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CANCEROUS BREASTS.
CLINICAL TAPPING
IN
RECORDS.
HYDROCEPHALUS.
a case of congenital, but now chronic young child, was treated by puncture 01 two occasions by Mr. Lawrence, at St. Bartholomew’s Hos pital. The enlargement of the head had increased somewha within a few weeks, and the expansion of the skull was b The child remained in a drowsy ant iao means uniform. semi-comatose condition, scarcely taking notice of anything and the symptoms were of an urgent character. The mothe1 consented with some reluctance to the puncture of the skull A very fine trocar and canula were introduced into the corona suture, an inch from the middle line, and seven or eighi ounces of a clear, pale fluid were withdrawn. This gav< immediate and marked relief, and produced indications o: liveliness; at the same time the skull did not seem so large Four days afterwards, Mr. Lawrence again punctured the head, not in the same situation, but at the posterior part, and re moving about ten ounces altogether. A very little hsemorrhagf ensued, but the head was not compressed by long strips o: adhesive plaster, as was practised on the first occasion. Foui days afterwards, when brought to the hospital, the child’! head had not enlarged any further, and it was said to be more restless than drowsy. Ten days later, the child’s health wal found to have improved, it being more lively, and the heac had not enlarged. With the above treatment was subjoinec small nightly doses of mercury with chalk. Some weeks had elapsed, when Mr. Chippendale, Mr. Lawrence’s house-surgeon, ascertained at the mother’s rest dence that the child had died, apparently from inanition, that the head had not increased in size, and it had had no convul sions. The operation here, then, so far as could be judged, did service for a time, and possibly, had the child been care. fully looked to, it might have lived much longer, if not alto. gether recovered. Our readers will recollect the notice of a case of this kind in our " Mirror," under the care of Mr. H. C. Johnson, at St. George’s Hospital, (THE LANCET, vol. i., 1857, p. 425,) when we took occasion to refer to some statistics of its success, as quoted in " Watson’s Practice of Physic," and which no doubt led Dr. Watson himself to form the opinion that this expedient, though doubtless hazardous, is really a valuable one. A careful examination of the writings of Drs. West, Battersby oj Dublin, and Winn, who have most carefully investigated this subject, will show a concurrence on the part of those writers in the inutility of simply tapping the head in this affection. Dr. West, who published a tabular statement of all the recorded cases, condemns the operation, and Dr. Battersby does so even more strongly than Dr. West. Dr. Godfrey, in a letter in the same volume of THE LANCET, (p. 566,) refers to the statistics quoted on a former occasion as utterly at variance with his own experience, and that of all the best authorities. From a careful consideration of the subject, we feel bound to say, that if the cases in question had been followed up more closely, the proportion of ten cures in nineteen cases would have been found very wide of the mark, and that probably two, or possibly three, cases were saved out of the nineteen.
SOME weeks
hydrocephalus,
back,
in
a
a short time in the same situation in this patient, and he had made up his mind, in addition to the removal, to destroy the surface or base of this little growth with some powerful caustic, which was subsequently done; for however unimportant this malady may appear, it is utterly impossible to say it will not return, and finally affect the alveolus. As a rule, the tumour is indolent and painless in its growth ; but its early removal should be invariably attempted, not only as holding out a< chance of permanent cure, but to prevent its increase, and sometimes, as we have witnessed, its becoming the seat of offensive ulceration. We shall say nothing on this occasion about the operation for the removal of a portion of the jaw, as the disease in Mr. Tatum’s patient had not gone so far as to. require such a measure.
CANCEROUS
I very
AT
BREASTS.
the removal of a cancerous breast was a was looked upon as an operation of considerable magnitude. Now, however, it is by no means seldom to be witnessed, for scarcely a week passes without our observing one or more breasts being taken away. All these it would be quite impossible to recount; but we will just referto a few of the more interesting and remarkable. On the 12th of May, Mr. Erichsen removed the breast of & woman, aged forty, whose general health was good, and in whom the disease in the breast had existed only ten months. It was of the atrophic form of cancer. The breast seemed tohave wasted away. We see many cases of this form of cancer at the Cancer Hospital, which remain stationary even for years without inconvenience to the patient. In Mr. Erichsen’s case-, the skin was involved to some extent, which was, as he said,, the only objection to the operation. It was freely and widely taken away, with the whole of the gland. It is a form gene rally which does not recur very rapidly. The patient is going on very well. At the Samaritan Free Hospital, a breast was removed by Dr. Routh, on the 19th of May, from a woman forty-two years. of age, a domestic, in whom the disease was a mixture of the cystic and scirrhous. She had been married nineteen years, and had one child three years after marriage. A tumour was noticed whilst suckling this child, which was brought on by rough usage of the breast. It remained the size of a marblefor some years, until four years ago there was some pain in it, when it commenced to increase, and lately the pain was veryThe wound united by adhesion; and she has made a. severe. quick convalescence. Another case, which we will now merely just mention, 3. one under Mr. Henry Tbompson’s care, at the Marylebone Infirmary, of an old woman, seventy-three years of age, with. scirrhus of the breast. It was removed on the 24th of May ; and the patient, although so old, is recovering rapidly from. one
rare
period,
occurrence, and
the operation. Reviews and Notices of Books.
