoarse for more than three 
years, but of late the hoarseness had 
increased so much that it interfered 
greatly with his occupation. He did 
not know of anything that may have 
caused the trouble, having always been 
in excellent health. The larynx was 
partly filled with a tumor the size of 
a small cherry, but irregularly shaped, 
attached to the anterior half of the 
right vocal cord and overlapping the 
left one. The color of the growth 
was pale, the surface rough, like a 
strawberry, but not ulcerated, and 
there was no hyperaemia around the 
broad base of the tumor. All pain, 
and also dyspnoea, were absent. From 
all appearances, the tumor was a pa- 
pilloma, which was readily removed 
with one of Mackenzie's laryngeal 
forceps. The voice improved, but 
there remained some huskiness. About 
three months after the operation the 
tumor had grown again to its former 
size, from a small piece on the lower 
surface of the cord that had not been 
removed. This time the tumor was 
chiefly attached to the edge of the 
right cord, and the hoarseness was 
complete. I now removed the growth 
with Voltolini's sponge instrument by 
introducing the sponge below the cords 
and detaching the papilloma by forcible 
rubbing movements. After this the 
tumor did not return. 
The voice became soon normal and 
remained so. 
Mr. Geo. L., aet. twenty-four, con- 
sulted me July 20, 1885. He had been 
very hoarse since eight months, when 
he had been putting his vocal organs 
to a very severe test during the last 
elections. Of late his voice had be- 
come completely aphonic. There was 
a general hyperaemia of the pharynx 
and larynx. The vocal cords were 
kept apart during phonation in their 
middle portion by an oval body of 
pinkish color that appeared to be in- 
serted in and below the anterior angle 
of the cords. During deep inspiration 
one could see that the tumor, the size 
of a small bean, was situated just 
below the cords, in the median line; 
that it had a smooth surface and was 
slightly movable. After training the 
larynx a few days with sounds, I 
removed part of the tumor with 
Schroetter's laryngeal tube forceps. 
The location of the neoplasm, being 
inserted below the cords, rendered 
the removal in one sitting impossible. 
After two more operations the entire 
growth had disappeared; improvement 
of voice was immediate, and after a 
few weeks' treatment of the co-existing 
laryngitis all the remaining hoarseness 
had disappeared. Patient has since 
been engaged as an insurance agent, 
without any recurrence of the trouble. 
The microscopic examination of the 
removed tumor showed it to be a 
fibroid. 
CASE I. Benign Tumors of the Larynx-Thorner. 
5 
was a small, triangular, whitish neo- 
plasm, the size of about a split pea. 
This tumor was immovable, had a 
smooth surface, and was attached with 
its base to the mass of the cord. It 
was readily to be seen that it was 
this growth that mainly caused the 
aphonia, the accompanying dyspnoea 
being principally due to the coexist- 
ing laryngitis. We had here, no 
doubt, a fibroma, a tumor that grows 
very slowly in the larynx, and there- 
fore we could direct our therapeutical 
efforts against the laryngitis, the re- 
moval of the tumor in this age being 
neither indicated nor practical at 
present. Without the laryngoscopic 
examination tracheotomy would prob- 
ably have been indispensable. There- 
fore, it was advised to treat the 
catarrhal condition of the larynx with 
inhalations, and watch, of course, the 
child closely for any aggravation of 
the dyspnoea, postponing an operation 
for the removal of the growth for a 
later period. The dyspnoea disappeared 
soon, and the child has been well all 
these four and a half years. I have 
seen hex' about two years ago; the 
tumor had not increased in size; the 
voice was rather hoarse but not 
aphonic, and there was no dyspnoea at 
all. A few days ago I wrote to her 
father, a clergyman, regarding her 
condition, and received the following 
reply: " I am pleased to say that ever 
since she had the whooping-cough, 
fifteen months ago, she has constantly 
improved in her voice, speaking at 
times almost as clearly as others. Her 
voice sounds at times as though she 
had a slight cold. If she continues to 
Geo. L., aet. thirty, of East Liver- 
pool, O., was sent to me by Dr. J. E. 
