History of the Laryngectomy
by Jack Henslee
The first recorded laryngectomy was performed on a dog in 1829 by H. Albers. The dog lived 9 days.
In 1866, Patrick Watson of Edinburgh performed the first laryngectomy on a man. The patient was 36 years old and his larynx was being destroyed by syphilis. He survived the operation but died several weeks later from pneumonia, and since he had died, the procedure was generally condemned.
In 1873, Billroth,of Vienna, performed what is considered to be the first successful laryngectomy. The patient was a 36 year old man with what was thought to be a tumor on one vocal cord which was removed. Nine days later however, the entire larynx had to be removed because the growth had spread and infection had developed. The patient survived for 1 year and then died from a recurrence.
From the first 103 total laryngectomies performed, 39% died from the immediate effects of the operation (ranging from several hours to 8 weeks), and over half of these died from pneumonia. Another 20% had a recurrence which resulted in death after an average of about 6 months. Only 9 of the first 103 survived for more than 1 year, and the longest survivor lasted 5 years. In order to be considered successful, a laryngectomy had to insure a survival of more than 1 year because it was believed that this length of survival could be achieved by tracheostomy alone.
The acceptance of laryngectomies came slowly for several reasons. The primary reason was of course the low survival rate. This survival rate (50% or less) was mainly attributed to unsanitary conditions plus a reluctance by physicians (as well as patients) to perform them during the early stages of disease. Laryngectomies were considered by many to be a last resort, and because of that attitude recurrence was common.
The post-operative treatment in those early days also left a lot to be desired. In 1892, Solis-Cohen (the physician that performed the firstsuccessful laryngectomy in the U.S.A) stated, "I am afraid that there is a tendency to the operation being overrated, if we do not appreciate the usually miserable conditions of the patients who have undergone it successfully, for there is an important difference between `recovery' and mere ‘survival' after the operation."
Another common reason for not doing laryngectomies was the perception by many (including some physicians) that removing the ability to speak was inhuman, regardless if life was spared. Because of this attitude there were attempts to construct an artificial larynx from the very beginning.
The first recorded artificial larynx was created by a Czech physiologist (Johann Czermak) in 1859. It's interesting to note that the patient was not a laryngectomee (that came 14 years later) but an 18 year old girl who was given a tracheostomy because her larynx had closed up. This device consisted of a tracheal cannula and a tube with a metal reed. Sound was produced by placing the tube in the mouth and breathing out to vibrate the reed. In 1873 an artificial larynx was placed in the first person to have a successful laryngectomy performed.
In these "early days" the opening into the pharyngeal cavity was not closed up, so artificial larynges were constructed in a kind of "T" shape. That is, there were 2 tubes, one coming out of the tracheal stoma for breathing, and the other (with a reed inside of it for sound) going into the pharynx. There were many variations of these devices, and some were reported to produce good quality sound, but the same problem always persisted; aspiration (the leakage of food and liquid into the lungs) and eventually pneumonia.
We've come a long way since then....