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A CASE OF RECURRENT SARCOMA WITH APPARENTLY SPONTANEOUS CURE AND GRADUAL SHRINKING OF THE TUMOUR.
300 bowel or bladder, but on investigating these cases we find beginning of the treatment with the toxins." Now, unless that only two patients suffered from lack of proper control there has been some gross error of observation or deduction, over the bowel ; they were usually constipated, but when the case here recorded stands quite apart from those of by artificial means the bowels were opened they were Coley, for there was no injection of toxins or any sponunable to control them. As regards the urinary system, taneous attack of erysipelas, yet the tumour shrank in a most
have had some trouble in micturition since the operation-in one case a ligature being passed per urethram-but this trouble has in every case ceased after the first year. Sexual instincts.-The influence of hysterectomy, with or without conservation of the ovaries, upon the sexual instincts is a subject about’which little is known and Out of upon which great diversity of opinion exists. the 95 patients 64 were unmarried, widows, or living apart from their husbands, but of the remaining 31 we find that in 19, or 61’2 per cent., the marital relations were unaltered (seven of these had had both ovaries removed). Nine of the patients, or 29 per cent., stated that their relations were not so good as formerly (only two of these had had both ovaries removed) ; and three, or 9’6 per cent., found these relations improved ; of these three patients the one who had this characteristic most markedly had had both her ovaries removed. From these facts neither the uterus nor the ovary appears to be essential for sexual instincts. The only factor which seems to have any bearing upon the condition is age. In those in whom a change had occurred the ages in seven cases were over 40 years and the remaining two patients were only just under that age, whereas three-fourths of those who had experienced no change were under 40 years of age. Whatever the cause may be, in the vast majority of cases hysterectomy does not interfere with the sexual passions. Conclusions.-In recapitulating the most prominent conclusions it may be stated that from the standpoint of the patients the operation is an eminently satisfactory one and their capacity for work is greatly increased. The statistics clearly demonstrate that one ovary should be retained, but that the importance of this diminishes in proportion as the age of the patient approaches more closely the climacteric period. The operation per se causes no tendency to insanity, but a certain number of patients complain of a diminution in their powers of memory. The pain and discharge resulting from the operation are very slight ; the functions of the bowel and bladder are not usually interfered with, and the sexual sensations, as far as can be gathered, are not generally influenced by the operation. In conclusion, I must express my indebtedness to the staff of the Chelsea Hospital for Women, who so kindly placed their patients at my disposal and without whose assistance this investigation could not have been made.
remarkable manner, and so far may be regarded as cured.
’eight patients
AND GRADUAL SHRINKING OF THE TUMOUR. SURGEON,
M.B., CH.B. GLASG.,
ROYAL
INFIRMARY, GLASGOW.
THE following case seems to derive an exceptional interest from the fact that, so far as I can gather from the literature, nothing similar has been recorded. The facts have been carefully revised and all possible sources of error eliminated ; indeed, in view of the unusual and unexpected result, I have been sceptical of everything that could admit the least suspicion. Coley,’ in his article on the treatment of tumours malignant by mixed toxins and cultures of streptococcus erysipelatosus and bacillus prodigiosus, collects statistics of cases thus treated, and if his figures are the results are certainly impressive ; but after referring to the analogous cases in which cure has resulted from a supervening attack of erysipelas he goes on to add : " It would be somewhat remarkable that these cases should be the first, and thus far the only ones with both clinical and microscopical diagnosis of malignancy to disappear spontaneously, and it would be more remarkable still that this disappearance should be coincident with the at all accurate
1
Twentieth
Century Practice, vol.
xvii.
malignancy is
concerned
patient, a strong, healthy-looking woman, aged 36 married, and with two children, was admitted to the Glasgow Royal Infirmary on Nov. 21st, 1900. She was absolutely free from ailment, and came into the hospital simply because a swelling on the back was annoying her
A CASE OF RECURRENT SARCOMA WITH APPARENTLY SPONTANEOUS CURE
BY A. LAURIE WATSON, M.A.,
its
The years,
London.
