- Email: [email protected]
A CASE OF LAND SCURVY.
370
severity are rare.
In this patient none of the usual causes of scurvy could be traced. He had never been to sea and had always used fresh vegetables as part of his food. The circumstances that he was a sufferer from chronic dyspepsia and that he was thus reduced to a state bordering on starvation may have been factors in the causation of his malady.
Clinical Notes: OBSTETRICAL AND THERAPEUTICAL.
MEDICAL, SURGICAL,
Ferndale, Glamorganshire. "A NOTE ON THE OCCURRENCE OF METRORRHAGIA AFTER THE MENOPAUSE IN CASES OF
A Mirror
OVARIAN TUMOUR." BY J. B. HENDERSON, M D. BRUX., L.R.C.P., L.R.C.S. EDIN.
OF
HOSPITAL
PRACTICE,
IN the interesting paper by Dr. Lewers in THE LANCET of BRITISH AND FOREIGN. Jan. 2nd under the above heading I notice the following sentence : " It may fairly be concluded that the occurrence Nulls autem est alia pro certo noscendi via, nisi quamplurimas et morof bleeding from the uterus after the menopause in cases of borum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus, Morb., ovarian tumour is a somewhat rare event " ; and I therefore lib. iv. Proœmium. feel justified in sending you the following note of a case at EDINBURGH ROYAL INFIRMARY. present under my observation. A woman aged sixty-one A CASE OF ENORMOUS PRIMARY SARCOMA OF THE LIVER in whom the occurred about fourteen years, years menopause IN WHICH A LARGE BLOOD CYST SIMULATING A ago, has noticed a swelling in the abdomen for two or three HEPATIC ABSCESS WAS DEVELOPED ; years, and although she thought that it might be something ASPIRATION, ETC.; NECROPSY. serious for the last two years, she only complained of it about I then examined found of a a month ago. her and signs (Under the care of Dr. BYROM BRAMWELL.) large cystic tumour probably connected with the right ovary THE carefully observed record of the case which we give and about the size of a seven months’ pregnancy. She says i that the tumour has been growing more quickly during the this week will be much appreciated by our readers, for it is last few months, and that within the last eight months she of much value from many standpoints. The occurrence of has had on three or four occasions a hscmorrhagic discharge, sarcoma as a primary growth of the liver is very rarely which lasted for about two days and made her think that her and a account of such a case, with the
observed,
monthly periods were returning. Glasgow.
----
-
A CASE OF LAND SCURVY.
BY S.
HAMILTON, B.A., M.B.R.U.I.
complete
addition of the bibliography on the subject is a gain to medical and pathological literature. The majority of cases which have been observed of primary sarcoma of the liver are mentioned in this paper ; there are two others which are referred to by Sajous.l 1. That of a girl, aged twentytwo years, under the care of Dr. G. Wach,2 in whom the growth was mistaken for hydatid cyst. 2. A primary sarcoma in a child, aged four months, reported by Dr. Lendruf.3 The abdomen was enormously distended; there was no jaundice. The liver contained numerous disseminated tumours of a light red-brown colour. A married woman aged twenty-five years was admitted to Ward 5A, Edinburgh Royal Infirmary, on June 23rd, 1894, complaining of debility, emaciation, shortness of breath, and pain in the lower part of the right chest at a point two and a half inches below, and slightly external to, the right nipple. The patient stated that she was quite well until her marriage, three months before. Since then she had suffered from pain in the right side in the position described above. She thought it was worse in wet weather. At first it was intermittent and of a dull, aching character, but lately it had been more constant, sharp, and boring. The patient attributed her illness to catching cold. At the commencement of the attack she was troubled with a dry cough, but there was no expectoration; the cough continued for two or three weeks and then disappeared ; the pain, however, remained. In other respects
aI
THE following case is interesting from the rarity of such condition at the present day and also from the fact that the usual causes of scurvy did not exist. The patient was a man aged forty-one years, tall and thin, who had worked underground in the Ferndale Collieries for years. His previous health was not robust; he was a sufferer from chronic dyspepsia, but was able to work till April, 1896. His habits were fairly regular, except a partiality The first symptoms of scurvy for whisky and snuff. appeared about the end of last April. The gums were swollen, soft and spongy, and bled on the slightest friction. His face had a peculiar sallow yellowish hue and was ansemic, with puffiness under the eyelids. He complained of lassitude and pains in his limbs, stiffness of his joints, and dyspnaea on fatigue. At this stage a satisfactory diagnosis could not be arrived at. Shortly afterwards he took to his bed and fresh symptoms appeared. Large irregular, ecchymotic patches were seen on his legs from the knees downwards; there was cedema of the legs, feet, and ankles ; the pains in the legs and thighs were more severe ; the gums became more turgid, spongy, and tender, and bled more easily; the teeth became loose ; his breath had a remarkably offensive odour, which could be perceived outside his bedroom ; hard swellings, very painful on palpation, were to be felt in the calves of the legs. At this stage there could be no doubt as to the nature of the case. All the most approved remedies for scurvy, both dietetic and therapeutic, were administered one after another without any improvement in the symptoms. The patient became gradually more emaciated and exhausted ; the pulse was slow, weak, and thready; the first sound of the heart and the impulse were weak ; the urine was scanty and dark red in colour and had an ammoniacal odour; the alvine evacuations were generally free and offensive ; and towards the end melasna was present. During the last month of his life the only food tolerated by the patient was fresh eggs beaten up in a little brandy. At this period the cedema of the legs and ankles disappeared-this being the only symptom that showed any improvement. Towards the end of July the patient died from exhaustion, about three months after the first
symptoms appeared.