I. Nouvelles Rec7terches sur l’Importance des Fonctions des Capsules Surrénales. Par M. BROWN-8ÉQUARD. " Journal dela Physiologie," Janvier, 1858. EPULIS OF THE GUMS. II. Causes de Mort aprèsl’Ablation du Naeud Vital. Par M. BROWX-SQUAED. " Journal de la Physiologie," Avril.. A SIMPLE epulis springing from the gum, generally com1858. mencing between two of the teeth, may not seem a matter at Additional Inquiries on the Impo7·tance of the Functions of tlae first sight of any great importance. It can be removed by the Sl(pra-1-enal Capsules. By M. BROWN-SÉQUARD. "Journal knife; the wound will heal up, and the patient supposed safe de la Physiologie,"January, 1858. from any further trouble. Unfortunately, however, this little tumour, which may be fibrous, or fibro-plastic, or perhaps The Causes of Death 4ter Removal of the Vital Knot. By M. BBOWN-SQUARD. " Journal de la Physiologie," April, primarily simply cellular, does return, and, if not completely 1858.-Paris : Baillière. eradicated, will actually give rise to so much mischief as to reof a the the removal of whose actual quire jaw-bone, portion II. WE select as fair specimens of the papers contained in the alveolus has become affected. This we have witnessed several Journal de la Physiologie the above-mentioned essays by the times at different hospitals. of this editor publication, and apologizing for the too cursory On the 27th of May, a healthy-looking young woman was manner in which they are here of necessity treated, we refer into of St. to the theatre George’s Hospital brought operating have a small and apparently insignificant epulis, scarcely the the reader to the originals contained in the January and April size of a large pea, removed from between the two upper numbers of the Journal-a work which will well repay the middle incisors, being attached to the gum in that situation, of any one interested in the progress of physiology, and extending between them. This was very carefully per- perusal which has only now reached its second number; and which formed by Mr. Tatum withoutgiving chloroform to the patient, and she was sent back to her ward. This operation, as that cannot but succeed so long as it is supported by such men as gentleman remarked, was the second he had performed within Claude Bernard, Bence Jones, C. Robin, M. A. Sanson, and
583
IN
RECORDS.
HYDROCEPHALUS.
a case of congenital, but now chronic young child, was treated by puncture 01 two occasions by Mr. Lawrence, at St. Bartholomew’s Hos pital. The enlargement of the head had increased somewha within a few weeks, and the expansion of the skull was b The child remained in a drowsy ant iao means uniform. semi-comatose condition, scarcely taking notice of anything and the symptoms were of an urgent character. The mothe1 consented with some reluctance to the puncture of the skull A very fine trocar and canula were introduced into the corona suture, an inch from the middle line, and seven or eighi ounces of a clear, pale fluid were withdrawn. This gav< immediate and marked relief, and produced indications o: liveliness; at the same time the skull did not seem so large Four days afterwards, Mr. Lawrence again punctured the head, not in the same situation, but at the posterior part, and re moving about ten ounces altogether. A very little hsemorrhagf ensued, but the head was not compressed by long strips o: adhesive plaster, as was practised on the first occasion. Foui days afterwards, when brought to the hospital, the child’! head had not enlarged any further, and it was said to be more restless than drowsy. Ten days later, the child’s health wal found to have improved, it being more lively, and the heac had not enlarged. With the above treatment was subjoinec small nightly doses of mercury with chalk. Some weeks had elapsed, when Mr. Chippendale, Mr. Lawrence’s house-surgeon, ascertained at the mother’s rest dence that the child had died, apparently from inanition, that the head had not increased in size, and it had had no convul sions. The operation here, then, so far as could be judged, did service for a time, and possibly, had the child been care. fully looked to, it might have lived much longer, if not alto. gether recovered. Our readers will recollect the notice of a case of this kind in our " Mirror," under the care of Mr. H. C. Johnson, at St. George’s Hospital, (THE LANCET, vol. i., 1857, p. 425,) when we took occasion to refer to some statistics of its success, as quoted in " Watson’s Practice of Physic," and which no doubt led Dr. Watson himself to form the opinion that this expedient, though doubtless hazardous, is really a valuable one. A careful examination of the writings of Drs. West, Battersby oj Dublin, and Winn, who have most carefully investigated this subject, will show a concurrence on the part of those writers in the inutility of simply tapping the head in this affection. Dr. West, who published a tabular statement of all the recorded cases, condemns the operation, and Dr. Battersby does so even more strongly than Dr. West. Dr. Godfrey, in a letter in the same volume of THE LANCET, (p. 566,) refers to the statistics quoted on a former occasion as utterly at variance with his own experience, and that of all the best authorities. From a careful consideration of the subject, we feel bound to say, that if the cases in question had been followed up more closely, the proportion of ten cures in nineteen cases would have been found very wide of the mark, and that probably two, or possibly three, cases were saved out of the nineteen.
