Evening star. [volume] (Washington, D.C.) 1854-1972, 1888-12-07
REMARKABLE SURGERY.
A Mans Larynx Entirely Removed for
Cancer-He IL now Apparently Well.

"A Mans Lafynx Entirely Removed Tor
Cancer-He is now Apparently Well.
The New York Herald tells the story Of the
extirpation of the larynx which YVES performed
at the New York hospital upon German Ia
borer named Joseph Leibreich. The cause
WA a cancerous growth similar to that of the
late Emperor Frederick. and the operation was
successful. Tracheotomy was first resorted to,
and then on April rs, 1888, two and one-hah
months from the time tracheotomy was per-
formed, the complete extirpation of the larynx
was accomplished. At this time there we're no
enlarged cervical glands, the larynx felt larger
and fuller than normal, but its outline was not
disturbed, though its whole interior was filed
with q growth apparently starting from the
right side. The epiglottis was not involved,
nor the wall Of the pharynx. The anesthetic
used was chloroform. aided by two hypodermic
injections of morphine. Then a vertical in
cision was made in the middle line of the neck.
crossed opposite the level of the hyoid bone by
transverse cut through the skin only. The
prominent thyroid cartilage, or adams
apple" was first split in two in order to ascer-
tain the extent of the growth. After opening
the interior of the larynx the trachea about
the tube was stuffed tightly with small sponges
attached to strings. This device, together with
keeping the head lightly depended, effectually
excluded all blood from the trachea or wind
pipe. The two halves of the larynx were re-
moved separately, the separation being made
first from the lower end. There was triiing
bleeding, it being necessary to tie only two or
three arteries.
AFTER THE OPERATION.
For forty-eight hours after the operation no
food passed Liebreich's lips. He was conscious,
but did not appear to suffer much. The mouth,
pharynz and wound were tightly plugged with
gauze, saturated with iodoform. Thirst was
relieved by wetting the lips and tongue, and
nourishmentwas injected into the lower bowel,
while the patient breathed easily through the
tracheal tube, which passed through the
packing Of gauze into the trachea. Gradually
the packing was removed and rubber tube
inserted, through which liquid nourishment
was passed. By the end of eight weeks the
wound in the neck was healed leaving a circu-
lar opening three-fourths of an inch in dame
ter opposite the side of the removed larynx.
This hole opened downward into the trachea or
wind passage and upward into the mouth. 1t
was fitted with silver tube having two
branches 1t was shaped like the letter T, or two
inverted letter LIS placed back to back, only
vertical arm Of the L thus occupies the front
part of the neck and the horizontal arm leads
from the mouth to the windpipe. When the
tube is in place the opening of the esopha-
gus, or food passage, is behind it. On closing
the upper branch with plug attached to a
small wire, a task the patient can easily accom-
plish, the food in the act of swallowing passes
| over the end of the tube and inside the Gsopha-
gus to the stomach. By plugging the outer end
OF the tube the air passes directly from the
mouth or nose into the lungs. When eating,
Liebreich consequently has to breath through
the tube projecting from his neck, just below
the chin, but at all other times through his
mouth or nose. The presence of the tube, no
larger than nickel in diameter, was easily
concealed by cravat.
MANAGES TO CONVERSE.
But he was unable to make any loud sound
and the plan was to furnish the tube leading
| to the trachea with artificial chords, whose
vibration would supply the loss of the natural
vocal organs. This has been done successfully
| in several cases in Europe. But the cearness
| of Liebreich's articulation seemed to increase
| He gained sort of hOarse whisper which was
audible several feet away, and he could make
himself understood in German with little diff
! ficulty. In view of this Improvement the idea
of providing an artificial apparatus or set of
vocal chords. which would be both expensive
and complicated, and easy to get out Of order
has been for the present given up. He is now
able to perform great deal of work about the
hospital spending good part of his time in
| the dispensary. where he washes bottles and
makes himself generally useful His general
health since his admittance to the hospital has
constantly improved. He looks robust and
happy. Seven full months have elapsed since
| the operation and there are signs of any re-
| turn of the disease. At least year must
| elapse before one can be sure that it will not
| reappear. Liebreich himself appears to have
| no fears.