Perrin reports a case of an old man of eighty-two who lost his life from the impaction of a small piece of meat in the trachea and glottis. In the Musee Valde-Grace is a prepared specimen of this case showing the foreign body in situ. In the same museum Perrin has also deposited a preparation from the body of a man of sixty-two, who died from the entrance of a morsel of beef into the respiratory passages. At the postmortem a mobile mass of food about the size of a hazel-nut was found at the base of the larynx at the glossoepiglottic fossa. About the 5th ring of the trachea the caliber of this organ was obstructed by a cylindric alimentary bolus about six inches long, extending almost to the bronchial division. Ashhurst shows a fibrinous cast, similar to that found in croup, caused by a foreign body removed by Wharton, together with a shawl-pin, from a patient at the Children's Hospital seven hours after the performance of tracheotomy. Search for the foreign body at the time of the operation was prevented by profuse hemorrhage.
The ordinary instances of foreign bodies in the larynx and trachea are so common that they will not be mentioned here. Their variety is innumerable and it is quite possible for more than two to be in the same location simultaneously. In his treatise on this subject Gross says that he has seen two, three, and even four substances simultaneously or successively penetrate the same location. Berard presented a stick of wood extracted from the vocal cords of a child of ten, and a few other similar instances are recorded.
The Medical Press and Circular finds in an Indian contemporary some curious instances of misapplied ingenuity on the part of certain habitual criminals in that country. The discovery on a prisoner of a heavy leaden bullet about 3/4 inch in diameter led to an inquiry as to the object to which it was applied. It was ascertained that it served to aid in the formation of a pouch-like recess at the base of the epiglottis. The ball is allowed to slide down to the desired position, and it is retained there for about half an hour at a time. This operation is repeated many times daily until a pouch the desired size results, in which criminals contrive to secrete jewels, money, etc., in such a way as to defy the most careful search, and without interfering in any way with speech or respiration. Upward of 20prisoners at Calcutta were found to be provided with this pouch-formation. The resources of the professional malingerer are exceedingly varied, and testify to no small amount of cunning.
The taking of internal irritants is very common, but would-be in-patients very frequently overshoot the mark and render recovery impossible. Castor-oil seeds, croton beans, and sundry other agents are employed with this object in view, and the medical officers of Indian prisons have to be continually on the lookout for artificially induced diseases that baffle diagnosis and resist treatment. Army surgeons are not altogether unfamiliar with these tricks, but compared with the artful Hindoos the British soldier is a mere child in such matters.
Excision of the larynx has found its chief indication in carcinoma, but has been employed in sarcoma, polyp), tuberculosis, enchondroma, stenosis, and necrosis. Whatever the procedure chosen for the operation, preliminary tracheotomy is a prerequisite. It should be made well below the isthmus of the thyroid gland, and from three to fifteen days before the laryngectomy. This affords time for the lungs to become accustomed to the new manner of breathing, and the trachea becomes fixed to the anterior wall of the neck.
Powers and White have gathered 69 cases of either total or partial extirpation of the larynx, to which the 240 cases collected and analyzed by Eugene Kraus, in 1890, have been added.
The histories of six new cases are given. Of the 309 operations, 101, or 32 per cent of the patients, died within the first eight weeks from shock, hemorrhage, pneumonia, septic infection, or exhaustion. The cases collected by these authors show a decrease in the death ratio in the total excision,--29 per cent as against 36 per cent in the Kraus tables. The mortality in the partial operation is increased, being 38 per cent as opposed to 25 per cent. Cases reported as free from the disease before the lapse of three years are of little value, except in that they diminish, by so much, the operative death-rate. Of 180 laryngectomies for carcinoma prior to January 1, 1892, 72, or 40 per cent, died as a result of the operation; 51 of the remaining 108 had recurrence during the first year, and 11, or ten per cent of the survivors, were free from relapse three or more years after operation. In 77cases of partial laryngectomy for cancer, 26, or 33 per cent, died during the first two months; of the remaining 51, seven cases, or 13 per cent, are reported as free from the disease three or more years after the operation.
