A RELIC OF THE JAMESON RAID:

992 with small scissors were thoroughly triturated in a mortar with fine silver sand. The resulting pasty mass was transferred to bottles containing sterile saline solution and the whole shaken up. Strict aseptic precautions were, of course, observed throughout. The bottles were kept in a cold chamber for two days, and thereafter the subsequent fluid was decanted into test-tubes, which were kept at freezing point until required. This fluid remained turbid for at least a month, though there was a gradual accumulation at the bottom of the tubes ; it was bacteriologically sterile and did not contain living cells as far as could be observed by microscopic examination or the results of injection. The chemical nature of the protoplasm was presumably not altered. (It may be noted that even advanced autolysis does not prevent

A RELIC OF THE JAMESON RAID: EXTRACTION OF BULLET AND SEQUESTRUM FROM THE UPPER THIRD OF THE THIGH TEN YEARS AFTER THE INJURY.

BY HENRY

CURTIS, B.S. LOND., F.R.C.S. ENG.,

SENIOR ASSISTANT SURGEON, METROPOLITAN HOSPITAL,

LONDON, N.E ;

ASSISTANT SURGEON, SEAMEN’S HOSPITAL SOCIETY; JOINT TEACHER OF OPERATIVE SURGERY AT THE LONDON SCHOOL OF CLINICAL MEDICINE.

THE

following

notes of the extraction of

Mauser rifle bullet, and

a

sequestrum, from

a

a soft-nosed wound in the

upper third of the thigh ten years after the injury during the Jameson Raid may be of interest. The wound was inflicted on Jan. 2nd, 1896, and before entering the outer side of the right thigh the bullet was said to have struck a clasp knife hanging from the belt of the patient, a farmer, aged 30 years at the time he came Twm under my care at Bulawayo on April 8th, 1906. medical men at Krugersdorp, who operated at the time, informed the patient that no bullet was recovered. The wound healed by March, 1896. At the end of 1904 and the beginning of 1905 severe right-sided sciatica confined the patient to bed for 13 weeks, and during October and November, 1905, he was unable to get about owing to severe neuralgic pains in the right groin and all down the thigh. Indeed, ever since the wound "the leg had always troubled the patient, and after much exertion gave the sensation of being asleep." In 1906, at the end of February, the wound broke open for the first On March 22nd, time and commenced discharging pus. at Salisbury, Rhodesia, two medical men examined and explored the wound, which was situated on the anteroexternal aspect of the upper third of the thigh. They followed the sinus-like track for about six inches or more in a direction downwards and inwards, and not locating the bullet concluded that it might be in the lower fourth of the inner side of the thigh. The X ray installation at that time being unavailable they were under the greatest dismuch larger. and for this reason the patient was sent to me at The tumour used throughout these experiments was an advantage, the Bulawayo Hospital, where at this time, by an unfortu" adeno-carcinoma-" No. 63 of the Imperial Cancer nate coincidence, our own apparatus happened to be almost Research Fund list-and I am deeply indebted to the useless. superintendent of these laboratories for his kindness in under my care on April 8th, 1906, 17 days after placing material at my disposal. For a few months this theComing previous exploration, the right thigh was seen to be much tumour grew well, succeeding in a very high percentage of wasted, doubtless from disuse. At the antero-external cases. Thereafter the successful " takes" rapidly diminished in the upper third of the limb there was an elongated until it failed completely. This has proved a fortunate aspect on the floor of which was the opening of a disaccident as far as these experiments are concerned. For my depression, sinus. The sinus was directed at first across the charging test inoculations I was confined to a single tumour 32 towards the postero-external aspect of months old which had been growing very slowly and which thigh, apparently the femur, and then passed downwards and inwards. No did not show the central necrosis so common in this strain. The or actual bare bone could be detected. The sudden resuscitation in the treated series is all the more foreign body attempt to obtain a skiagram was most unsatisfactory, the remarkable. result being a very faint and ill-defined blur, but as this From these preliminary experiments it is evident that the only was the only hint available, it was assumed to indicate the cells which are of cancer physically disintegrated injection of the bullet-a very fortunate assumption as it without probably being chemically altered has markedly presence It appeared to be situated rather to the inner side proved. affected the resistance towards living tumour cells. So far of the femur, just below the level of the sinus seen on the from conferring anything in the nature of immunity it has outer side of the thigh. This, of course, was contrary to undoubtedly exalted the susceptibility. what had been suspected, and it was quite impossible to 11’ote.-I have evidently been working on similar lines to guess whether it was on the inner or outer side of the linea Dr. M Haaland, whose paper was published in THE LANCET aspera, a point of practical importance, when the attachment of March 19th last. Owing to the fact that his tumour was of the muscles is remembered, in determining whether the I takingnormally in a high percentage of cases, the incision should be from the anterior or posterior aspect increase of susceptibility is not so evident as in the above of the thigh. Fig. 1, from Sir William MacCormac’s experiments where the testing tumour is in a dormant" "Surgical Operations,"will serve to emphasise the importphase. ance of this point by illustrating the relations of the parts, Dundee. and will facilitate the following description. Operation.-This was undertaken on April 19th, 1906. THE HOSPITAL FOR CONSUMPTION AND DISEASES Deciding to examine the linea aspera at its inner edge, OF THE CHEST, BROMPTON.-The lectures and demonstrations where it gave insertion to the tendon of the adductor brevis, at this hospital for the forthcoming summer term will the anterior incision was selected ; and failing to find the commence on Aprll 13th with a lecture by Dr. J. Kingston bullet here, or from this position to get evidence of its Fowler on the diagnosis, prognosis, and treatment of presence on the postero-external aspect of the bone, it was pneumonia. The lectures, which will be continued on the intended to make a fresh incision on the back of the thigh succeeding Wednesdays in April, May, and June, will be between the vastus externus and the biceps. announced week by week in the Medical Diary of With the thigh flexed and a little everted, as for ligature On Thursday, May 26th, Dr. F. J. of the superficial femoral artery, a 3-2L inch longitudinal THE LANCET. Wethered will give a demonstration at Frimley Sana- incision was made along the anterior aspect of the thigh torium. The lectures and demonstrations are free to all in its upper third, so that its centre corresponded with the apex of Scarpa’s triangle, formed by the crossing of qualified medical practitioners and to students fo medicine.

