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DEVON COUNTY ASYLUM.
1030 DEVON COUNTY ASYLUM. EPILEPTIFORM
CONVULSIONS DUE TO HÆMORRHAGICA.
PACIIYMENINGITIS
(Under the care of Dr. SAUNDERS.)
Medical Societies. ROYAL MEDICAL &
CHIRURGICAL SOCIETY.
THE
Soot in Cells of Chimney-sweep’s Cancer.—Suppurative following case is interesting as an example of Affections of Testicle and Epididymis. epileptiform convulsions commencing late in life, for which a definite cause, pachymeningitis hnemorrhagica, was found AN ordinary meeting of this Society was held on Nov. lltb, the President, Mr. Timothy Holmes, being in the chair. on post-mortem examination, and shows the frequently A paper was read by Mr. W. G. SPENCER on Soot in Cells duration of this disease and the incomparatively long of Chimney-sweep’s Cancer. He said that, although chimneyteresting alternation of periods in which the most serious sweep’s cancer had been always ascribed to soot, and the symptoms were present, and intervals of rapid improve- skin of sweeps noted to be discoloured in a way which could ment and comparative restoration to health. For the not be removed by washing, yet the actual occurrence of, account of this case we are indebted to Dr. C. F. soot in the growth had not been described. The present paper described the microscopical specimens shown, in Bailey. which soot was seen to be contained in cells of th& A. F-, a little, spare farm labourer, aged seventy-two, growth. The soot was shown to be present in the corneous was admitted to the Devon County Asylum on Nov. 14th, layer of the epidermis, in the cells of the rete Malpighii,, 1889, suffering from senile melancholia. His previous in the cells of the growing ends of the epithelial history was that he had been a steady, hard-working man, columns, and in the nest cells. Cells full of the same and had only exhibited symptoms of insanity for one material were seen in the centre of the growth, at the month. He now fancied that he had committed murder, deep margin, and in the tissues outside. He drew the There was following conclusions: 1. The presence of soot in the cell& for which he was about to be punished. no history of any apoplectic seizure, although he of the epidermis and in the tissues outside offered an exappeared to be a little weak on his left side. He planation on the following points: the dusky patches in had suffered from chronic bronchitis, had emphysema, the skin of sweeps, the occurrence of cancer long after all and thickened arteries, but no anasarca or albuminuria. contact with soot, the recurrence of the disease at a distance In a day or two he became quite satisfied with his position, from the scar of the first operation, the primary chimneyhis delusions left him, he conversed in a quiet sensible sweep’s cancer in the inguinal glands. 2. The cells con. manner, and was soon afterwards transferred from the taining soot in the tissues outside could be identified by their dark colour, and were seen to be scattered beyond the suicidal ward to a pleasanter one. On Jan. 18th, two months after admission, the attendant apparent margin of the growth. Hence the specimens em. (who had spoken to him as he lay in bed, only a few phasised by positive evidence the necessity of wide removal.minutes previously, when he had seemed in his usual con- The PRESIDENT observed that less was seen now of this dition) found him at 7 A.M. in an unconscious state. When affection than when he commenced to practise surgery.examined a few minutes later he was still unconscious, Mr. BUTLIX said he had been long engaged in studying the livid, breathing stertorously, pulse slow and full, extremi- subject from a general point of view. The soot penetrated ties motionless and flaccid, pupils small, and the eyes devia- much deeper than was usually supposed, and SirJamesPaget ting upwards and to the right. He gradually regained had shown that it became ingrained into the cells at th? consciousness, but in the middle of the day the attendant orificesof the glands, forming little black spots in various parts stated he had " three epipleptic fits in succession." Later on ofthe body. The author seemed to confound the occurrence he had more or less recovered, and he then stated that he had of soot particles with the occurrence of cancer; it should become suddenly unconscious in the morningand remembered be remembered that there was a wide difference between nothing. He had had no aura. He remained fairly well the two, for the soot probably only produced changes in the until March 30th, when he again had epileptiform convul- integument, which prepared it for the occurrence of cancer, sions. Afterwards he seemed feebler mentally, would begin and something else was required to develop the latter. Thiersch had stated that he suspected in cases of primary a sentence, and forget words, and be unable to finish it until prompted with the words he wanted. There was no cancer of the inguinal glands the original cancer had definite paralysis of his limbs, but he was generally weaker. been overlooked, but observers like Sir James Paget and On May 1st he had his third attack, and here, being under Mr. George Lawson would scarcely have done this. If the observation at the time, the convulsions were seen to be growth were produced simply by the irritation of soot in limited to the left side, the face, arm, and leg being all the glands, something like lympho-sarcoma, rather than affected ; loss of consciousness was not present, however. true cancer, should result.