Fifty Cases of Innocent Laryngeal Growths

Original Articles are accepted on the condition that they have not previously been published elsewhere. If reprints are required it is requested that this be stated when the article is first forwarded to this Journal. Such reprints will be charged to the author. Editorial Communications are to be addressed to "Editor of JOURNAL OF LAitTNGOt.oay. care of Messrs. Adlard $f Son fy West Newman, Limited, Bartholomew Close, K.C"

obstruct the whole lumen of the larynx (Fig. 1). Removed with MacKenzie's forceps in two parts as shown (Fig. 2). Two weeks later another piece was removed. Six months later a third piece was removed. First piece was squamous papilloma, second piece was fibroid tissue, and the last piece was a fibroma. No recurrence. Pathologist reports: Squamous papilloma, with scanty core and a few plasma cells. stridulous covigh, ehloroform was administered, Killian's tube was passed, and several of the largest growths removed with Patterson's forceps. The smaller growths disappeared. Pathologist reports : Villous papilloma (JOUKN. OP LABYN-GOL., RHINOL., AND OTOL., November, 1917).
CASE 12.-R. D , aged thirty-five. Male. Hawker. Complained of roughness of voice of several years' duration. A ragged-looking growth (sessile in character) on the anterior end of the left vocal cord. Removed with the " universal" forceps ( Fig. 3). No recurrence. Pathologist reports : A horny papilloma echinoid in appearance, with concentric " pearls " (see Fig. 12).
CASE 13.-J. C , aged forty. Female. Dressmaker. Complained of difficulty in speaking, of one year's duration. Several growths seen on the right vocal cord and one on the left." Removed with MacKenzie's and Grant's forceps. Three months later again removed, but appeared in a month, and were destroyed, as far as possible, with the galvano-cautery. Once more returned, and caustics were applied at intervals, such as zinc chloride, salicylic acid, and sulphate of copper. Gradually the growths disappeared. Multiple irregular growths-three on the right vocal cord, and one on the left. Removed several times with Grant's forceps at intervals of two weeks between each operation. The place where the growth was attached to the vocal cord was touched with the cautery. This caused a considerable amount of pain, oedema, and difficulty in breathing for ten days. No recurrence. Pathologist  Complained of hoarseness at times, with an alteration in the character of the voice. Small growth on the anterior end of the left vocal cord. Removed with the " universal " forceps. No recurrence. Pathologist reports : Fibroma (Fig 6.) CASE 33.-A. S , aged twenty-two. Hale. Ship's steward. Complained of huskiness of eight months' duration. There was marked obstruction in the nose due to deviation of the septum. Small sessile growth on the middle-third of the left vocal cord. Removed with MacKenzie's forceps. The growth recurred and was removed with the " universal" forceps, and also a nasal resection performed. Pathologist reports : Fibroma. Patient cannot be traced. CASE 34.-A. S , aged forty-four. Male. Stockbroker. Complained of roughness of voice of two years' duration. On examination a small smooth growth was found hanging from the posterior end of the right vocal cord. The patient insisted on having a general anaesthetic, and the growth was removed by direct laryngoscopy (Bruning's). Pathologist reports: Fibroma. Removed with Grant's forceps. Patient returned a year later with the same growth. Again removed with Grant's forceps, and the cautery was applied to the point of removal. There was a considerable amount of oedema, pain, and breathlessness for fourteen days, which gradually svibsided. There has been no recm-rence. Pathologist reports: Sercedematous fibroma.
CASE 40.-G. B , aged thirty nine. Male. Foreman works. Complained of slight bleeding from the nose of some months' duration, and general discomfort in breathing. A large pendulous growth (subglottic) from the middle-third of the left vocal cord. The growth hung down into the trachea, and was seen only at forced expiration. Removed with laryngeal snare. Epistaxis cured. No recurrence. Pathologist reports : Sercedematous growth.
CASE 41.-A H , aged twenty-seven. Male. Painter. Complained of hoarseness of two years' duration. A transparent polypoid-looking growth hang ing from the anterior end of the left vocal cord. Removed with Grant's forceps. A small fragment remained, which was destroyed by the galvano-cautery a week later. There was considerable pain and dyspnoea for several days, which gradually subsided. Later on, a slight recurrence of the growth called for another application of the cautery, which destroyed it. Pathologist reports: Sercedetnatous papilloma (Fig. 7), (LSkcet, November, 1907 {Continued from p. 15.) Experimental Results. In proceeding to record the results of the experimental side of the investigation, I desire in the first place to point out how very small is the number of cases in which hitherto tubercle bacilli have been obtained from a tonsil and cultivated, and the type of bacillus determined. The only instances of which I know are three cases reported by Brown and Smith (1907 7 ), and one case by Hess (1908 I8 ).
Of the cases investigated by Brown and Smith all were due to the bovine bacillus. The ages were two, five, five. The patient had in each instance tuberculosis of the cervical glands. The single case studied by Hess was a girl, aged six, with a negative family history. She was a pale, thin child, with a poorly-developed chest. The tonsils were hypertrophied ; microscopically they showed no evidence of tuberculosis. Clinical examination of the chest disclosed no changes in the lungs, but a radiograph showed a well-defined infiltration of a tuberculous character around the roots of the lungs, more marked on the right side. There was slight enlargement of the cervical lymph nodes, this probably being of a toxic non-tuberculous nature. The faucial tonsils yielded the bovine type of tubercle bacillus.
The experimental results of the present investigation are as follows: