Notes of a Case of Carcinomatous Growth in the Larynx

Bruce Hamilton
1898 The Journal of Laryngology Rhinology and Otology  
a coachman, aged forty-one yearSj first came to consult me on 22nd November, 1896. Speaking in a hoarse whisper he related the following history of his case :-For the last twenty years he had been afflicted with hoarseness, at times amounting to complete loss of voice. He should attribute the cause to exposure to cold winds, as considerable improvement in quality of the voice had attended any spell of warm weather, but with return of the winter months relapses were inevitable. At times the
more » ... . At times the throat felt dry and hot. Cough, which always got worse in the winter, was usually accompanied by expectoration of a few pellets of mucus. He was a married man, with several healthy children; had not had syphilis or indulged in stimulants. Would I say whether his throat were affected with cancerous disease ? His reason for making this request was that his mother had died of cancer of the breast, and he was beginning to feel anxious about himself. In appearance he was a short, muscular man, of resolute bearing, with regular features and grey hair. On examination of his chest both heart and lungs were found to be healthy. The mucous membrane of nose and pharynx was normal. A careful inspection and palpation of the neck provoked the remark that the part had frequently been swollen at the sides, but no enlargement of the. glands or other swelling was detected. With the laryngoscopic mirror an image of the interior of the larynx and trachea was readily seen. Nowhere was there a particle of new growth ; but the lining membrane throughout exhibited an extreme degree of hyperaemia, affecting equally the two sides and shading away toward the epiglottis and ary-epiglottic folds. The true vocal cords had quite lost their normal appearance ; they looked shrunken and differed but Httle in colour from the surrounding parts. Mobility was not impaired. Superficial erosions were looked for, but not found. A special note was made of the "roomy" aspect of the laryngeal cavity. The case was diagnosed as one of simple chronic aryngitis of the atrophic type. It was not until the 9th of June, 1897-that is to say, about six months and a half after his first visit-that the patient again called on me, when it was at once seen that some grave change in his condition had taken place. Inspiratory stridor was plainly audible, and speech was reduced to the merest whisper. He told me that he had continued to enjoy good health up to within three weeks back, when his voice left him and lumps appeared in his neck. This state of things lasted a fortnight, at the end of which he began to cough up bright red blood; and this alarming
doi:10.1017/s1755146300165862 fatcat:rktw2w7vg5b3lfescmtr57u4ka