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WOLVERHAMPTON AND STAFFORDSHIRE INFIRMARY.
370 him at the West London Hospital. The advantages of this procedure are its easy application and its means of securely fixing the stomach, which in this instance was very desirable on account of the very troublesome cough. The amount of adhesion between the stomach and the abdominal parieteswas
ample and firm,
as
shown
by the post-mortem examination.
WOLVERHAMPTON AND STAFFORDSHIRE INFIRMARY. EPITHELIOMA OF PENIS AND
SCROTUM,
INGUINAL
WITH ENLARGED
GLANDS ; COMPLETE REMOVAL OF EXTERNAL GENITALS, FOLLOWED BY RECOVERY AND AN
and easily controlled. The recovery of the patient after this severe operation may be considered satisfactory, and the process of healing rapid. There cannot be the slightest question that the operation removed a most loathsome and destructive disease, and by so doing restored to activity, comfort, and a renewed life a man who would quickly have ended his days worn out by the consequences of so terrible an infliction.
slight
Rewiews
and
Notices of Books.
APPARENT CURE.
The Diseases of the Ear and their Treatment. By ARTHUR of Mr. VINCENT JACKSON.) (Under HARTMANN, M.D. Berlin. Translated from the Third J. T--, aged fifty-one, single, was admitted in May, German Edition, by JAMES EBSEiNE, M.A., M.B. Glas. 1886. He had never had gonorrhoea or syphilis. There was Edinburgh: Young J. Pentland. 1887. no family history of cancer. Fourteen days ago he landed Practitioner’s Handbook of Diseases of the Ear and Nasoin Liverpool from America, and, having tramped to the Pharynx. Third Edition of the Aural Surgery. By H. MACNAUGHTON JONES. M.D., 1I.Ch. Cannock Workhouse, was from there sent to the hospital. The man is tall, pale-faced, and a gardener by occupation. DR. HARTMANN’S work will be found very useful, conTwo years since he noticed a small warty growth on the the kind of information that is requisite for under surface of the penis. This gradually extended in all taining just the diagnosis and treatment of diseases of the ear. It does directions, until the whole of the penis and the greater not The was involved. were of the scrotum profess to be a book for specialists. After a few pages discharge part free and most offensive in odour. Pain was not complained which are devoted to a brief historical retrospect, the book of. From childhood the prepuce has never been retracted. may be said to commence with a description of the different The chain of glands in each groin running parallel with methods of and in this chapter the testing of Poupart’s ligament is enlarged, but the glands are not tender, the hearingexamination, the is described in a more by tuning-fork and are freely movable in all directions on pressure. The examination of the urine indicated no abnormality. thorough and complete manner than we are accustomed to On June 3rd, ether having been given, Thiersch’s operation see in any of our English text-books. A short chapter is was performed, the testes, as well as the penis and scrotum, devoted to some special symptoms, and another to general being removed. Before the necessary dissection was com- therapeutics; and then at page 76, in a book of 250 pages,. menced, the corpus spongiosum and urethra were exposed, the diseases of the auricle and external meatus are dedivided across, and freed from their connexions as far back as was necessary, to permit the urethra to be stitched to scribed, the middle and internal ear following in their the lower angle of the wound without the slightest traction. natural order. Each chapter opens with a brief anatomical During the operation the bleeding was free, and required to description of the part involved in the diseases about to bebe arrested by ligatures and forci-pressure forceps. The which serves to refresh the memory of those who lateral portions of the scrotum which had been left were described, united along their edges by points of gut suture. The have not had recent opportunities of working at the subject. whole having been dusted over with iodoform, covered with The account given of the various diseases and the treatcotton wool, and fixed by a binder, the patient was removed ment that should be adopted is, as a general rule, admirable,. to bed. especially where local treatment is required. A little more In the after progress of the case there was nothing of stress we think, be laid upon the value of scraping importance to report; a portion of