Walton for examination. He had a 
very small fibroma, a little smaller than 
a split pea, on the edge of the left 
vocal cord. The voice had been 
husky, and at times hoarse, as long 
as patient could remember. Endo- 
laryngeal removal of the excrescence 
had been ineffectually tried by a New 
York laryngologist. The patient did 
not wish to undergo another operation, 
as the annoyance to him was very 
slight, and an improvement of the 
voice by an operation not certain. I 
have since heard that his voice at this 
time is unchanged. 
CASE III. 
CASE IV. 
Florence R., aet. three and a half, 
was sent to me by Dr. Wm. Carson 
March 23, 1887. The principal com- 
plaint was a complete aphonia, which 
had been developing since some time, 
but of late, after the child had been 
taking a cold, an alarming dyspnoea, 
mainly inspiratory in character, had set 
in. It was with considerable difficulty 
that a laryngoscopic examination could 
be made. But after a number of futile 
attempts, a good and distinct view of 
the larynx was finally obtained. This 
case demonstrates the invaluable help 
a laryngoscopic examination may render 
in deciding the course of treatment 
that must be pursued. There was a 
general congestion of the whole larynx, 
and on the edge of the left cord, about 
in the middle of the same, projecting 
into the lumen of the larynx, there 6 
Benign Tumors of the Larynx-Thorner. 
improve as hitherto, it will not be 
long till all indications of her trouble 
are gone." 
There is no reasonable doubt that 
this growth has undergone a retro- 
grade change, probably fatty degener- 
ation, and that particles of it have 
been coughed out during a paroxysm 
of whooping-cough. 
lowing the internal administration of 
such drugs as tincture of iodine, tinc- 
ture of Thuja occidentalis, and sul- 
phate of magnesia. However, the 
number of such observations is very 
small, and the same are not confirmed 
by the majority of writers. This case 
demonstrates also the fact, above al- 
luded to, that an operation undertaken 
for the restoration of the voice is not 
always followed by a complete suc- 
cess, though the tumor may have been 
wholly removed. As competent an 
observer as Prof. J. Gottstein says in 
this respect: " Concerning the restora- 
tion of the voice, even in cases where 
the endolaryngeal removal of the 
tumor is accomplished, the chances 
are not always favorable. The results 
are good in pedunculated fibroids. If, 
however, we have to deal with mul- 
tiple tumefactions which have a broad 
basis, and which are diffusely inserted 
in the surrounding tissues, then there 
is liability of the remaining of uneven- 
esses and infiltrations that will surely 
interfere with the action of the vocal 
cords." 
Dr. M. M. J., set. twenty-two, of 
Hamilton, O., was, on May 20, 1889, 
referred to me by Dr. C. R. Holmes 
on account of hoarseness, bordering at 
times on complete aphonia. There 
was a flat tumor the size of about one- 
third of a silver dime attached with a 
broad base to the left vocal cord. 
From all appearances it was a fibroid. 
The removal was completed partly 
with a ring knife (Stoerk's guillotine), 
on account of its broad base, partly 
with Voltolini's sponge instrument. 
There followed an improvement of 
voice, which, however, was not en- 
tirely clear, owing to a diffuse thick- 
ening at the site of the growth. An- 
other operation, however, was not 
needed, since the voice continued to 
improve, caused by an absorption of 
the larger part of the infiltration. This 
was attributed by the doctor to, and 
probably caused by, the internal med- 
ication with iodine he resorted to; and 
his voice shows at present only at 
times a certain degree of huskiness. 
In this connection I will not omit to 
say that there are some authorities who 
recommend internal medication for 
such growths as fibroma, papilloma, 
etc., and who report good results fol- 
CASE V. 
CASE VI. 
Mr. J. M., fifty-two years of age, 
was referred to me by Dr. E. Timmer- 
man, of Batesville, Ind., August 9, 
1889. There was complete loss of 
voice and a slight inspiratory dyspnoea. 
