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TREATMENT OF TIC DOULOUREUX BY DIVISION OF THE NERVE.
frequency on the linea aspora of the fumur, and disease. Notwithstanding all this, the man’s general health is especially on the ridge leading from it to the inner condyle, good. also on the borders of the bicipital groove of the humerus, Shortly before the operation in this case, we saw Mr. Cock, whilst they are rarely ever found growing from surfaces per- at Guy’s, remove a large cancerous ulcerated tubercle from the fectly smooth, whether round or flat. This condition of rough- under-lip of a man by V incision; it had its origin in a, pipe. The wound healed up perfectly. ness is possessed remarkably by that part of the terminal the nail. The wearing of much closer This disease is most probably at first local, and free and phalanx which supports fitting shoes was no doubt the reason, why women have them early extirpation is the remedy. Sometimes the cure is peron, the toes so much oftener than men. The great toe was in fect, at other times a relapse occurs in from six months ta two
Thus their
nineteen
out of twenty the one affected, and almost inouter border, just where the shoe would press.
cases
variably its
years.
I
this form of exostosis once on the finger, the young woman under the care of Mr. Spencer Smith in St. Mary’s Hospital. If we remember right, the thimble-finger was the affected one. With regard to treatment, although amputation of the phalanx had been advised by Mr. Liston, and subsequently by M. Lenoir, of the Necker Hospital, simple excision is- perhaps much preferable when it can be done. It must, however, be done deeply, and requires a small crnved pair of cutting pliers. It is essential to cut out the growth from its very base, as if merely its surface be removed a, troublesome sore is apt to remain. This case turned out We have
seen
patient being
____
THE INFLUENCE OF HEAT ON DISEASE.
a
THE influence of heat in producing an aggravation in the symptoms of many diseases is a fact well known to everybody. Lately, during the very hot weather, we observed that many patients, the subjects of exhausting diseases, whether internal or external, medical or surgical, had their sufferings greatly increased. Perhaps in no class of patients was this more marked than in cancerous affections, amongst the female sex especially. This forcibly struck us at the Cancer Hospital, as well as elsewhere, for nearly all of the patients complained of an increase of pain, even when the cancer was not ulcerated; well. and when so, the discharge was greater, as well as the pain perhaps still more severe. CLINICAL RECORDS On the 25th of August, of several cases of cancer of the tongue which we saw, most of them hitherto doing pretty well, the greater number had slightly relapsed. One poor woman; TREATMENT OF TIC DOULOUREUX BY DIVISION OF THE NERVE. whose case we referred to on a former occasion, who was adWHEN all other means have failed to cure that agonizing mitted almost moribund, with sub-maxillary enlarnements, affection, tic douloureux, the next thing which comes under con- conjoined with a deep ulcer at the side of the tongue, and sideration is the division of the nerve, or the removal of a por- great emaciation and debility, has completely recovered tion of it. We have seen both of these practised many times. under treatment. All the lumps had become absorbed, the The latter is, perhaps, a preferable proceeding, because, in cancer had improved, as well as her general health in every simple division, the ends of the nerve are sure to reunite, with way, yet a few hot days threw her back. The prolonged influence of heat, such as we have had it subsequent return of the old pain and extension of the influence along its course, like a connected electric wire. This lately, produces a. certain amount of depression and languor connexion is certainly destroyed when a piece of the nerve is in the healthy, but in the weak and oppressed by disease, removed. On the 22nd of August, Mr. Fergusson divided the particularly cancer, it is followed by debility and exhaustion, sub,maxillary branch of the fifth nerve, as it passes through and hence an increased activity to nervous irritability and its the mental foramen, of an old man who has been for years sub- consequent pain. We have observed also that operative proceedings were to ject to this painful disease, which-the old story-has resisted everything that usually affords relief. Under the influence of some extent inadmissible, as many cases, and s .me of them chloroform this was easily effected. It may produce a cure, as trivial, took on a sort of low fever, which ran into pyæmia and it sometimes does: it will, no doubt, for a time afford relief. death. At the same time .Mr. Fergusson showed another man, an old patient of King’s College Hospital, in whom the nerve had URETHRO-RECTAL FISTULA. been twice divided, with relief for a