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COMPOUND DISLOCATION OF A TERMINAL PHALANX ; EXCISION.
613 to dose himself with soamin. persuaded him to do had
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. STARVATION CURE" IN A CASE OF DIABETES MELLITUS. BY F. CARMINOW DOBLE, M.R.C.S. ENG., L.R.C.P. LOND., LATE HOUSE SURGEON AT THE GREAT NORTHERN CENTRAL HOSPITAL LONDON.
WHETHER or not starvation has any effect on diabetes mellitus is a most difficult point to prove, as very few patients would submit to this treatment for long enough to enable any inference to be drawn one way or another. One case that I have under my care has given me the opportunity of judging the effect, and in a very remarkable manner. A man, aged 56 years, had been suffering from this disease for some years, and the urine had never been free from sugar. A year ago he had an attack of apoplexy, probably from a cerebral haemorrhage due to diabetic endarteritis. There was no paralysis afterwards but a transient aphasia and mania, which are now chronic. His delusion was that he and those dependent on him were in a state of poverty. Week by week he thought that his money and estate were gradually diminishing and that his wife and children were starving. He then absolutely refused food and although acknowledging that he was very hungry the most tempting dishes of his favourite foods when set before him would not induce him to eat. Twice a day he was forcibly fed with Benger’s food, milk, beef tea, and eggs, but only sufficient could be given to keep him alive. This lasted for three months ; after that period he started eating on an average one meal a day, the forcible feeding still being kept up. He lost weight rapidly and at the end of the three months had dropped from 16 to 10 stones. Every symptom of diabetes has now disappeared and the sugar has not been present in his urine since his three months’ fast. At the present moment he is rapidly gaining weight, being now 122 stones. He takes two meals a day, one consisting of meat and green vegetables and the other of milk and eggs. Except for potatoes, bread, and sugar his diet is unlimited. As an opportunity of observing the abstinence from food in this disease must be very rare I thought that the case would be worth publishing. Reedham, Norfolk. TWO NOTES ON THE TREATMENT OF SYPHILIS BY ARYLARSONATES. BY E. URQUHART BARTHOLOMEW, M.R.C.S. ENG., L.R.C.P. LOND., L.M.S.S.A. LOND.
potassium but no improvement finally sent to me. When I and cheeks surrounding it for durated, painful, and covered
patient
observed and he was him the whole nose about one inch were inwith tertiary ulcers. He was very anaemic and debilitated and was undergoing much mental suffering from his fear of losing his employment and from the failure of his previous treatment. I at on once commenced injections of orsudan (10 grains) alternate days until I had injected 100 grains. I was much struck by the rapidity of the improvement and the absence of any toxic symptoms. The induration has now disappeared, the ulcers are healed, and the appearance of the nose is not There is no worse than after a severe attack of small-pox. doubt that in certain cases mercury loses part, if not all, of its specific power, and in these cases we appear to have a valuable means of cure in the arylarsonates. Green-street, W.C. was
saw
COMPOUND DISLOCATION OF A TERMINAL PHALANX ; EXCISION. BY W. E. HOME, B.SC., M.D. EDIN., M.R.C.P. EDIN.,
D.P.H., FLEET-SURGEON,
THE two following cases may be of interest to those readers of THE LANCET who are at present watching the results of the treatment of syphilis by the various preparations of arsenious acid. The first case shows the danger of this particular treatment unless under the direct and continuous supervision of a medical practitioner. CASE 1.-A man, aged 30 years, consulted me on account of vomiting, diarrhoea, pains and a feeling of heat in the abdomen. He complained of debility and feeling nervous and unfit for his work and was evidently ii. d, very depressed and hypochondriacal state. He was a man of magnificent muscular development and told me that he had never had a day’s illness in his life. After some little beating about the bush he confessed that he had come to consult me because he was afraid he had contracted syphilis and had supposed that his symptoms were a manifestation of that disease. Moreover, he had recently noticed a rash. The history proved to be as follows. Six days after exposure to possible contagion he noticed " a little red pimple " on his prepuce, whichitched very much " and whichhe scratched until it bled." This pimple first became yellow and discharged matter and finally became an open sore. He was told by a friend that this was a chancre and that he had contracted syphilis. His friend, who appears to be a studious reader of medical literature, also advised him on no account to take any mercury as it would rot his bones and bring him out in a rash and prevent him from carrying on his work. He finally
This the
commenced and been taking gradually increasing doses for a fortnight. He acknowledged that occasionally he forgot to take his dose and made up for it by increasing the successive doses during that day. He took the tabloids by the mouth and not by hypodermic injection. He had treated the sore on the penis by boric lotion and that was now healed. Upon examination I could find no evidence of syphilis. There was no induration or loss of tissue at the place where the sore had been ; there was no history of sore-throat, bone pains, or headache. The patient was slightly anæmic and evidently highly nervous. The supposed secondary rash proved to be Here we have a man who takes the opinion of a an acne. friend and doses himself according to his own ideas with a dangerous drug and suffers much mental torture which would instantly have been allayed by a visit to a medical man. I am afraid that he is one of many such. The second case shows the value of the arsonates in cases in which mercury seems to have lost its power. CASE 2.-A man, aged 26 years, contracted syphilis during March, 1902. Eight weeks after the primary sore a secondary roseolar rash appeared. He was treated with pills for three months, then an interval of six weeks was allowed, and treatment resumed on and off" for a period of two years. He then considered himself cured. About two years ago his nose became affected. It at first appeared simply swollen; then just on the edge of the swelling on the right side a hard red spot appeared which became pustular and finally ulcerated. This slowly healed under treatment. About seven months ago another hard papule appeared at the base of the nose and gradually spread all over it. He was energetically treated with mercury and iodide of
R.N.
