SECT. XXXIII.—ON LARYNGOTOMY.
The most famous surgeons have also described this operation. Antyllus, therefore, says, “In cases of cynanche (as we will explain under the head of Dietetics) we entirely disapprove of this operation, because the incision is utterly unavailing when all the arteries (the whole of the trachea?) and the lungs are affected; but in inflammations about the mouth and palate, and in cases of indurated tonsils which obstruct the mouth of the windpipe as the trachea is unaffected, it will be proper to have recourse to pharyngotomy, in order to avoid the risk of suffocation. When, therefore, we engage in the operation we slit open a part of the arteria aspera (for it is dangerous to divide the whole) below the top of the windpipe, about the third or fourth ring. For this is a convenient situation, as being free of flesh, and because the vessels are placed at a distance from the part which is divided. Wherefore, bending the patient’s head backwards, so as to bring the windpipe better into view, we are to make a transverse incision between two of the rings, so as that it may not be the cartilage which is divided, but the membrane connecting the cartilages. If one be more timid in operating, one may first stretch the skin with a hook and divide it, and then, removing the vessels aside, if they come in the way, make the incision.” These are the words of Antyllus. We judge that the windpipe has been opened from the air rushing through it with a whizzing noise, and from the voice being lost. After the urgency of the suffocation has passed over, we pare the lips of the incision so as to make them raw surfaces again, and then have recourse to sutures, but sew the skin only, without the cartilage. Then we use the applications proper for bloody or fresh wounds, but if it does not unite we must treat it with incarnants. We must follow the same plan of treatment if we should meet with the case of a person who had cut his own throat from a wish to commit suicide.
Commentary. Aretæus makes mention of this operation in such terms as proves that it must have been practised occasionally in his time. He, however, does not approve of it, at least in cases of angina. (De Curat. Morb. Acut. i, 7.)
Cælius Aurelianus says that Asclepiades performed the operation in cases of cynanche; but he himself disapproves of it. (De Morb. Acut. i, 7.) We may mention further in this place that Avicenna, Avenzoar, Haly Abbas, Mesue, and Rhases express themselves rather favorably of the operation in urgent cases of cynanche. From the circumstance mentioned by Pollux of cynanche, that it mostly attacks children, we are inclined to think that the ancients meant the croup by it.
None of the Greek authorities, except our author, have left a description of the operation. Psellus, however, mentions it in such a manner as would lead us to infer that the operation had not been lost sight of in his time, i. e. “Laryngotomy is a certain surgical operation.”
Avicenna and Albucasis merely copy our author’s description, and appear to have never seen the operation performed. To show, however, that the windpipe may be opened without occasioning death, Albucasis relates the case of a female who cut her trachea while attempting to commit suicide; in which case, by sewing up the wound, he effected a cure without difficulty. (Chirurg. ii, 13.)
Rhases mentions that, in cases of cynanche which threaten instant death, a certain physician, Ancilisius (Antyllus?) recommends the surgeon to open the windpipe. His description of the operation is as follows: The patient’s head being kept back the skin is to be divided, and the sides of it separated by means of threads, so as to expose the windpipe, which is to be opened by making an incision in the membrane which connects two of the rings together. After the abcess bursts the wound is to be sewed up. (Cont. vii, 2.)
Haly Abbas likewise describes the operation accurately. He directs us to make an incision in the skin, and to separate the edges with hooks so as to expose the windpipe, which is to be opened between two cartilages. (Pract. ix, 38.)
The modern history of the operation is given in Van Sweiten’s Comment. (814); Mémoires de l’Acad. Royale (ii); and Cooper’s Surgical Dictionary. See a complete history of the operation by Sprengel. (Hist. de la Méd. 18, 6.) He says, that Anthony Benivieni, a surgeon of Florence, is the first after Antyllus who is known for certain to have performed the operation.