1
335 and a half by an inch in extent was present on the right side. There was much constitutional depression, and the patient had vomited frequently during the day. Chloro. form having been arlruiuistered, a vertical incision was made over the swelling, and from this line another incision was made obliqnely ontwards and downwards through the dusky-red and cedematous skin. The sac being opened, a large quantity of purulent fluid escaped, the bowel, more- over, being covered with large nukes of lymph. The intes- tine was then retnrned, and the wound dressed with dry lint, and supported by pads, an opium suppository being at once administered. June 8th.-Wind passed per rectum. Temperature 98 6°F. ; pulse 105. Patient complained of pain in the abdomen. To have nothing but iced milk. 10th.-Pain less. Had a motion during the i3ight. Tem- perature 992°. 11th.-Vomited several times during the eight. Pain less. Had another motion in the night. Wound nearly healed. The urine to be drawn off twice a day by a catheter. 12th.-Bowels regular; vomiting ceased; urine passed voluntarily. 22nd.-Patient much improved. To have some fish or fowl. 26th.- Wound not quite bealed, but discharges very little pus. To be dressed with dry lint. July l6th.-No discharge from wound. 27th.-To wear a trusa. Aug. 8th.-Patient much stronger. To leave the hospital in a day or two. CANCER HOSPITAL. INDURATED CYSTIC TUMOUR OF THE MAMMARY GLAND FROM NON-EMPLOYMENT DURING LACTATION. (Under the care of Dr. MARSDEN.) THE origin of tumours is generally so obscure that a case whose antecedents are tolerably clear is always interesting. The following history shows that the development of the tumour was in all probability due to the disuse of the gland in which it was formed during lengthened periods of lactation with the other gland. We are indebted for the report of the case to Dr. Crombie, house-surgeon. E. H- was admitted into the Cancer Hospital with a tumour in the right breast about the size of a small orange, irregular in outline, hard and nodulated on the surface, but without adhesion to the skin or muscle, and without impli- -cation of the axillary glands. It is to be remarked that, although the patient was only twenty-four years of age, and in other respects a tolerably healthy-looking woman, her sound breast was a very ill-developed one. The tumour was first observed ahout ten months ago, after she had discon- tinued fortwomonthsto suckle on tbat, side, owing to soreness of the nipple. She had therefore suckled on both breasts for seven months, and for nineteen months on the affected gland, as she weaned her child only on admission into the hospital. She bad followed much the same plan on three previous occasions, discontinuing to use the right breast after a time in consequence of soreness of the nipple, and going on suckling with the other for eighteen or twenty months. She had never observed any tumour in the neglected gland, but it had often felt uneasy, and bad always continued to discharge milky fluid from the nipple as long as milk remained in the opposite breast. Iodine paint had been used for the tumour repeatedly, but with- out any beneficial result, there being a gradual increase in its size and hardness. It did not occasion much pain. No perceptible effect having been obtained by the treat- ment employed. Dr. Marsden removed the whole gland on the 24th July. On examination no trace of gland-structure could be de- tected, the tumour consisting of a dense solid material siir- rounding a number of small cysts of various shapes, full of rich yellow cheesy or creamy matter, evidently the inspis- sated secretion of the gland without any admixture of other materials. The colour of these contents was most marked in the portions next the walls of the cysts, which were more deep y tinted, being of abrownish colour; while the portions fnrthest removed were nearly white. The solid portion was made up of a hard, greyish, elastic material, without any appearance of structure to the naked eye; and a section examined under the microscope presented the appearance of molecules destitute of any cellular character, arranged in lines of considerable regularity. Although several por- tions were examined, nothing like a cell could be found. Strong nitric acid had little action when applied on the surface of a section, but hydrochloric acid acted powerfully - the opposite to their bebaviuur when applied to the akin. There sepms little d-’uht that the discontinuance of the normal relief of the one gland while lactation was fostered for an undue length of time, in a woman with weak breasts, by the use of its fellow, was the occasion of the stagnation and deposition of the more solid elements of the secretion and the subsequent induration of the gland. The w und healed slowly, but presented a good healthy cicatrix when the patient left the hospital on Aug. 6th. LEEDS GENERAL INFIRMARY. MALIGNANT DISEASE OF THE TONGUE. (Under the care of Mr. JESSOP.) THE notes of the two following interesting cases were taken by Mr. Robson. In one the tongue was removed by Chassaignac’s method under the chin, in the other by liga- tures applied round the base of the tongue after an incision was made in the cheek, from the corner of the mouth to the angle of the jaw on the left side. Both seem to have been successful for a time at least, but it is to be feared that recurrence is about to take place in the case removed by the 6,,.raseur submentally. Epithelioma of tongue; removal of entire organ by Chas- saignac’s method.-John A-, cart-driver, aged sixty-one, had always enjoyed good health, never having been troubled with rheumatism, sore-throat, ulcers, specific nodes, nor sores on penis. Has always been steady, but has smoked a great deal-five or six ounces of tobacco weekly-generally using a short clay pipe. Two years and a half ago, with- out any apparent exciting cause, a small hard lump, about the size of a pea, formed on the upper surface of the left half of tongue, midway between the base and apex, and over this he noticed a little white patch. The whiteness soon disappeared, but the small tumour remained, giving no pain up to four months ago, when it began to increase, and continued to do so until May 21st, 1872, at which time it was about the size ot a bea.n. He showed it to a friend, who applied some burning fluid to it, which converted it into an open sore, and caused it to spread very rapidly. He has had it touched with the fluid several times since, each application giving him great pain and causing the surface of the sore to have a white appearance. He then consulted Mr. White of Doncaster, who, recognising the nature of the case, advised its removal, and immediately sent him to Mr. Jessop for that purpose. The patient was accordingly admitted into the Leeds General Infirmary on the lst of June, at which time there was an open sore on the left half of the upper surface of the tongue, measuring one inch and three-quarters antero- posteriorly by one inch and a half laterally, and raised three-eighths of an inch above the surface of the mucous membrane. The elevation consisted of small granulations, raised in cauliflower-like excrescences, which had spread to the apex and down the left side of the tongue, but had not encroached much on the right side. It did not give much pain when at rest; but on moving his tongue, as in masti- cation or deglutition, the pain was great. There was no enlargement of glands nor cachectic appearance, and he seemed to be in good health, having a good appetite, but only being able to take liquid food, on account of the pain he had in mastication. The following operation was performed on June 6th :- An incision of about an inch was made through the skin and cellular tissue, immediately above and parallel with the upper border of the byoid bone. Into this a needle- broad, flat, and curved, with an open eye, and having an é,:ra.sel1r wire attached in the form of a loop-was inserted and passed into the noor of the mouth by the side of the frænum linguae. The loop having been brought through, and the needle released, the wire was passed over the

