H Feldmann1. 1. HNO-Klinik, Universität Münster, Germany.
Abstract
BACKGROUND: Laryngology a discipline of its own: When in 1855 Garcia had invented the indirect laryngoscopy and Türck and Czermak had introduced the method in clinical medicine numerous laryngological centres were founded in Austria, Germany, England, and France. FIRST INTERVENTIONS AND SOLUTION OF TECHNICAL PROBLEMS: In 1859 Czermak had already examined 20 patients with laryngeal diseases and demonstrated that it was possible to apply local treatment such as cautery under laryngoscopic view. The surgeon von Bruns in Tübingen (Germany) reported in 1862 on the successful removal of a polyp in the larynx. One common problem was the epiglottis preventing the view on the anterior part of the glottis. Czermak had suggested to make the epiglottis rise by intoning "hee". Methods of holding the epiglottis with a suture or with a forceps were not successful. In 1879 Reichert in Rostock (Germany) presented his epiglottis retractor which is still in common use. The irritability of the laryngeal mucosa remained the major problem for the next 20 years. CONSERVATIVE ENDOLARYNGEAL TREATMENT: The dominant means were local applications with brushes, powder blowers or injections of caustic fluids. Starting at about 1860 there were also steam inhalations. SURGICAL ENDOLARYNGEAL INTERVENTIONS: In a very early stage numerous instruments were devised such as sickle knives, various forceps, polyp snares and instruments for applications of electric currents. These were used in a monopolar and a bipolar way to induce electrolysis, coagulation and stimulation. INTRODUCTION OF SURFACE ANAESTHESIA: In 1884 in Vienna the surface anaesthesia with cocaine was introduced by Koller in the ophthalmology and by Jelinek in the laryngology. THE SPECIAL CASE HISTORY: The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported, because here all knowledge and technical facilities available at that time were brought into play. The treatment was guided by the German surgeons von Bergmann and Bramann, the laryngologists Gerhardt, Tobold and Schrötter (Vienna), the pathologists Virchow and Waldeyer, and the English laryngologist Mackenzie. The dominant problem was to have a safe diagnosis preoperatively. There was a passionate discussion about who was to blame for the fatal outcome of the emperor's disease. CONCLUDING: Another case history is reported when the surgeon von Bergmann believed he could demonstrate a successful operation on a patient with an apparently secure diagnosis of a laryngeal carcinoma the way it should have been done on the emperor. He was wrong: it turned out to be a tuberculosis and the patient died three hours after the operation.
BACKGROUND: Laryngology a discipline of its own: When in 1855 Garcia had invented the indirect laryngoscopy and Türck and Czermak had introduced the method in clinical medicine numerous laryngological centres were founded in Austria, Germany, England, and France. FIRST INTERVENTIONS AND SOLUTION OF TECHNICAL PROBLEMS: In 1859 Czermak had already examined 20 patients with laryngeal diseases and demonstrated that it was possible to apply local treatment such as cautery under laryngoscopic view. The surgeon von Bruns in Tübingen (Germany) reported in 1862 on the successful removal of a polyp in the larynx. One common problem was the epiglottis preventing the view on the anterior part of the glottis. Czermak had suggested to make the epiglottis rise by intoning "hee". Methods of holding the epiglottis with a suture or with a forceps were not successful. In 1879 Reichert in Rostock (Germany) presented his epiglottis retractor which is still in common use. The irritability of the laryngeal mucosa remained the major problem for the next 20 years. CONSERVATIVE ENDOLARYNGEAL TREATMENT: The dominant means were local applications with brushes, powder blowers or injections of caustic fluids. Starting at about 1860 there were also steam inhalations. SURGICAL ENDOLARYNGEAL INTERVENTIONS: In a very early stage numerous instruments were devised such as sickle knives, various forceps, polyp snares and instruments for applications of electric currents. These were used in a monopolar and a bipolar way to induce electrolysis, coagulation and stimulation. INTRODUCTION OF SURFACE ANAESTHESIA: In 1884 in Vienna the surface anaesthesia with cocaine was introduced by Koller in the ophthalmology and by Jelinek in the laryngology. THE SPECIAL CASE HISTORY: The case history of the German emperor Frederick III, who died of laryngeal cancer in 1888, is briefly reported, because here all knowledge and technical facilities available at that time were brought into play. The treatment was guided by the German surgeons von Bergmann and Bramann, the laryngologists Gerhardt, Tobold and Schrötter (Vienna), the pathologists Virchow and Waldeyer, and the English laryngologist Mackenzie. The dominant problem was to have a safe diagnosis preoperatively. There was a passionate discussion about who was to blame for the fatal outcome of the emperor's disease. CONCLUDING: Another case history is reported when the surgeon von Bergmann believed he could demonstrate a successful operation on a patient with an apparently secure diagnosis of a laryngeal carcinoma the way it should have been done on the emperor. He was wrong: it turned out to be a tuberculosis and the patient died three hours after the operation.
Authors: João Flávio Nogueira; Diego Rodrigo Hermann; Ronaldo dos Reis Américo; Iulo Sérgio Barauna Filho; Aldo Eden Cassol Stamm; Shirley Shizuo Nagata Pignatari Journal: Braz J Otorhinolaryngol Date: 2007 Sep-Oct