ON March 2nd, 1908, a chief armourer was brought to me in H.M.S. Excellent having some 15 minutes before experienced a compound dislocation of the terminal joint of the right middle finger. The distal phalanx was hanging, attached merely by the tissues on the palmar surface of the joint, but as there was bleeding from that distal part it was clear that the arterial supply was not entirely cut off, so it seemed it might be possible to do an excision and spare the patient an amputation. He was put under an anaesthetic and the parts were cleaned. (I think a tooth brush very useful for cleaning parts about the fingers ; it is difficult to reach the web with a nail brush, this being generally too large.) I removed with a metacarpal saw the head of the second phalanx and cut all the cartilage off the base of the distal phalanx. I kept these in apposition by stitches through the extensor tendons and other soft parts and sutured the skin. The wound healed well, though I did not get the skin to heal by first intention, but the patient was sent to duty able to do his work on April lst (30 days after). I saw him again on July 31st. Ankylosis was complete. The He was saved the stiffness gave him no inconvenience. deformities of shortening and loss of nail while the pulp of the finger with its greater sensitiveness remained. Though I daresay often done, these small things are rarely reported, and it had not previously occurred to me that such an
operation might be feasible.T3 ,
-
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL,
AND
THERAPEUTICAL. STARVATION CURE" IN A CASE OF DIABETES MELLITUS. BY F. CARMINOW DOBLE, M.R.C.S. ENG., L.R.C.P. LOND., LATE HOUSE SURGEON AT THE GREAT NORTHERN CENTRAL HOSPITAL LONDON.
WHETHER or not starvation has any effect on diabetes mellitus is a most difficult point to prove, as very few patients would submit to this treatment for long enough to enable any inference to be drawn one way or another. One case that I have under my care has given me the opportunity of judging the effect, and in a very remarkable manner. A man, aged 56 years, had been suffering from this disease for some years, and the urine had never been free from sugar. A year ago he had an attack of apoplexy, probably from a cerebral haemorrhage due to diabetic endarteritis. There was no paralysis afterwards but a transient aphasia and mania, which are now chronic. His delusion was that he and those dependent on him were in a state of poverty. Week by week he thought that his money and estate were gradually diminishing and that his wife and children were starving. He then absolutely refused food and although acknowledging that he was very hungry the most tempting dishes of his favourite foods when set before him would not induce him to eat. Twice a day he was forcibly fed with Benger’s food, milk, beef tea, and eggs, but only sufficient could be given to keep him alive. This lasted for three months ; after that period he started eating on an average one meal a day, the forcible feeding still being kept up. He lost weight rapidly and at the end of the three months had dropped from 16 to 10 stones. Every symptom of diabetes has now disappeared and the sugar has not been present in his urine since his three months’ fast. At the present moment he is rapidly gaining weight, being now 122 stones. He takes two meals a day, one consisting of meat and green vegetables and the other of milk and eggs. Except for potatoes, bread, and sugar his diet is unlimited. As an opportunity of observing the abstinence from food in this disease must be very rare I thought that the case would be worth publishing. Reedham, Norfolk. TWO NOTES ON THE TREATMENT OF SYPHILIS BY ARYLARSONATES. BY E. URQUHART BARTHOLOMEW, M.R.C.S. ENG., L.R.C.P. LOND., L.M.S.S.A. LOND.