LATE RESIDENT ASSISTANT
as
I
and she wished to have it removed. This tumour was large and pendulous, being attached to the left side of the back by a base nine inches wide and rather less than four inches in vertical measurement ; the apex hung down for almost four inches below the lower margin of its attachment to the back, while the upper margin was just below the inferior scapular angle. It was soft, but not fluctuant, slightly nodulated, and had the appearance of a lipoma undergoing degeneration ; the skin covering the dependent portion was of a dark reddish colour. The tumour was regarded as simple, partly because of its character and partly because its history went back to the patient’s childhood, though it had grown considerably in recent years. On Nov. 23rd Dr. D. McK. Dewar, acting for Dr. D. Newman, removed it freely with all the discoloured skin, and remarked at the time that in three respects it differed from an ordinary lipoma : (1) the tissue was of a dirty greyishyellow colour and very friable ; (2) it was exceedingly vascular ; and (3) its margins were diffuse and indefinite. After the operation haemorrhage was so free that the dressings had to be frequently changed in the first few hours ; thereafter they were left for four days untouched. On the 27th it was observed that the dressings had become tight and on exposing the back the tumour was found to be almost as large as before operation. In the expectation that this might be due to accumulation of blood-clot beneath the flaps a portion of the wound was opened up, but no blood could be expressed, even when a director was introduced and worked about inside the wound. It was therefore concluded that the swelling was due to a rapid re-formation of the tumour. By an unfortunate oversight the tumour first removed had been destroyed without microscopical examination ; but at this stage two small portions of the tissue were removed. One of these I hardened and stained myself, the other was sent to Dr. The sections C. Workman, pathologist to the infirmary. obtained from the first portion were examined by Dr. Newman, by Dr. Dewar, and by myself ; and the recognition of sarcomatous tissue, chiefly round-celled, was unhesitating. Dr. Workman’s quite independent report described the tissue as a mixed round-cell and spindlecell sarcoma. A week later the operation wound had begun to ulcerate along its margins, and it was decided to attempt a wider removal, but when on Dec. 4th the patient was placed on the table and anaesthetised, the tumour had attained such a size and was so diffuse in its margins that further radical interference was considered cut of the question ; the ulcerated edges were therefore cut away and the wound was again stitched up. During the remaining days of her residence in the infirmary the patient looked and felt very ill and weak. A bad prognosis was given and she was After this several medical ’men dismissed on the 13th. saw her and all took a gloomy view of the case ; but in spite of everything she improved and a month after dismissal from the hospital a letter was received from her own medical attendant stating that the operation wound had almost completely healed. When I visited her at her home in the country on Feb. 9th, 1901, I reported as follows : "The operation wound has entirely healed up, with only a small scab at its lower extremity, and leaves a firm healthylooking cicatrix. The tumour is much less tense than at the time of dismissal and shows a tendency to return to the pendulous form which it had when first seen ; it is flaccid and quite painless. At its anterior margin are some subcutaneous livid patches which were noticed at the time of the recurrence of the tumour, but these do not appear to have changed at all or to be spreading. The patient’s general condition is much improved ; she is able to be up and about, eats with a good appetite, and in general feels very comfortable." She again reported herself at the infirmary in April and the tumour seemed to be still further diminished in size.