-Dr. DELEPINE did not regard He had epileptiform convulsions on July 4th and again on the particles as soot at all. There was always a certain Sept. 20th. He now, in this interval, began to have a amount of pigment in the deep layers of the rete tendency to spasmodic over action of the left side of Malpighii, and it could be easily demonstrated if they the face and twitchings of the left arm and leg, occur- were prepared in balsam simply. In many varieties of ring more particularly when he conversed. His limbs tumour it was not uncommon to find pigment in the deeper were feeble, but more especially the left side, and layers, and such pigment masses often found their way His intellect was into the lymph vessels and glands. When the skin over he spent most of his time in bed. that people a tumour was stimulated, then an increase of pigment delusions and he had rapidly weakening came into his room and molested him &c. On Oct. 6th was usually found in the deeper layers.-Mr. HULKE had he became quite unconscious, passing his urine and read elsewhere an account of the histological examinafaeces involuntarily ; face livid; body cold. His left tion of sections of chimney-sweep’s cancer, in which arm was flexed and rigid ; right arm flaccid. He did carbonaceous particles were found deep down in the tissue. not regain consciousness, but died on October 8th at It was certain that the particles alone were not of very 7.15 A.M. great moment. As the result of tattooing, which was At the necropsy, which was made next day, a localised usually done with finely-ground gunpowder, the axillary adherence of the dura mater to the calvaria was found over glands could be found crammed with pigment, and yet cancer never developed. He showed three drawings illusa spot about the size of a shilling in the right upper parietal region. On the under surface of the dura mater at this trative of chimney-sweep’s cancer ; two ofthem occurred in point was attached a flattened encapsulated haematoma, brothers, one grew from the leg and one from the containing coagula of various ages. The cyst wall had rup- thigh.-Mr. SPENCER, in reply, stated that in his paper tured, and blood coagula were present in the arachnoid he had carefully distinguished between pigmentatioc cavity. Tbeeist had a smooth surface externally; its wall the result of unburnt carbon such as occurred in miners was fairly tough, and was not adherent to the pia mater. ’ or coal porters, and that produced by xoot. The The surface of the brain was rather flattened on the right changes wrought by combustion were exceedingly difficultof ’
pia mater and brain otherwise presented elucidation. He referred to the soot as the primary naked-eye appearance. The carotids, ver- irritation, and the epithelial cells containing the pigment tebrals, basilar, circle of Willis, and arterial branches were could be themselves carried to the lymphatic glands, where they might multiply, and produce epithelioma. In a negro’s highly atheromatous. but the abnormal
side,
no
CONVULSIONS DUE TO HÆMORRHAGICA.
PACIIYMENINGITIS
(Under the care of Dr. SAUNDERS.)
Medical Societies. ROYAL MEDICAL &
CHIRURGICAL SOCIETY.
THE
Soot in Cells of Chimney-sweep’s Cancer.—Suppurative following case is interesting as an example of Affections of Testicle and Epididymis. epileptiform convulsions commencing late in life, for which a definite cause, pachymeningitis hnemorrhagica, was found AN ordinary meeting of this Society was held on Nov. lltb, the President, Mr. Timothy Holmes, being in the chair. on post-mortem examination, and shows the frequently A paper was read by Mr. W. G. SPENCER on Soot in Cells duration of this disease and the incomparatively long of Chimney-sweep’s Cancer. He said that, although chimneyteresting alternation of periods in which the most serious sweep’s cancer had been always ascribed to soot, and the symptoms were present, and intervals of rapid improve- skin of sweeps noted to be discoloured in a way which could ment and comparative restoration to health. For the not be removed by washing, yet the actual occurrence of, account of this case we are indebted to Dr. C. F. soot in the growth had not been described. The present paper described the microscopical specimens shown, in Bailey. which soot was seen to be contained in cells of th& A. F-, a little, spare farm labourer, aged seventy-two, growth. The soot was shown to be present in the corneous was admitted to the Devon County Asylum on Nov. 14th, layer of the epidermis, in the cells of the rete Malpighii,, 1889, suffering from senile melancholia. His previous in the cells of the growing ends of the epithelial history was that he had been a steady, hard-working man, columns, and in the nest cells. Cells full of the same and had only exhibited symptoms of insanity for one material were seen in the centre of the growth, at the month. He now fancied that he had committed murder, deep margin, and in the tissues outside. He drew the There was following conclusions: 1. The presence of soot in the cell& for which he was about to be punished. no history of any apoplectic seizure, although he of the epidermis and in the tissues outside offered an exappeared to be a little weak on his left side. He planation on the following points: the dusky patches in had suffered from chronic bronchitis, had emphysema, the skin of sweeps, the occurrence of cancer long after all and thickened arteries, but no anasarca or albuminuria. contact with soot, the recurrence of the disease at a distance In a day or two he became quite satisfied with his position, from the scar of the first operation, the primary chimneyhis delusions left him, he conversed in a quiet sensible sweep’s cancer in the inguinal glands. 