potassium but no improvement finally sent to me. When I and cheeks surrounding it for durated, painful, and covered
patient
observed and he was him the whole nose about one inch were inwith tertiary ulcers. He was very anaemic and debilitated and was undergoing much mental suffering from his fear of losing his employment and from the failure of his previous treatment. I at on once commenced injections of orsudan (10 grains) alternate days until I had injected 100 grains. I was much struck by the rapidity of the improvement and the absence of any toxic symptoms. The induration has now disappeared, the ulcers are healed, and the appearance of the nose is not There is no worse than after a severe attack of small-pox. doubt that in certain cases mercury loses part, if not all, of its specific power, and in these cases we appear to have a valuable means of cure in the arylarsonates. Green-street, W.C. was
saw
COMPOUND DISLOCATION OF A TERMINAL PHALANX ; EXCISION. BY W. E. HOME, B.SC., M.D. EDIN., M.R.C.P. EDIN.,
D.P.H., FLEET-SURGEON,
THE two following cases may be of interest to those readers of THE LANCET who are at present watching the results of the treatment of syphilis by the various preparations of arsenious acid. The first case shows the danger of this particular treatment unless under the direct and continuous supervision of a medical practitioner. CASE 1.-A man, aged 30 years, consulted me on account of vomiting, diarrhoea, pains and a feeling of heat in the abdomen. He complained of debility and feeling nervous and unfit for his work and was evidently ii. d, very depressed and hypochondriacal state. He was a man of magnificent muscular development and told me that he had never had a day’s illness in his life. After some little beating about the bush he confessed that he had come to consult me because he was afraid he had contracted syphilis and had supposed that his symptoms were a manifestation of that disease. Moreover, he had recently noticed a rash. The history proved to be as follows. Six days after exposure to possible contagion he noticed " a little red pimple " on his prepuce, whichitched very much " and whichhe scratched until it bled." This pimple first became yellow and discharged matter and finally became an open sore. He was told by a friend that this was a chancre and that he had contracted syphilis. His friend, who appears to be a studious reader of medical literature, also advised him on no account to take any mercury as it would rot his bones and bring him out in a rash and prevent him from carrying on his work. He finally
This the
commenced and been taking gradually increasing doses for a fortnight. He acknowledged that occasionally he forgot to take his dose and made up for it by increasing the successive doses during that day. He took the tabloids by the mouth and not by hypodermic injection. He had treated the sore on the penis by boric lotion and that was now healed. Upon examination I could find no evidence of syphilis. There was no induration or loss of tissue at the place where the sore had been ; there was no history of sore-throat, bone pains, or headache. The patient was slightly anæmic and evidently highly nervous. The supposed secondary rash proved to be Here we have a man who takes the opinion of a an acne. friend and doses himself according to his own ideas with a dangerous drug and suffers much mental torture which would instantly have been allayed by a visit to a medical man. I am afraid that he is one of many such. The second case shows the value of the arsonates in cases in which mercury seems to have lost its power. CASE 2.-A man, aged 26 years, contracted syphilis during March, 1902. Eight weeks after the primary sore a secondary roseolar rash appeared. He was treated with pills for three months, then an interval of six weeks was allowed, and treatment resumed on and off" for a period of two years. He then considered himself cured. About two years ago his nose became affected. It at first appeared simply swollen; then just on the edge of the swelling on the right side a hard red spot appeared which became pustular and finally ulcerated. This slowly healed under treatment. About seven months ago another hard papule appeared at the base of the nose and gradually spread all over it. He was energetically treated with mercury and iodide of
R.N.
ON March 2nd, 1908, a chief armourer was brought to me in H.M.S. Excellent having some 15 minutes before experienced a compound dislocation of the terminal joint of the right middle finger. The distal phalanx was hanging, attached merely by the tissues on the palmar surface of the joint, but as there was bleeding from that distal part it was clear that the arterial supply was not entirely cut off, so it seemed it might be possible to do an excision and spare the patient an amputation. He was put under an anaesthetic and the parts were cleaned. (I think a tooth brush very useful for cleaning parts about the fingers ; it is difficult to reach the web with a nail brush, this being generally too large.) I removed with a metacarpal saw the head of the second phalanx and cut all the cartilage off the base of the distal phalanx. I kept these in apposition by stitches through the extensor tendons and other soft parts and sutured the skin. The wound healed well, though I did not get the skin to heal by first intention, but the patient was sent to duty able to do his work on April lst (30 days after). I saw him again on July 31st. Ankylosis was complete. The He was saved the stiffness gave him no inconvenience. deformities of shortening and loss of nail while the pulp of the finger with its greater sensitiveness remained. Though I daresay often done, these small things are rarely reported, and it had not previously occurred to me that such an
operation might be feasible.T3 ,
-