301 A child, aged two years, when brought to the hospital was As I have already stated, there was nothing of the nature said to be having about 12 motions a day. The patient was an attack of erysipelas in this case ; but although locally no inflammatory phenomena manifested themselves the given two drachms three times daily of a medicine composed For the of equal parts of a simple chalk mixture and petroleum emul- details of the temperature chart are suggestive. first six days after admission the temperature records sion. At the end of a week the bowels were said to have .showed a subnormal and normal range with a minimum of been opened on an average from two to three times a day. 97.2° F. and a maximum of 98.6°, being quite unaffected by There was then no petroleum emulsion in the dispensary the operation on Nov. 23rd, 1900. Then during the follow- and the child was given one and a half drachms of the ing week a slight upward tendency was noted, a maximum chalk mixture three times a day, but at the end of the of 99’8° being registered on Dec. 3rd, and after the second second week the diarrhoea was nearly as bad as before treatvisit to the theatre (on the 4th) the temperature shot up to ment was commenced. One grain of beta-naphthol was 101.8°, remaining febrile and subfebrile, with daily remis- added to two-drachm doses of the chalk mixture, but at the sions for five days, the highest point reached being 102° on end of another fortnight the bowels were still moved eight From the 10th to dismissal on the 13th it was or nine times a day. The mixture containing one drachm of the 8th practically normal. Whether this post-operative fever was petroleum emulsion was then given again and the frequency of the motions immediately fell to twice a day. ;an important factor in determining the subsequent resolution In the treatment of threadworms petroleum emulsion has of the tumour I cannot pretend to say, but certainly the often seemed to me to be useful. A curious case may be progress was continuous and most satisfactory. Finally, I again visited the patient at her home on mentioned which came under the observation of my colleague. Nov. 21st, exactly a year after her admission to the infir- Dr. Cecil Williams. A young womar.. aged 25 years, had mary, and the following is my report :" The general health suffered from threadworms for about 15 years and had been is excellent. The tumour is much less prominent and hangs under the care of several medical men for the complaint. At like a loose sac, as if almost all its contents had been my suggestion Dr. Williams tried petroleum emulsion and .evacuated. There is slight lividity at the margins but no after it had been taken for about three weeks the worms had pain, except an occasional stinging like neuralgia in damp ceased to trouble her. I have not, I regret to say, investiweather. The tumour covers about the same area as at the gated in any reliable way the value of petroleum emulsion Children are rarely time of dismissal but consists of little more than loose skin. in the treatment of threadworms. The scar of the operation wound is perfectly sound and firm, brought up to a hospital for them alone and when the worms No pain is caused by free manipulation and the clothes are disappear while the child is taking the emulsion the medicine worn without discomfort." given for the primary disease may be the responsible remedial The recorded cases of sarcomata which have disappeared agent in the minor complaint. My belief in the power of after an attack of erysipelas are fairly numerous. One such petroleum emulsion to get rid of these worms is somewhat has come under my own observation. It was that of a man shaken by finding that the emulsion does not possess bacteriunder the care of Dr. J. McC. Johnston in the Town’s cidal power. If in some cases of diarrhoea petroleum emulHospital, Glasgow, and at the time it impressed me greatly. sion is of real, not merely of apparent, value the explanation First of all, a small rounded tumour of about the size of a may be that it has some beneficial mechanical action upon walnut was removed from beneath the chin and micro- the walls of the intestines. It is worthy of note, however, scopical examination showed it to be a round-cell sarcoma. that naphtha has been thought by physicians practising in A few weeks later the patient returned with a chain of the East to be of value in the treatment of cholera. One greatly enlarged glands on both sides of the neck. Dr. can ccnceive it to be possible that there may be forms of Johnston dissected away all the tumours on one side in a petroleum less volatile than naphtha, but sufficiently volatile first operation, and just as he was ready to deal with the to be antiseptic when used in considerable quantity, yet other side the patient developed a violent attack of erysipelas which, when used internally, would, like the oil contained in all over the neck and upper part of the chest, and with the petroleum emulsion, pass through the intestines without clearing up of this the glandular swellings also disappeared. being absorbed. From such cases as this the treatment by toxic injections Clifton, Bristol. was a natural corollary, but in this country it does not SIX MONTHS’ IMPACTION OF A COIN IN THE appear to have been systematically and persistently tried with any measure of success. Yet the analogy between ŒSOPHAGUS ; SUCCESSFUL REMOVAL sarcoma as a morbid overgrowth of