time, the pain returning. AN in the pennasum, about four weeks ago; abscess formed On the third occasion he removed a piece of the nerve by means of a gouge applied just over the bone; this was more effectual between the rectum and urethra of a young man aged twentyfor a longer time, but still the poor man, who is otherwise two years, in University College Hospital, which produced restout and ablebodied, is a great sufferer. The anxious expres- tention of urine from pressure on the urethra alone. This unsion of countenance, with the worn-out aspect, is really dis- dermined the mucous membrane of both canals, and burst into rectum, and was subsequently followed by the formation of£ tressing to witness in these cases. We are not aware whether atheurethro-rectal fistula. The patient’s general health was veryit has ever been tried in tic douloureux, but we should like to bad indeed. He is an assistant-tutor by occupation, and his see the nerve destroyed by the delicate wires of the electric par. He had the remains of an abscess cautery, which is being used with so much advantage at the wholea systeminbelow (not bubo) the riht groin, one or two about his body, one present time in a variety of affections. in his left hand, and two or three about the fingers of his right hand, and his general aspect showed an absence of vital energy. On the 12th of August, all the perineal passages were laid illtoRECURRENT EPITHELIOMA OF THE LIP. one by Mr. Erichsen, and attention was paid to his general A SHORT time back we witnessed the operation of removal health. This treatment, when last we saw him, was answering. from the lower lip of a cancerous growth, by Mr. De Méric, at some urine still passed by the perineal wound, which may: well; the, Royal Free Hospital, and which has evinced a disposition. be expected for a little while; the irritability was certainly to recur. The particulars of the case, as furnished us by Mr. and the absence of spasm was marked since the division W. Curran, house-surgeon to the hospital, are, that the patient less; of the sphincter ani at the time of laying all the passages into was a labourer, thirty-one years of age, a large, muscular, A good-sized catheter could be passed into the bladder, one. healthy idan, of temperate habits, and free from any hereditary on overcoming some spasmodic closing of the membranous; taint. When admitted, there was a hard, irregular swelling, of the urethra. We have no doubt this case will do; portion of. considerable size, on the outer margin of the lower lip, of well. four months’ growth, first noticed as a chapping, and then assuming the appearance of a blister, being regarded as due to A PAIR OF ARTIFICIAL FEET. the irritation of a pipe, to which, Mr. Ourran’s notes mention, OUR readers will remember the description which we briefly the patient " clings with a tenacity worthy of a better cause." Two weeks before admission he had severe darting pain, par- gave of a case of spontaneous gangrene of both feet, with ticularly at night, with aching along the face and jaws. The separation at the epiphysis, and a sort of natural, Syme’s, disease was entirely removed by a V incision, the edges being amputation, at the ankle joint, at page 425 of the preceding brought together by needles. The wound healed up, but left volume of this journal. This occurred about ten years ago, a rugged cicatrix, at the bottom of which a fistulous tract re- and the stumps remained so sore and painful that the patient, mained, which admitted of the occasional escape of saliva. a girl, could not bear artificial feet. On the 20th of last When we last saw this man there was an indurated fissure, March, Mr. M’Whiiinie, at St. Bartholomew’s Hospital, ampuwith return of pain, relieved by smoking or friction. The sur- tated the stump of the left leg, a little higher up, and which, rounding skin was hard and nodulated, and adherent to the healetl in a satisfactory manner. Some weeks later, he re-, adjacent bone, which is itself likely to become involved in the peated the operation on the right leg, with equally good results. ____
’
247
Thus their
nineteen
out of twenty the one affected, and almost inouter border, just where the shoe would press.
cases
variably its
years.
I
this form of exostosis once on the finger, the young woman under the care of Mr. Spencer Smith in St. Mary’s Hospital. If we remember right, the thimble-finger was the affected one. With regard to treatment, although amputation of the phalanx had been advised by Mr. Liston, and subsequently by M. Lenoir, of the Necker Hospital, simple excision is- perhaps much preferable when it can be done. It must, however, be done deeply, and requires a small crnved pair of cutting pliers. It is essential to cut out the growth from its very base, as if merely its surface be removed a, troublesome sore is apt to remain. This case turned out We have
seen
patient being
____
THE INFLUENCE OF HEAT ON DISEASE.