growth

inoculation.) fluid was injected on

into the peritoneum of a number The of mice on three occasions with ten days’ intervals, employing for the first injection 0’ 5 cubic centimetre and 1 cubic As the material was not centimetre for the last two. standardised, it can only be said that in comparison with the ordinary quantity of tumour emulsion used for transplantations (in this case 0’ 05 cubic centimetre) it represented an excessively minute dose of epithelium. 24 days after the last intraperitoneal injection the 29 mice that survived were inoculated subcutaneously in the usual way with 0’ 05 cubic centimetre of fresh tumour emulsion. A similar number of controls were instituted. The treatment, instead of increasing the resistance to test inoculation, had a marked effect to the contrary. In ten days’ time, of the 27 treated mice that remained alive, 18 showed tumours ; a week later, 21 out of the 27 (78 per cent.) had growing cancers. The controls gave 9 tumours in 27 mice (33 per cent.). There is a striking disparity between the two sets. But this disparity is all the more marked when we take into account the size of the tumours produced in both cases. By carefully mapping out the contours of the tumours on graph paper it was found that the average area covered by the tumours in the treated set was approximately 110 square millimetres, as compared with an area of 39 square millimetres in the case of the controls. The average mass is

’

993 the inner border of the sartorius over the outer border of the indicated the course of the bullet, which must have struck adductor longus muscle, about four inches, that is to say, the femur from the outer side near its anterior surface and below Poupart’s ligament. Having exposed the pectineus then slipped, or wandered subsequently, into the inner aspect and adductor longus muscles forming the inner portion of the of the femur, in close contact with the inner lip of the linea floor of the triangle, and leaving the femoral vessels undis- aspera. The patient must be congratulated upon the fact turbed to the outer side, the outer border of the adductor that the femoral vessels and their branches were so skilfully longus was defined and well retracted, thus bringing into eluded by the bullet during its course and subsequently. view, between it and the pectineus, the adductor brevis. Very offensive pus escaped from the wound next day, but Following this muscle towards its insertion and well retract- the discharge soon ceased to be so, and greatly diminished ing, exploration soon revealed, deep down, at the back of in quantity. On June lst, after a fortnight of normal

Transverse section of the right thigh at the apex of Scarpa’s triangle. (From MacCormac’s "Surgical Operations," by kind permission of the publishers, Messrs. and Co.) Smith, Elder,

the inner aspect of the femur, the object of our search, the Mauser bullet, which, mushroomed at one end, was then extracted. It presented the appearance shown in the accompanying reproduction of a photograph (Fig. 2), in which it is shown of the exact size. For this and the next picture I have to thank the hospital secretary, Mr. H. W. Garbutt, the patient naturally desiring to keep the bullet itself as a souvenir. The anterior wound and the sinus externally were drained. Five days after the operation the pus became so offensive i as to suggest the presence of necrosed bone, the temperature having risen to 1020 F., as it had previously done four days before the operation. The temperature then steadily fell to normal, but 17 days after the operation, with a temperature of 100-6°, a great deal of pus escaped from the dressings. and both drainage-tubes were re- inserted. Six days later, on !I May 12th, a large sequestrum was removed through the external wound, derived from the anteiior surface of the femnr. This is shown in Fig. 3. The position of the sequestrumI

attacks of

sciatica, temperature, sharp I the patient returned home with the wounds nearly healed.

I

with still occasional

The following give the approximate measurements :Bullet : length, 25 cm. (1 inch) ; diameter, shortest, 8 mm. 3inch); longest, (where fungated) 1-7 cm. (H inch). Sequestrum : length, 2 - 2 cm. Clo inch).

THE GEOLOGISTS’ AssociATioN.—The

Geologists

Association of London held their Easter excursion this year in North Devon with Barnstaple as the headquarters. The visitors were about 50, and included Professor W. W. Watts, F R.S., President of the Geological Society; Dr. J. Evans, F.R.S., of the Imperial Institute ; Dr. A. Smith-Woodward, F.R.S., British Museum. A very successful meeting was held, the places visited including Bileford, which has a museum

with

Lynton and Instow, &c.

several

the

interesting geological specimens, Valley of Recks Abbotsham ClifE,