connective tissue and BY PROBANG. simple inflammatory hyperplasia seems to indicate a rational BY CHESNUT PEACOCK, M.B., B. CH. R. U. I., basis for such treatment, and certainly much progress may HOUSE SURGEON, MILLER HOSPITAL, GREENWICH-ROAD, S.E. in this direction. be’made yet Ayr. ON Dec. 21st, 1901, a boy, aged six years, was admitted into the Miller Hospital, Greenwich-road, S.E.. suffering from brassy cough and regurgitation of food, accompanied by rise of temperature. The history elicited the fact that in AND the previous July the patient had swallowed a halfpenny. MEDICAL, THERAPEUTICAL. Vomiting occurred immediately afterwards but was not repeated. For the next three weeks the patient said that he could ’’taste the ha’penny,"and he complained A BRIEF NOTE ON THE USE OF PETROLEUM of pain under the chin every time he took food ; EMULSION AS AN INTESTINAL DRUG. but at the end of that period these symptoms ceased, and until December the patient suffered no further BY THEODORE FISHER, M.D., M.R.C.P. LOND., At the beginning of December a dry, inconvenience. PHYSICIAN TO OUT-PATIENTS, BRISTOL HOSPITAL FOR SICK CHILDREN ; difficulty in swallowing, dyspnoea, and clanging cough, PATHOLOGIST TO THE BRISTOL ROYAL INFIRMARY. regurgitation of food came on, and as the symptoms steadily worse he was brought to hospital for treatment. IN a letter to THE LANCET of Nov. 23rd, 1901, p. 1448, grew Examination by the x rays showed a coin impacted in the - commenting upon the morbid anatomy lesions of typhoid oesophagus at the level of the third rib, the flat surfaces fever, I suggested that petroleum emulsion might be found facing anteriorly and posteriorly respectively. On Jan. lst, useful as an intestinal antiseptic in that disease. At that 1902, the patient was ansesthetised and an attempt was made time I had not tested the value of the emulsion in the to move the coin with the coin-catcher. As this effort failed was tried, and on the second attempt the coin the laboratory, but a few experiments undertaken since seem was probang found to be lying free in the pharynx. It was to show that when mixed in equal quantities with ordinary quite black in colour and was entirely covered on one surface culture media it has no power to restrain the growth of with an inflammatory exudation. Immediately the coin was -either aerobic or anaerobic micro-organisms. My belief in removed the patient’s breathing, which up till then had been the value of petroleum emulsion was based upon the laboured, became easy, and he made a rapid recovery from anaesthetic. As it was not deemed advisable to allow experience of the out-patient room where one is exposed to many fallacies. One instance, however, where this emulsion him anything by the mouth, rectal feeding was tried, but the was used in chronic diarrhoea is worth mentioning. enemata were very imperfectly retained, and as on the
- of
Clinical Notes:
SURGICAL, OBSTETRICAL,
the
have had some trouble in micturition since the operation-in one case a ligature being passed per urethram-but this trouble has in every case ceased after the first year. Sexual instincts.-The influence of hysterectomy, with or without conservation of the ovaries, upon the sexual instincts is a subject about’which little is known and Out of upon which great diversity of opinion exists. the 95 patients 64 were unmarried, widows, or living apart from their husbands, but of the remaining 31 we find that in 19, or 61’2 per cent., the marital relations were unaltered (seven of these had had both ovaries removed). Nine of the patients, or 29 per cent., stated that their relations were not so good as formerly (only two of these had had both ovaries removed) ; and three, or 9’6 per cent., found these relations improved ; of these three patients the one who had this characteristic most markedly had had both her ovaries removed. From these facts neither the uterus nor the ovary appears to be essential for sexual instincts. The only factor which seems to have any bearing upon the condition is age. In those in whom a change had occurred the ages in seven cases were over 40 years and the remaining two patients were only just under that age, whereas three-fourths of those who had experienced no change were under 40 years of age. Whatever the cause may be, in the vast majority of cases hysterectomy does not interfere with the sexual passions. Conclusions.-In recapitulating the most prominent conclusions it may be stated that from the standpoint of the patients the operation is an eminently satisfactory one and their capacity for work is greatly increased. The statistics clearly demonstrate that one ovary should be retained, but that the importance of this diminishes in proportion as the age of the patient approaches more closely the climacteric period. The operation per se causes no tendency to insanity, but a certain number of patients complain of a diminution in their powers of memory. The pain and discharge resulting from the operation are very slight ; the functions of the bowel and bladder are not usually interfered with, and the sexual sensations, as far as can be gathered, are not generally influenced by the operation. In conclusion, I must express my indebtedness to the staff of the Chelsea Hospital for Women, who so kindly placed their patients at my disposal and without whose assistance this investigation could not have been made.
remarkable manner, and so far may be regarded as cured.