a
THE influence of heat in producing an aggravation in the symptoms of many diseases is a fact well known to everybody. Lately, during the very hot weather, we observed that many patients, the subjects of exhausting diseases, whether internal or external, medical or surgical, had their sufferings greatly increased. Perhaps in no class of patients was this more marked than in cancerous affections, amongst the female sex especially. This forcibly struck us at the Cancer Hospital, as well as elsewhere, for nearly all of the patients complained of an increase of pain, even when the cancer was not ulcerated; well. and when so, the discharge was greater, as well as the pain perhaps still more severe. CLINICAL RECORDS On the 25th of August, of several cases of cancer of the tongue which we saw, most of them hitherto doing pretty well, the greater number had slightly relapsed. One poor woman; TREATMENT OF TIC DOULOUREUX BY DIVISION OF THE NERVE. whose case we referred to on a former occasion, who was adWHEN all other means have failed to cure that agonizing mitted almost moribund, with sub-maxillary enlarnements, affection, tic douloureux, the next thing which comes under con- conjoined with a deep ulcer at the side of the tongue, and sideration is the division of the nerve, or the removal of a por- great emaciation and debility, has completely recovered tion of it. We have seen both of these practised many times. under treatment. All the lumps had become absorbed, the The latter is, perhaps, a preferable proceeding, because, in cancer had improved, as well as her general health in every simple division, the ends of the nerve are sure to reunite, with way, yet a few hot days threw her back. The prolonged influence of heat, such as we have had it subsequent return of the old pain and extension of the influence along its course, like a connected electric wire. This lately, produces a. certain amount of depression and languor connexion is certainly destroyed when a piece of the nerve is in the healthy, but in the weak and oppressed by disease, removed. On the 22nd of August, Mr. Fergusson divided the particularly cancer, it is followed by debility and exhaustion, sub,maxillary branch of the fifth nerve, as it passes through and hence an increased activity to nervous irritability and its the mental foramen, of an old man who has been for years sub- consequent pain. We have observed also that operative proceedings were to ject to this painful disease, which-the old story-has resisted everything that usually affords relief. Under the influence of some extent inadmissible, as many cases, and s .me of them chloroform this was easily effected. It may produce a cure, as trivial, took on a sort of low fever, which ran into pyæmia and it sometimes does: it will, no doubt, for a time afford relief. death. At the same time .Mr. Fergusson showed another man, an old patient of King’s College Hospital, in whom the nerve had URETHRO-RECTAL FISTULA. been twice divided, with relief for a time, the pain returning. AN in the pennasum, about four weeks ago; abscess formed On the third occasion he removed a piece of the nerve by means of a gouge applied just over the bone; this was more effectual between the rectum and urethra of a young man aged twentyfor a longer time, but still the poor man, who is otherwise two years, in University College Hospital, which produced restout and ablebodied, is a great sufferer. The anxious expres- tention of urine from pressure on the urethra alone. This unsion of countenance, with the worn-out aspect, is really dis- dermined the mucous membrane of both canals, and burst into rectum, and was subsequently followed by the formation of£ tressing to witness in these cases. We are not aware whether atheurethro-rectal fistula. The patient’s general health was veryit has ever been tried in tic douloureux, but we should like to bad indeed. He is an assistant-tutor by occupation, and his see the nerve destroyed by the delicate wires of the electric par. He had the remains of an abscess cautery, which is being used with so much advantage at the wholea systeminbelow (not bubo) the riht groin, one or two about his body, one present time in a variety of affections. in his left hand, and two or three about the fingers of his right hand, and his general aspect showed an absence of vital energy. On the 12th of August, all the perineal passages were laid illtoRECURRENT EPITHELIOMA OF THE LIP. one by Mr. Erichsen, and attention was paid to his general A SHORT time back we witnessed the operation of removal health. This treatment, when last we saw him, was answering. from the lower lip of a cancerous growth, by Mr. De Méric, at some urine still passed by the perineal wound, which may: well; the, Royal Free Hospital, and which has evinced a disposition. be expected for a little while; the irritability was certainly to recur. The particulars of the case, as furnished us by Mr. and the absence of spasm was marked since the division W. Curran, house-surgeon to the hospital, are, that the patient less; of the sphincter ani at the time of laying all the passages into was a labourer, thirty-one years of age, a large, muscular, A good-sized catheter could be passed into the bladder, one. healthy idan, of temperate habits, and free from any hereditary on overcoming some spasmodic closing of the membranous; taint. When admitted, there was a hard, irregular swelling, of the urethra. We have no doubt this case will do; portion of. considerable size, on the outer margin of the lower lip, of well. four months’ growth, first noticed as a chapping, and then assuming the appearance of a blister, being regarded as due to A PAIR OF ARTIFICIAL FEET. the irritation of a pipe, to which, Mr. Ourran’s notes mention, OUR readers will remember the description which we briefly the patient " clings with a tenacity worthy of a better cause." Two weeks before admission he had severe darting pain, par- gave of a case of spontaneous gangrene of both feet, with ticularly at night, with aching along the face and jaws. The separation at the epiphysis, and a sort of natural, Syme’s, disease was entirely removed by a V incision, the edges being amputation, at the ankle joint, at page 425 of the preceding brought together by needles. The wound healed up, but left volume of this journal. This occurred about ten years ago, a rugged cicatrix, at the bottom of which a fistulous tract re- and the stumps remained so sore and painful that the patient, mained, which admitted of the occasional escape of saliva. a girl, could not bear artificial feet. On the 20th of last When we last saw this man there was an indurated fissure, March, Mr. M’Whiiinie, at St. Bartholomew’s Hospital, ampuwith return of pain, relieved by smoking or friction. The sur- tated the stump of the left leg, a little higher up, and which, rounding skin was hard and nodulated, and adherent to the healetl in a satisfactory manner. Some weeks later, he re-, adjacent bone, which is itself likely to become involved in the peated the operation on the right leg, with equally good results. ____
’
247