CANCER HOSPITAL

Embed Size (px)

Citation preview

335

and a half by an inch in extent was present on the rightside. There was much constitutional depression, and thepatient had vomited frequently during the day. Chloro.form having been arlruiuistered, a vertical incision wasmade over the swelling, and from this line another incisionwas made obliqnely ontwards and downwards through thedusky-red and cedematous skin. The sac being opened, alarge quantity of purulent fluid escaped, the bowel, more-over, being covered with large nukes of lymph. The intes-tine was then retnrned, and the wound dressed with drylint, and supported by pads, an opium suppository being atonce administered.June 8th.-Wind passed per rectum. Temperature 98 6°F. ;

pulse 105. Patient complained of pain in the abdomen.To have nothing but iced milk.

10th.-Pain less. Had a motion during the i3ight. Tem-

perature 992°.11th.-Vomited several times during the eight. Pain

less. Had another motion in the night. Wound nearlyhealed. The urine to be drawn off twice a day by acatheter.12th.-Bowels regular; vomiting ceased; urine passed

voluntarily.22nd.-Patient much improved. To have some fish or

fowl.26th.- Wound not quite bealed, but discharges very little

pus. To be dressed with dry lint.July l6th.-No discharge from wound.27th.-To wear a trusa.Aug. 8th.-Patient much stronger. To leave the hospital

in a day or two.