’eight patients
AND GRADUAL SHRINKING OF THE TUMOUR. SURGEON,
M.B., CH.B. GLASG.,
ROYAL
INFIRMARY, GLASGOW.
THE following case seems to derive an exceptional interest from the fact that, so far as I can gather from the literature, nothing similar has been recorded. The facts have been carefully revised and all possible sources of error eliminated ; indeed, in view of the unusual and unexpected result, I have been sceptical of everything that could admit the least suspicion. Coley,’ in his article on the treatment of tumours malignant by mixed toxins and cultures of streptococcus erysipelatosus and bacillus prodigiosus, collects statistics of cases thus treated, and if his figures are the results are certainly impressive ; but after referring to the analogous cases in which cure has resulted from a supervening attack of erysipelas he goes on to add : " It would be somewhat remarkable that these cases should be the first, and thus far the only ones with both clinical and microscopical diagnosis of malignancy to disappear spontaneously, and it would be more remarkable still that this disappearance should be coincident with the at all accurate
1
Twentieth
Century Practice, vol.
xvii.
malignancy is
concerned
patient, a strong, healthy-looking woman, aged 36 married, and with two children, was admitted to the Glasgow Royal Infirmary on Nov. 21st, 1900. She was absolutely free from ailment, and came into the hospital simply because a swelling on the back was annoying her
A CASE OF RECURRENT SARCOMA WITH APPARENTLY SPONTANEOUS CURE
BY A. LAURIE WATSON, M.A.,
its
The years,
London.
LATE RESIDENT ASSISTANT
as
I
and she wished to have it removed. This tumour was large and pendulous, being attached to the left side of the back by a base nine inches wide and rather less than four inches in vertical measurement ; the apex hung down for almost four inches below the lower margin of its attachment to the back, while the upper margin was just below the inferior scapular angle. It was soft, but not fluctuant, slightly nodulated, and had the appearance of a lipoma undergoing degeneration ; the skin covering the dependent portion was of a dark reddish colour. The tumour was regarded as simple, partly because of its character and partly because its history went back to the patient’s childhood, though it had grown considerably in recent years. On Nov. 23rd Dr. D. McK. Dewar, acting for Dr. D. Newman, removed it freely with all the discoloured skin, and remarked at the time that in three respects it differed from an ordinary lipoma : (1) the tissue was of a dirty greyishyellow colour and very friable ; (2) it was exceedingly vascular ; and (3) its margins were diffuse and indefinite. After the operation haemorrhage was so free that the dressings had to be frequently changed in the first few hours ; thereafter they were left for four days untouched. On the 27th it was observed that the dressings had become tight and on exposing the back the tumour was found to be almost as large as before operation. In the expectation that this might be due to accumulation of blood-clot beneath the flaps a portion of the wound was opened up, but no blood could be expressed, even when a director was introduced and worked about inside the wound. It was therefore concluded that the swelling was due to a rapid re-formation of the tumour. By an unfortunate oversight the tumour first removed had been destroyed without microscopical examination ; but at this stage two small portions of the tissue were removed. One of these I hardened and stained myself, the other was sent to Dr. The sections C. Workman, pathologist to the infirmary. obtained from the first portion were examined by Dr. Newman, by Dr. Dewar, and by myself ; and the recognition of sarcomatous tissue, chiefly round-celled, was unhesitating. Dr. Workman’s quite independent report described the tissue as a mixed round-cell and spindlecell sarcoma. A week later the operation wound had begun to ulcerate along its margins, and it was decided to attempt a wider removal, but when on Dec. 4th the patient was placed on the table and anaesthetised, the tumour had attained such a size and was so diffuse in its margins that further radical interference was considered cut of the question ; the ulcerated edges were therefore cut away and the wound was again stitched up. During the remaining days of her residence in the infirmary the patient looked and felt very ill and weak. A bad prognosis was given and she was After this several medical ’men dismissed on the 13th. saw her and all took a gloomy view of the case ; but in spite of everything she improved and a month after dismissal from the hospital a letter was received from her own medical attendant stating that the operation wound had almost completely healed. When I visited her at her home in the country on Feb. 9th, 1901, I reported as follows : "The operation wound has entirely healed up, with only a small scab at its lower extremity, and leaves a firm healthylooking cicatrix. The tumour is much less tense than at the time of dismissal and shows a tendency to return to the pendulous form which it had when first seen ; it is flaccid and quite painless. At its anterior margin are some subcutaneous livid patches which were noticed at the time of the recurrence of the tumour, but these do not appear to have changed at all or to be spreading. The patient’s general condition is much improved ; she is able to be up and about, eats with a good appetite, and in general feels very comfortable." She again reported herself at the infirmary in April and the tumour seemed to be still further diminished in size.
