Laryngo-fissure for Intrinsic Carcinoma of the Larynx: Four cases in medical men, who are now in active practice, 21, 3, 41, and 51 years after operation.By Sir STCLAIR THOMSON, M.D. CASE I.-This case is interesting in view of the comparatively early age of the patient and some difficulty in diagnosis. (Case card 52.) An old house-surgeon of mine, aged 40, was referred to me on March 28, 1922, by Dr. Arnold Jones. Ten weeks previously he had a sudden attack of hoarseness, and was reported then to have general laryngeal catarrh, which subsided slowly, leaving a lesion of the right cord. The right cord, except both extremities, was invaded by an irregular, mammillated growth, with necrotic, white, ulcerating points over the centre. The cord moved freely. No history of lues. Dr. R. A. Young found no signs of pulmonary, vascular or renal disease.Efforts to remove a portion, under cocaine, were not successful, as the reflexes could not be controlled. Two months' voice rest improved the voice, but local irregularity and ulceration slightly increased. Seen by Mr. Herbert Tilley and Mr. C. W. M. Hope. I urged operation although clinical diagnosis of epithelioma was unsupported by a biopsy; I explained that, while a piece could be removed under general anaesthesia, and examination might confirm the diagnosis, yet a negative report would not alter my opinion and might lead to disastrous delay, and possibly stimulate diffusion of the growth.May 19, 1922.-Usual laryngo-fissure.The anetsthetist (Mr. Hugh Phillips) reported as follows: " Operation commenced 9.47; trachea opened 10.7; growth removed 10.47; operation completed 11.39. (N.B.-Profuse haemorrhage requiring pressure forceps, peroxide, and ligatures.) Anaesthetic (as the patient objected to ether): chloroform 13 drachms, oxygen 40 gallons."A considerable portion of the right ala was removed. The tracheotomy tube was left in situ until 9 p.m., when it was abandoned. The same evening the patient could swallow and could read his newspaper. Five days later he went for a walk; within the week he was at a cricket match at Lord's; twelve days after his operation he looked on at another laryngo-fissure in the same home; the neck wound closed ten days after the operation; he left the home within the fortnight. Dr. C. Fletcher reported the growth to be a typical squamous-celled carcinoma, penetrating the submucous tissue to the level of the small muscles. The excision appeared complete in all directions.