2. The cells con. manner, and was soon afterwards transferred from the taining soot in the tissues outside could be identified by their dark colour, and were seen to be scattered beyond the suicidal ward to a pleasanter one. On Jan. 18th, two months after admission, the attendant apparent margin of the growth. Hence the specimens em. (who had spoken to him as he lay in bed, only a few phasised by positive evidence the necessity of wide removal.minutes previously, when he had seemed in his usual con- The PRESIDENT observed that less was seen now of this dition) found him at 7 A.M. in an unconscious state. When affection than when he commenced to practise surgery.examined a few minutes later he was still unconscious, Mr. BUTLIX said he had been long engaged in studying the livid, breathing stertorously, pulse slow and full, extremi- subject from a general point of view. The soot penetrated ties motionless and flaccid, pupils small, and the eyes devia- much deeper than was usually supposed, and SirJamesPaget ting upwards and to the right. He gradually regained had shown that it became ingrained into the cells at th? consciousness, but in the middle of the day the attendant orificesof the glands, forming little black spots in various parts stated he had " three epipleptic fits in succession." Later on ofthe body. The author seemed to confound the occurrence he had more or less recovered, and he then stated that he had of soot particles with the occurrence of cancer; it should become suddenly unconscious in the morningand remembered be remembered that there was a wide difference between nothing. He had had no aura. He remained fairly well the two, for the soot probably only produced changes in the until March 30th, when he again had epileptiform convul- integument, which prepared it for the occurrence of cancer, sions. Afterwards he seemed feebler mentally, would begin and something else was required to develop the latter. Thiersch had stated that he suspected in cases of primary a sentence, and forget words, and be unable to finish it until prompted with the words he wanted. There was no cancer of the inguinal glands the original cancer had definite paralysis of his limbs, but he was generally weaker. been overlooked, but observers like Sir James Paget and On May 1st he had his third attack, and here, being under Mr. George Lawson would scarcely have done this. If the observation at the time, the convulsions were seen to be growth were produced simply by the irritation of soot in limited to the left side, the face, arm, and leg being all the glands, something like lympho-sarcoma, rather than affected ; loss of consciousness was not present, however. true cancer, should result.-Dr. DELEPINE did not regard He had epileptiform convulsions on July 4th and again on the particles as soot at all. There was always a certain Sept. 20th. He now, in this interval, began to have a amount of pigment in the deep layers of the rete tendency to spasmodic over action of the left side of Malpighii, and it could be easily demonstrated if they the face and twitchings of the left arm and leg, occur- were prepared in balsam simply. In many varieties of ring more particularly when he conversed. His limbs tumour it was not uncommon to find pigment in the deeper were feeble, but more especially the left side, and layers, and such pigment masses often found their way His intellect was into the lymph vessels and glands. When the skin over he spent most of his time in bed. that people a tumour was stimulated, then an increase of pigment delusions and he had rapidly weakening came into his room and molested him &c. On Oct. 6th was usually found in the deeper layers.-Mr. HULKE had he became quite unconscious, passing his urine and read elsewhere an account of the histological examinafaeces involuntarily ; face livid; body cold. His left tion of sections of chimney-sweep’s cancer, in which arm was flexed and rigid ; right arm flaccid. He did carbonaceous particles were found deep down in the tissue. not regain consciousness, but died on October 8th at It was certain that the particles alone were not of very 7.15 A.M. great moment. As the result of tattooing, which was At the necropsy, which was made next day, a localised usually done with finely-ground gunpowder, the axillary adherence of the dura mater to the calvaria was found over glands could be found crammed with pigment, and yet cancer never developed. He showed three drawings illusa spot about the size of a shilling in the right upper parietal region. On the under surface of the dura mater at this trative of chimney-sweep’s cancer ; two ofthem occurred in point was attached a flattened encapsulated haematoma, brothers, one grew from the leg and one from the containing coagula of various ages. The cyst wall had rup- thigh.-Mr. SPENCER, in reply, stated that in his paper tured, and blood coagula were present in the arachnoid he had carefully distinguished between pigmentatioc cavity. Tbeeist had a smooth surface externally; its wall the result of unburnt carbon such as occurred in miners was fairly tough, and was not adherent to the pia mater. ’ or coal porters, and that produced by xoot. The The surface of the brain was rather flattened on the right changes wrought by combustion were exceedingly difficultof ’
pia mater and brain otherwise presented elucidation. He referred to the soot as the primary naked-eye appearance. The carotids, ver- irritation, and the epithelial cells containing the pigment tebrals, basilar, circle of Willis, and arterial branches were could be themselves carried to the lymphatic glands, where they might multiply, and produce epithelioma. In a negro’s highly atheromatous. but the abnormal
side,
no