301 A child, aged two years, when brought to the hospital was As I have already stated, there was nothing of the nature said to be having about 12 motions a day. The patient was an attack of erysipelas in this case ; but although locally no inflammatory phenomena manifested themselves the given two drachms three times daily of a medicine composed For the of equal parts of a simple chalk mixture and petroleum emul- details of the temperature chart are suggestive. first six days after admission the temperature records sion. At the end of a week the bowels were said to have .showed a subnormal and normal range with a minimum of been opened on an average from two to three times a day. 97.2° F. and a maximum of 98.6°, being quite unaffected by There was then no petroleum emulsion in the dispensary the operation on Nov. 23rd, 1900. Then during the follow- and the child was given one and a half drachms of the ing week a slight upward tendency was noted, a maximum chalk mixture three times a day, but at the end of the of 99’8° being registered on Dec. 3rd, and after the second second week the diarrhoea was nearly as bad as before treatvisit to the theatre (on the 4th) the temperature shot up to ment was commenced. One grain of beta-naphthol was 101.8°, remaining febrile and subfebrile, with daily remis- added to two-drachm doses of the chalk mixture, but at the sions for five days, the highest point reached being 102° on end of another fortnight the bowels were still moved eight From the 10th to dismissal on the 13th it was or nine times a day. The mixture containing one drachm of the 8th practically normal. Whether this post-operative fever was petroleum emulsion was then given again and the frequency of the motions immediately fell to twice a day. ;an important factor in determining the subsequent resolution In the treatment of threadworms petroleum emulsion has of the tumour I cannot pretend to say, but certainly the often seemed to me to be useful. A curious case may be progress was continuous and most satisfactory. Finally, I again visited the patient at her home on mentioned which came under the observation of my colleague. Nov. 21st, exactly a year after her admission to the infir- Dr. Cecil Williams. A young womar.. aged 25 years, had mary, and the following is my report :" The general health suffered from threadworms for about 15 years and had been is excellent. The tumour is much less prominent and hangs under the care of several medical men for the complaint. At like a loose sac, as if almost all its contents had been my suggestion Dr. Williams tried petroleum emulsion and .evacuated. There is slight lividity at the margins but no after it had been taken for about three weeks the worms had pain, except an occasional stinging like neuralgia in damp ceased to trouble her. I have not, I regret to say, investiweather. The tumour covers about the same area as at the gated in any reliable way the value of petroleum emulsion Children are rarely time of dismissal but consists of little more than loose skin. in the treatment of threadworms. The scar of the operation wound is perfectly sound and firm, brought up to a hospital for them alone and when the worms No pain is caused by free manipulation and the clothes are disappear while the child is taking the emulsion the medicine worn without discomfort." given for the primary disease may be the responsible remedial The recorded cases of sarcomata which have disappeared agent in the minor complaint. My belief in the power of after an attack of erysipelas are fairly numerous. One such petroleum emulsion to get rid of these worms is somewhat has come under my own observation. It was that of a man shaken by finding that the emulsion does not possess bacteriunder the care of Dr. J. McC. Johnston in the Town’s cidal power. If in some cases of diarrhoea petroleum emulHospital, Glasgow, and at the time it impressed me greatly. sion is of real, not merely of apparent, value the explanation First of all, a small rounded tumour of about the size of a may be that it has some beneficial mechanical action upon walnut was removed from beneath the chin and micro- the walls of the intestines. It is worthy