Sporadic
cases
of land scurvy of this nature and of such
she had been fairly well, though getting weaker. Her appetite and her digestion had been good, though she had been somewhat troubled with flatulence. She had noticed that the right side of the chest had recently become more prominent than the left. The patient stated that until the present illness commenced she had always enjoyed good health. She had never lived abroad and bad never suffered from dysentery, diarrhca, or any affection of the bowels. She last menstruated some six weeks previously. The patient was one of a family of five; four were living, being strong and healthy, and one died at the age of six years from tuberculous meningitis. Her father and mother were both alive and well. So far as she knew none of her relatives had suffered from any liver affection. On admission the patient was pale and thin; she looked extremely ill. She lay on her right side ; she said that the pain was worse when she attempted to move or when she lay in any other position. There was no jaundice. The evening temperature was about 100° F. and the morning temperature
I
1 Annual of the Universal Medical Sciences. 2 Bulletin de la Société Anatomique. Paris. 1892. 3 Universal Medical Journal. Philadelphia. 1893.
severity are rare.
In this patient none of the usual causes of scurvy could be traced. He had never been to sea and had always used fresh vegetables as part of his food. The circumstances that he was a sufferer from chronic dyspepsia and that he was thus reduced to a state bordering on starvation may have been factors in the causation of his malady.
Clinical Notes: OBSTETRICAL AND THERAPEUTICAL.
MEDICAL, SURGICAL,
Ferndale, Glamorganshire. "A NOTE ON THE OCCURRENCE OF METRORRHAGIA AFTER THE MENOPAUSE IN CASES OF
A Mirror
OVARIAN TUMOUR." BY J. B. HENDERSON, M D. BRUX., L.R.C.P., L.R.C.S. EDIN.
OF
HOSPITAL
PRACTICE,
IN the interesting paper by Dr. Lewers in THE LANCET of BRITISH AND FOREIGN. Jan. 2nd under the above heading I notice the following sentence : " It may fairly be concluded that the occurrence Nulls autem est alia pro certo noscendi via, nisi quamplurimas et morof bleeding from the uterus after the menopause in cases of borum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.-MORGAGNI De Sed. et Caus, Morb., ovarian tumour is a somewhat rare event " ; and I therefore lib. iv. Proœmium. feel justified in sending you the following note of a case at EDINBURGH ROYAL INFIRMARY. present under my observation. A woman aged sixty-one A CASE OF ENORMOUS PRIMARY SARCOMA OF THE LIVER in whom the occurred about fourteen years, years menopause IN WHICH A LARGE BLOOD CYST SIMULATING A ago, has noticed a swelling in the abdomen for two or three HEPATIC ABSCESS WAS DEVELOPED ; years, and although she thought that it might be something ASPIRATION, ETC.; NECROPSY. serious for the last two years, she only complained of it about I then examined found of a a month ago. her and signs (Under the care of Dr. BYROM BRAMWELL.) large cystic tumour probably connected with the right ovary THE carefully observed record of the case which we give and about the size of a seven months’ pregnancy. She says i that the tumour has been growing more quickly during the this week will be much appreciated by our readers, for it is last few months, and that within the last eight months she of much value from many standpoints. The occurrence of has had on three or four occasions a hscmorrhagic discharge, sarcoma as a primary growth of the liver is very rarely which lasted for about two days and made her think that her and a account of such a case, with the
observed,
monthly periods were returning. Glasgow.