SOME weeks
hydrocephalus,
back,
in
a
a short time in the same situation in this patient, and he had made up his mind, in addition to the removal, to destroy the surface or base of this little growth with some powerful caustic, which was subsequently done; for however unimportant this malady may appear, it is utterly impossible to say it will not return, and finally affect the alveolus. As a rule, the tumour is indolent and painless in its growth ; but its early removal should be invariably attempted, not only as holding out a< chance of permanent cure, but to prevent its increase, and sometimes, as we have witnessed, its becoming the seat of offensive ulceration. We shall say nothing on this occasion about the operation for the removal of a portion of the jaw, as the disease in Mr. Tatum’s patient had not gone so far as to. require such a measure.
CANCEROUS
I very
AT
BREASTS.
the removal of a cancerous breast was a was looked upon as an operation of considerable magnitude. Now, however, it is by no means seldom to be witnessed, for scarcely a week passes without our observing one or more breasts being taken away. All these it would be quite impossible to recount; but we will just referto a few of the more interesting and remarkable. On the 12th of May, Mr. Erichsen removed the breast of & woman, aged forty, whose general health was good, and in whom the disease in the breast had existed only ten months. It was of the atrophic form of cancer. The breast seemed tohave wasted away. We see many cases of this form of cancer at the Cancer Hospital, which remain stationary even for years without inconvenience to the patient. In Mr. Erichsen’s case-, the skin was involved to some extent, which was, as he said,, the only objection to the operation. It was freely and widely taken away, with the whole of the gland. It is a form gene rally which does not recur very rapidly. The patient is going on very well. At the Samaritan Free Hospital, a breast was removed by Dr. Routh, on the 19th of May, from a woman forty-two years. of age, a domestic, in whom the disease was a mixture of the cystic and scirrhous. She had been married nineteen years, and had one child three years after marriage. A tumour was noticed whilst suckling this child, which was brought on by rough usage of the breast. It remained the size of a marblefor some years, until four years ago there was some pain in it, when it commenced to increase, and lately the pain was veryThe wound united by adhesion; and she has made a. severe. quick convalescence. Another case, which we will now merely just mention, 3. one under Mr. Henry Tbompson’s care, at the Marylebone Infirmary, of an old woman, seventy-three years of age, with. scirrhus of the breast. It was removed on the 24th of May ; and the patient, although so old, is recovering rapidly from. one
rare
period,
occurrence, and
the operation. Reviews and Notices of Books.
I. Nouvelles Rec7terches sur l’Importance des Fonctions des Capsules Surrénales. Par M. BROWN-8ÉQUARD. " Journal dela Physiologie," Janvier, 1858. EPULIS OF THE GUMS. II. Causes de Mort aprèsl’Ablation du Naeud Vital. Par M. BROWX-SQUAED. " Journal de la Physiologie," Avril.. A SIMPLE epulis springing from the gum, generally com1858. mencing between two of the teeth, may not seem a matter at Additional Inquiries on the Impo7·tance of the Functions of tlae first sight of any great importance. It can be removed by the Sl(pra-1-enal Capsules. By M. BROWN-SÉQUARD. "Journal knife; the wound will heal up, and the patient supposed safe de la Physiologie,"January, 1858. from any further trouble. Unfortunately, however, this little tumour, which may be fibrous, or fibro-plastic, or perhaps The Causes of Death 4ter Removal of the Vital Knot. By M. BBOWN-SQUARD. " Journal de la Physiologie," April, primarily simply cellular, does return, and, if not completely 1858.-Paris : Baillière. eradicated, will actually give rise to so much mischief as to reof a the the removal of whose actual quire jaw-bone, portion II. WE select as fair specimens of the papers contained in the alveolus has become affected. This we have witnessed several Journal de la Physiologie the above-mentioned essays by the times at different hospitals. of this editor publication, and apologizing for the too cursory On the 27th of May, a healthy-looking young woman was manner in which they are here of necessity treated, we refer into of St. to the theatre George’s Hospital brought operating have a small and apparently insignificant epulis, scarcely the the reader to the originals contained in the January and April size of a large pea, removed from between the two upper numbers of the Journal-a work which will well repay the middle incisors, being attached to the gum in that situation, of any one interested in the progress of physiology, and extending between them. This was very carefully per- perusal which has only now reached its second number; and which formed by Mr. Tatum withoutgiving chloroform to the patient, and she was sent back to her ward. This operation, as that cannot but succeed so long as it is supported by such men as gentleman remarked, was the second he had performed within Claude Bernard, Bence Jones, C. Robin, M. A. Sanson, and
583