of note, however, scopical examination showed it to be a round-cell sarcoma. that naphtha has been thought by physicians practising in A few weeks later the patient returned with a chain of the East to be of value in the treatment of cholera. One greatly enlarged glands on both sides of the neck. Dr. can ccnceive it to be possible that there may be forms of Johnston dissected away all the tumours on one side in a petroleum less volatile than naphtha, but sufficiently volatile first operation, and just as he was ready to deal with the to be antiseptic when used in considerable quantity, yet other side the patient developed a violent attack of erysipelas which, when used internally, would, like the oil contained in all over the neck and upper part of the chest, and with the petroleum emulsion, pass through the intestines without clearing up of this the glandular swellings also disappeared. being absorbed. From such cases as this the treatment by toxic injections Clifton, Bristol. was a natural corollary, but in this country it does not SIX MONTHS’ IMPACTION OF A COIN IN THE appear to have been systematically and persistently tried with any measure of success. Yet the analogy between ŒSOPHAGUS ; SUCCESSFUL REMOVAL sarcoma as a morbid overgrowth of connective tissue and BY PROBANG. simple inflammatory hyperplasia seems to indicate a rational BY CHESNUT PEACOCK, M.B., B. CH. R. U. I., basis for such treatment, and certainly much progress may HOUSE SURGEON, MILLER HOSPITAL, GREENWICH-ROAD, S.E. in this direction. be’made yet Ayr. ON Dec. 21st, 1901, a boy, aged six years, was admitted into the Miller Hospital, Greenwich-road, S.E.. suffering from brassy cough and regurgitation of food, accompanied by rise of temperature. The history elicited the fact that in AND the previous July the patient had swallowed a halfpenny. MEDICAL, THERAPEUTICAL. Vomiting occurred immediately afterwards but was not repeated. For the next three weeks the patient said that he could ’’taste the ha’penny,"and he complained A BRIEF NOTE ON THE USE OF PETROLEUM of pain under the chin every time he took food ; EMULSION AS AN INTESTINAL DRUG. but at the end of that period these symptoms ceased, and until December the patient suffered no further BY THEODORE FISHER, M.D., M.R.C.P. LOND., At the beginning of December a dry, inconvenience. PHYSICIAN TO OUT-PATIENTS, BRISTOL HOSPITAL FOR SICK CHILDREN ; difficulty in swallowing, dyspnoea, and clanging cough, PATHOLOGIST TO THE BRISTOL ROYAL INFIRMARY. regurgitation of food came on, and as the symptoms steadily worse he was brought to hospital for treatment. IN a letter to THE LANCET of Nov. 23rd, 1901, p. 1448, grew Examination by the x rays showed a coin impacted in the - commenting upon the morbid anatomy lesions of typhoid oesophagus at the level of the third rib, the flat surfaces fever, I suggested that petroleum emulsion might be found facing anteriorly and posteriorly respectively. On Jan. lst, useful as an intestinal antiseptic in that disease. At that 1902, the patient was ansesthetised and an attempt was made time I had not tested the value of the emulsion in the to move the coin with the coin-catcher. As this effort failed was tried, and on the second attempt the coin the laboratory, but a few experiments undertaken since seem was probang found to be lying free in the pharynx. It was to show that when mixed in equal quantities with ordinary quite black in colour and was entirely covered on one surface culture media it has no power to restrain the growth of with an inflammatory exudation. Immediately the coin was -either aerobic or anaerobic micro-organisms. My belief in removed the patient’s breathing, which up till then had been the value of petroleum emulsion was based upon the laboured, became easy, and he made a rapid recovery from anaesthetic. As it was not deemed advisable to allow experience of the out-patient room where one is exposed to many fallacies. One instance, however, where this emulsion him anything by the mouth, rectal feeding was tried, but the was used in chronic diarrhoea is worth mentioning. enemata were very imperfectly retained, and as on the
- of
Clinical Notes:
SURGICAL, OBSTETRICAL,
the