----
-
A CASE OF LAND SCURVY.
BY S.
HAMILTON, B.A., M.B.R.U.I.
complete
addition of the bibliography on the subject is a gain to medical and pathological literature. The majority of cases which have been observed of primary sarcoma of the liver are mentioned in this paper ; there are two others which are referred to by Sajous.l 1. That of a girl, aged twentytwo years, under the care of Dr. G. Wach,2 in whom the growth was mistaken for hydatid cyst. 2. A primary sarcoma in a child, aged four months, reported by Dr. Lendruf.3 The abdomen was enormously distended; there was no jaundice. The liver contained numerous disseminated tumours of a light red-brown colour. A married woman aged twenty-five years was admitted to Ward 5A, Edinburgh Royal Infirmary, on June 23rd, 1894, complaining of debility, emaciation, shortness of breath, and pain in the lower part of the right chest at a point two and a half inches below, and slightly external to, the right nipple. The patient stated that she was quite well until her marriage, three months before. Since then she had suffered from pain in the right side in the position described above. She thought it was worse in wet weather. At first it was intermittent and of a dull, aching character, but lately it had been more constant, sharp, and boring. The patient attributed her illness to catching cold. At the commencement of the attack she was troubled with a dry cough, but there was no expectoration; the cough continued for two or three weeks and then disappeared ; the pain, however, remained. In other respects
aI
THE following case is interesting from the rarity of such condition at the present day and also from the fact that the usual causes of scurvy did not exist. The patient was a man aged forty-one years, tall and thin, who had worked underground in the Ferndale Collieries for years. His previous health was not robust; he was a sufferer from chronic dyspepsia, but was able to work till April, 1896. His habits were fairly regular, except a partiality The first symptoms of scurvy for whisky and snuff. appeared about the end of last April. The gums were swollen, soft and spongy, and bled on the slightest friction. His face had a peculiar sallow yellowish hue and was ansemic, with puffiness under the eyelids. He complained of lassitude and pains in his limbs, stiffness of his joints, and dyspnaea on fatigue. At this stage a satisfactory diagnosis could not be arrived at. Shortly afterwards he took to his bed and fresh symptoms appeared. Large irregular, ecchymotic patches were seen on his legs from the knees downwards; there was cedema of the legs, feet, and ankles ; the pains in the legs and thighs were more severe ; the gums became more turgid, spongy, and tender, and bled more easily; the teeth became loose ; his breath had a remarkably offensive odour, which could be perceived outside his bedroom ; hard swellings, very painful on palpation, were to be felt in the calves of the legs. At this stage there could be no doubt as to the nature of the case. All the most approved remedies for scurvy, both dietetic and therapeutic, were administered one after another without any improvement in the symptoms. The patient became gradually more emaciated and exhausted ; the pulse was slow, weak, and thready; the first sound of the heart and the impulse were weak ; the urine was scanty and dark red in colour and had an ammoniacal odour; the alvine evacuations were generally free and offensive ; and towards the end melasna was present. During the last month of his life the only food tolerated by the patient was fresh eggs beaten up in a little brandy. At this period the cedema of the legs and ankles disappeared-this being the only symptom that showed any improvement. Towards the end of July the patient died from exhaustion, about three months after the first
symptoms appeared.
Sporadic
cases
of land scurvy of this nature and of such
she had been fairly well, though getting weaker. Her appetite and her digestion had been good, though she had been somewhat troubled with flatulence. She had noticed that the right side of the chest had recently become more prominent than the left. The patient stated that until the present illness commenced she had always enjoyed good health. She had never lived abroad and bad never suffered from dysentery, diarrhca, or any affection of the bowels. She last menstruated some six weeks previously. The patient was one of a family of five; four were living, being strong and healthy, and one died at the age of six years from tuberculous meningitis. Her father and mother were both alive and well. So far as she knew none of her relatives had suffered from any liver affection. On admission the patient was pale and thin; she looked extremely ill. She lay on her right side ; she said that the pain was worse when she attempted to move or when she lay in any other position. There was no jaundice. The evening temperature was about 100° F. and the morning temperature
I
1 Annual of the Universal Medical Sciences. 2 Bulletin de la Société Anatomique. Paris. 1892. 3 Universal Medical Journal. Philadelphia. 1893.