EXPLANATORY NOTE. THE following Essay was written during the first week of June, 1864. It was immediately sent to the Chairman of the Committee on Prize Essays of the American Medical Association; but, coming too late for competition in that year, was allowed to lie over till 1865. It was planned and finished, including the drawing of most of the wood-cuts, in three days and nights, and has not been touched since. Though considering the state of the subject at the date of its composition sufficiently well represented, I do not wish it to be supposed that the omission of revising the Essay during the year that followed arose from non-recognition of its imperfections. Much as I felt the desire of improving it, I was prevented by severe illness, in consequence of a dissecting wound, and constrained absence from home. I therefore add a few remarks here. I have considerably modified the opinion on the removal of an intralaryngeal growth by laryngotomy preceded by tracheotomy, expressed on page 667, namely, "that in cases in which loss of voice is a principal question, it could never be indicated, and that it could be justly performed only as a last resort to save life if no other means should succeed." My views of the serious nature and risks of the operation remain unchanged, and I would lay down, even more positively than before, the rule that in all cases of choice, the preference should be given to the laryngoscopal operation through the mouth. But enlarged experience has taught me. that cases do oceur, in which the tumor is either not sufficiently accessible, or, at all events, not entirely removable by the mouth; and the recently recorded cases of Ulrich and Lewin, Sands, and others, prove that success as to extirpation, combined with at least partial success as to voice, may crown the operation after tracheo-laryngotomy. Sands' case is referred to in the Essay, page 666; being at the time unpublished, however, its details had not then come to my knowledge. Dr. Sands deserves great credit for his accurate performance of the whole operation, and his case is especially important in this connection, as the first on record, in which the voice was improved. I have become more familiar, practically, with Türck's and Lewin's instruments for laryngoscopal surgery, than I was at the time of writing the Essay, and now recommend these very strongly, especially the scissors of Lewin, regretting that I have no opportunity at present of figuring and describing them. Four additional cases of intra-laryngeal growths have come under my observation. In one I removed a rounded excrescence a quarter of an inch in diameter, and a number of smaller ones, and sent the patient home perfectly well, within a week after I saw her for the first time; one-the case of a child three years old, sent from a distance, and seen but once to make the diagnosis, as the mother was unable to stay in the city longer— died, post-mortem examination proving the larynx filled with epithelioma ; one awaits operation by ecraseur or cutting instruments; and one is very nearly cured, but is still under treatment (present treatment, chromic acid and tannin as deprivers of moisture). All these will be published in due time. Of the eleven cases of the Essay, I have to state that CASE I., I now consider an appropriate one for tracheo-laryngotomy, as the morbid mass continues to grow in spite of all removals and cauterizations practised per vias naturales, by which ways it certainly can never be eradicated. I defer details for later publication. CASE II. Returned for treatment; fear of recurrence of tumor unfounded; voice now materially improved, only at times a little hoarse. CASE III. Perfectly well. CASE IV. This lady I have not seen, but heard through friends that without further treatment, she gradually improved, and is now entirely comfortable. She has no cough, speaks naturally, and is thought to be able to sing. She has since confessed her belief that she herself contributed much, by great imprudence, neglect, and exposure, during the time she was under my care, to the occurrence and continuance of the violent laryngitis, from which she suffered soon after the removal of the polypus. CASE V. I have examined frequently since. The shrunken stump is still visible; the voice has remained very good, except that on two or three occasions he "caught cold" and was temporarily hoarse. CASES VI., VII., and VIII. I have every reason to believe remain well. In CASE IX., cauterization was irregularly continued for several months after the Essay was written, until the harshness and hoarseness of voice yielded. CASE X. This young lady is an excellent singer. CASE XI. Remains still unoperated on. The polypus has grown very little, but I intend to remove it soon. This tumor has become a standard one for exhibition to physicians visiting my office, the patient kindly consenting, having gained unusual control over the organs involved. NEW YORK, 153 West 15th St., January, 1866. CONTENTS. Fatality of the disease, modern triumph over it SECTION II.-OPERATIONS HERETOFORE PRACTISED I. Removal after tracheo-laryngotomy-Ehrmann's case, Buck's and II. Removal after subhyoidean pharyngotomy-Prat's case-Advan- III. Removal through oral cavity. A. By the knife-Green's first case. B. By the ligature. Simple ligature-Koderik's case Galvano-caustic wire-Middeldorpf's case C. By the probang-Green's second case. Inapplicability of these operations SECTION III.-THE SURGICAL TREATMENT OF TO-DAY. 659 II. Discision-Instruments-Case recorded-Mode of operating IV. Evulsion-Indication-Caution-Instruments V. Ligation-Galvano-Caustic Ligature-Ecraseur SECTION IV.-REPORT OF ELEVEN CASES, OCCURRING IN THE WRITER'S PRACTICE, 691 PRIZE ESSAY. ON THE SURGICAL TREATMENT OF MORBID SECTION I.-INTRODUCTORY. Ar its session in New York, in May, 1853, Dr. Gurdon Buck presented to the Association a paper entitled as the present. Since then the diagnosis and treatment of laryngeal affections have been entirely revolutionized by what is termed authoritatively "one of the most important inventions of modern times." The subject of this essay, which illustrates the most brilliant achievement resulting from this invention has well-founded claims, therefore, it seems to the present writer, to be again brought before this body. Inevitably fatal in their tendency-destroying in a greater or less degree the The Laryngoscope, Illustrations of its Practical Application, and Descriptions of its Mechanism. By George D. Gibb, M. D., M. A., Member Royal College of Physicians, London; Physician to the West London Hospital, etc. London: Churchill, 1863, p. 3. Die erste Ausrottung eines Polypen in der Kehlkopfshöhle durch Zerschneiden ohne blutige Eröffnung der Luftwege nebst einer kurzen Anleitung zur Laryngoskopie, von Victor v. Bruns, Doctor der Medicin und Chirurgie, Professor der Chirurgie und Chirurgischen Klinik, Ritter, etc. etc. Tübingen, 1862, p. 1. Die Laryngoskopie und ihre Verwerthung für die ärztliche Praxis. Von Dr. Friedrich Semeleder, Docenten an der Wiener Hochschule, etc. Wien, 1863. Wilhelm Braumüller. Reviews by Dr. C. L. Merkel. Schmidt's Jahrbücher der in- und ausländischen gesammten Medicin. Leipzig: Otto Wigand, 1861, '62, '63. Cours Complet de Laryngoscopie. Par Dr. Moura-Bourouillou, etc. Paris, 1861. "In the hands of those accustomed to its manipulation, its use effects what has been heretofore looked upon as marvellous, for it renders 'the dumb to speak and the deaf to hear.' Diseases of the Throat and Windpipe, etc. By George Duncan Gibb, M. D., M. A., etc. Second Edition. London: John Churchill & Sons, 1864. Preface, p. viii. |