the flaps as well as out might, granulations and old caseous products from the middle of the deeper tissues sloughed, but the wound soon cleaned ear with a sharp spoon under an anaesthetic. The author,. and the healing process was quickly concluded. As the if on other a little smaller the hand, advocates the use of a special metallic enlarged inguinal glands were, anything, than when admitted, the patient was discharged in July tube connected by rubber with a syringe. If the former be without their removal. In May, 1887, the patient visited and skilfully performed, it is of great assistthe hospital, and in appearance he seemed to be in perfect intelligently ance to the latter operation, and should be accompanied by health. There was no return of the disease, and the enlarged inguinal glands had disappeared. The perineal urethral no greater risk than the forcible injection of fluids into orifice was perfectly patent, the mucous membrane being the tympanic cavity. The old intra-tympanic injections slightly prolapsed. through the Eustachian tube for chronic dry catarrh of the. Remarks by Mr. JACKsoN.-This case is published as a middle ear are still apparently recommended. We wish contribution to the surgery of this particular operation, that the author had had the boldness to say at once and as distinct evidence that it is not only curative it is as a curative measure for this variety of how useless are observed which but permanently so. No doubt cases possibly are considered, on account of the depth and deafness, where no secretion exists. There is very little extensive area of the malignant ulceration, to be beyond said about cerebral abscess dependent upon disease of the the reach of prudent surgery. The case reported was, ear; and absolutely nothing worth reading as to its treatI consider, approaching the border line of those cases ment. At the present day we should expect to find in a which may be removed and those which no experienced book so good as this some expression of opinion as to when surgeon would feel justified in jeopardising the life of his patient by attempting, not a forlorn hope, but a foregone and under what circumstances the skull should be treconclusion. I have not witnessed a more extensive case of phined ; and the exact site of operation in different cases epitheliomatous ulceration of the male external genitals ought to have been discussed. The book, however, taken as than the present one, and in attempting its entire re- a whole, appears to us to be the best in the English language moval I felt that the operation to be permanently successful for the class of readers for whom it is intended-namely, must be as radical as it was possible to make it. The encircling incisions were made as wide of the disease as those who have not time to read such works as those of possible, and after the testes had been exposed, enucleated, Politzer, Gruber, and Troltsch. The translation, with the and removed, the urethra was cut across, and, with the exception of a very few German sentences which have not corpus spongiosum, was dissected back until pendent ; it received quite enough alteration in construction, leaves occupied the lower angle of the wound. In removing the nothing to be desired. body of the penis, and in separating by a process of tearing The previous editions of Dr. Macnaughton Jones’s book and scraping the crura from their bony attachments I was have been favourably noticed in THE LANCET, and the new the rather free haemorrhage which had not prepared for to be assuaged, as previous writers in reporting cases of one has been made more useful to its readers by the addition Thiersch’s operation had stated that the bleeding was of a few coloured plates, taken from Dr. Jones’s Aural Atlas, the
care
ample and firm,
as
shown
by the post-mortem examination.
WOLVERHAMPTON AND STAFFORDSHIRE INFIRMARY. EPITHELIOMA OF PENIS AND
SCROTUM,
INGUINAL
WITH ENLARGED
GLANDS ; COMPLETE REMOVAL OF EXTERNAL GENITALS, FOLLOWED BY RECOVERY AND AN
and easily controlled. The recovery of the patient after this severe operation may be considered satisfactory, and the process of healing rapid. There cannot be the slightest question that the operation removed a most loathsome and destructive disease, and by so doing restored to activity, comfort, and a renewed life a man who would quickly have ended his days worn out by the consequences of so terrible an infliction.
slight
Rewiews
and
Notices of Books.
APPARENT CURE.