Patient had, in 1863, during the war, 
after having been exposed to the most 
severe inclemencies of weather, con- 
tracted a very aggravated cold. 
Rheumatism and hoarseness had been 
the result, and the latter had never left 
him since that time. On the contrary, Benign Tumors of the Larynx-Thorner. 
7 
it had been growing worse of late, to 
such an extent that it began to ser- 
iously interfere with his business. 
Laryngoscopic examination proved the 
existence of a tumor the size of a small 
bean attached to the anterior portion of 
the right vocal cord. The surface of 
the tumor was irregularly shaped, and 
impressed me as a papilloma. Micro- 
scopic examination, and subsequent 
developments proved this supposition 
to be correct. The removal was read- 
ily accomplished in several sittings 
with Schrotter's laryngeal tube for- 
ceps. The voice improved at once 
greatly, the dyspnoea disappeared. 
There was, however, after some time, 
a multiple recurrence of the growth, 
and this took place not at the former 
site, but in different parts of the 
larynx; as well on the cords as on the 
ventricular bands of both sides. The 
voice, however, never became as bad 
as it had been before the first opera- 
tion. A number of subsequent oper- 
ations became necessary, without en- 
tirely suppressing the recurrence of 
small excrescences. Finally I resorted 
to the galvanocaustic burner, applying 
it directly to small growths, or after 
having removed them previously with 
other instruments. The result was, that 
May 15, 1890, not quite nine months 
after the first operation, every trace 
of the tumor had disappeared and the 
voice was clear and distinct, although 
there was a slight huskiness noticeable 
at times, caused by a chronic laryngitis. 
I have seen Mr. M. a few weeks ago, 
more than fifteen months after the last 
examination. His voice is now at all 
times loud, distinct and clear, and 
there is no sign of any recurrence in 
the larynx. 
CASE VII. 
Mr. E. G., aged forty-two, of 
Logansport, Ind., consulted me Feb- 
ruary 24, 1891, on account of loss of 
voice. This condition was present 
since over a year, although he had 
been hoarse some time before. He did 
not know of any cause of the trouble. 
There was a small fibroid, the size of 
a split pea, attached to the free edge 
of the left cord, very close to the an- 
terior commissure, which made an 
operation somewhat difficult. The 
patient, however, was willing to be 
relieved of his trouble by an opera- 
tion, especially since he had been sub- 
jected for the last year to a number 
of the most heterogeneous treatments 
for the relief of his aphonia. The 
operation was accomplished in one 
sitting with Krause's tube forceps, an 
instrument admirably adapted to oper- 
ations of this kind. I did not use any 
after-treatment, except such as directed 
against the congestion produced by the 
operative procedures. Thirteen days 
after the operation the patient left me 
with a perfectly clear voice, which 
Jias remained thus ever since. 
In conclusion, I will say that I 
intentionally did not go into a de- 
tailed account of the pathology of 
these growths, for the reason that the 
same does not differ in any way from 
the histology of similar growths in 
other locations. Yet I must say that 
the term "papilloma" has always 
been used in its clinical, and not in 8 
Benign Tumors of the Larynx-Thorner. 
its histological sense. That these 
formations have sometimes a certain 
tendency to recur, even in places dif- 
ferent from their original seat (as in 
case vi), is not unusual. They have 
this tendency in common with neo- 
plasms in other parts of the body, for 
instance with the ordinary skin wart. 
However, that they show a great in- 
clination to change into malignant 
tumors, either spontaneously or after 
repeated attempts at operation, as was 
formerly believed by many authorities, 
is now doubted on all sides; in fact, 
the exhaustive collective investigation 
on upwards of six thousand cases, carried 
on by Dr. Felix Semon, of London, 
a few years ago, has proved conclu- 
sively that if such a transformation 
ever happens it is an exceedingly rare 
occurrence. 
366 West Eighth Street. 
Reprint from 
The Cincinnati Lancet- Clinic, 
February 13, 189%.