The Diseases of the Ear and their Treatment. By ARTHUR of Mr. VINCENT JACKSON.) (Under HARTMANN, M.D. Berlin. Translated from the Third J. T--, aged fifty-one, single, was admitted in May, German Edition, by JAMES EBSEiNE, M.A., M.B. Glas. 1886. He had never had gonorrhoea or syphilis. There was Edinburgh: Young J. Pentland. 1887. no family history of cancer. Fourteen days ago he landed Practitioner’s Handbook of Diseases of the Ear and Nasoin Liverpool from America, and, having tramped to the Pharynx. Third Edition of the Aural Surgery. By H. MACNAUGHTON JONES. M.D., 1I.Ch. Cannock Workhouse, was from there sent to the hospital. The man is tall, pale-faced, and a gardener by occupation. DR. HARTMANN’S work will be found very useful, conTwo years since he noticed a small warty growth on the the kind of information that is requisite for under surface of the penis. This gradually extended in all taining just the diagnosis and treatment of diseases of the ear. It does directions, until the whole of the penis and the greater not The was involved. were of the scrotum profess to be a book for specialists. After a few pages discharge part free and most offensive in odour. Pain was not complained which are devoted to a brief historical retrospect, the book of. From childhood the prepuce has never been retracted. may be said to commence with a description of the different The chain of glands in each groin running parallel with methods of and in this chapter the testing of Poupart’s ligament is enlarged, but the glands are not tender, the hearingexamination, the is described in a more by tuning-fork and are freely movable in all directions on pressure. The examination of the urine indicated no abnormality. thorough and complete manner than we are accustomed to On June 3rd, ether having been given, Thiersch’s operation see in any of our English text-books. A short chapter is was performed, the testes, as well as the penis and scrotum, devoted to some special symptoms, and another to general being removed. Before the necessary dissection was com- therapeutics; and then at page 76, in a book of 250 pages,. menced, the corpus spongiosum and urethra were exposed, the diseases of the auricle and external meatus are dedivided across, and freed from their connexions as far back as was necessary, to permit the urethra to be stitched to scribed, the middle and internal ear following in their the lower angle of the wound without the slightest traction. natural order. Each chapter opens with a brief anatomical During the operation the bleeding was free, and required to description of the part involved in the diseases about to bebe arrested by ligatures and forci-pressure forceps. The which serves to refresh the memory of those who lateral portions of the scrotum which had been left were described, united along their edges by points of gut suture. The have not had recent opportunities of working at the subject. whole having been dusted over with iodoform, covered with The account given of the various diseases and the treatcotton wool, and fixed by a binder, the patient was removed ment that should be adopted is, as a general rule, admirable,. to bed. especially where local treatment is required. A little more In the after progress of the case there was nothing of stress we think, be laid upon the value of scraping importance to report; a portion of the flaps as well as out might, granulations and old caseous products from the middle of the deeper tissues sloughed, but the wound soon cleaned ear with a sharp spoon under an anaesthetic. The author,. and the healing process was quickly concluded. As the if on other a little smaller the hand, advocates the use of a special metallic enlarged inguinal glands were, anything, than when admitted, the patient was discharged in July tube connected by rubber with a syringe. If the former be without their removal. In May, 1887, the patient visited and skilfully performed, it is of great assistthe hospital, and in appearance he seemed to be in perfect intelligently ance to the latter operation, and should be accompanied by health. There was no return of the disease, and the enlarged inguinal glands had disappeared. The perineal urethral no greater risk than the forcible injection of fluids into orifice was perfectly patent, the mucous membrane being the tympanic cavity. The old intra-tympanic injections slightly prolapsed. through the Eustachian tube for chronic dry catarrh of the. Remarks by Mr. JACKsoN.-This case is published as a middle ear are still apparently recommended. We wish contribution to the surgery of this particular operation, that the author had had the boldness to say at once and as distinct evidence that it is not only curative it is as a curative measure for this variety of how useless are observed which but permanently so. No doubt cases possibly are considered, on account of the depth and deafness, where no secretion exists. There is very little extensive area of the malignant ulceration, to be beyond said about cerebral abscess dependent upon disease of the the reach of prudent surgery. The case reported was, ear; and absolutely nothing worth reading as to its treatI consider, approaching the border line of those cases ment. At the present day we should expect to find in a which may be removed and those which no experienced book so good as this some expression of opinion as to when surgeon would feel justified in jeopardising the life of his patient by attempting, not a forlorn hope, but a foregone and under what circumstances the skull should be treconclusion. I have not witnessed a more extensive case of phined ; and the exact site of operation in different cases epitheliomatous ulceration of the male external genitals ought to have been discussed. The book, however, taken as than the present one, and in attempting its entire re- a whole, appears to us to be the best in the English language moval I felt that the operation to be permanently successful for the class of readers for whom it is intended-namely, must be as radical as it was possible to make it. The encircling incisions were made as wide of the disease as those who have not time to read such works as those of possible, and after the testes had been exposed, enucleated, Politzer, Gruber, and Troltsch. The translation, with the and removed, the urethra was cut across, and, with the exception of a very few German sentences which have not corpus spongiosum, was dissected back until pendent ; it received quite enough alteration in construction, leaves occupied the lower angle of the wound. In removing the nothing to be desired. body of the penis, and in separating by a process of tearing The previous editions of Dr. Macnaughton Jones’s book and scraping the crura from their bony attachments I was have been favourably noticed in THE LANCET, and the new the rather free haemorrhage which had not prepared for to be assuaged, as previous writers in reporting cases of one has been made more useful to its readers by the addition Thiersch’s operation had stated that the bleeding was of a few coloured plates, taken from Dr. Jones’s Aural Atlas, the
care