CANCER HOSPITAL.INDURATED CYSTIC TUMOUR OF THE MAMMARY GLAND

FROM NON-EMPLOYMENT DURING LACTATION.

(Under the care of Dr. MARSDEN.)THE origin of tumours is generally so obscure that a case

whose antecedents are tolerably clear is always interesting.The following history shows that the development of thetumour was in all probability due to the disuse of the

gland in which it was formed during lengthened periods oflactation with the other gland. We are indebted for the

report of the case to Dr. Crombie, house-surgeon.E. H- was admitted into the Cancer Hospital with a

tumour in the right breast about the size of a small orange,irregular in outline, hard and nodulated on the surface, butwithout adhesion to the skin or muscle, and without impli--cation of the axillary glands. It is to be remarked that,although the patient was only twenty-four years of age, andin other respects a tolerably healthy-looking woman, hersound breast was a very ill-developed one. The tumourwas first observed ahout ten months ago, after she had discon-tinued fortwomonthsto suckle on tbat, side, owing to sorenessof the nipple. She had therefore suckled on both breasts forseven months, and for nineteen months on the affectedgland, as she weaned her child only on admission into thehospital. She bad followed much the same plan on threeprevious occasions, discontinuing to use the right breastafter a time in consequence of soreness of the nipple, andgoing on suckling with the other for eighteen or twentymonths. She had never observed any tumour in the

neglected gland, but it had often felt uneasy, and badalways continued to discharge milky fluid from the nippleas long as milk remained in the opposite breast. Iodine

paint had been used for the tumour repeatedly, but with-out any beneficial result, there being a gradual increase inits size and hardness. It did not occasion much pain.No perceptible effect having been obtained by the treat-

ment employed. Dr. Marsden removed the whole gland onthe 24th July.On examination no trace of gland-structure could be de-

tected, the tumour consisting of a dense solid material siir-rounding a number of small cysts of various shapes, full ofrich yellow cheesy or creamy matter, evidently the inspis-sated secretion of the gland without any admixture of othermaterials. The colour of these contents was most markedin the portions next the walls of the cysts, which were moredeep y tinted, being of abrownish colour; while the portionsfnrthest removed were nearly white. The solid portion was

made up of a hard, greyish, elastic material, without anyappearance of structure to the naked eye; and a sectionexamined under the microscope presented the appearanceof molecules destitute of any cellular character, arrangedin lines of considerable regularity. Although several por-tions were examined, nothing like a cell could be found.Strong nitric acid had little action when applied on thesurface of a section, but hydrochloric acid acted powerfully- the opposite to their bebaviuur when applied to the akin.

There sepms little d-’uht that the discontinuance of thenormal relief of the one gland while lactation was fosteredfor an undue length of time, in a woman with weak breasts,by the use of its fellow, was the occasion of the stagnationand deposition of the more solid elements of the secretionand the subsequent induration of the gland.The w und healed slowly, but presented a good healthy

cicatrix when the patient left the hospital on Aug. 6th.

LEEDS GENERAL INFIRMARY.MALIGNANT DISEASE OF THE TONGUE.

(Under the care of Mr. JESSOP.)

THE notes of the two following interesting cases weretaken by Mr. Robson. In one the tongue was removed byChassaignac’s method under the chin, in the other by liga-tures applied round the base of the tongue after an incisionwas made in the cheek, from the corner of the mouth to theangle of the jaw on the left side. Both seem to have been

successful for a time at least, but it is to be feared thatrecurrence is about to take place in the case removed bythe 6,,.raseur submentally.

Epithelioma of tongue; removal of entire organ by Chas-saignac’s method.-John A-, cart-driver, aged sixty-one,had always enjoyed good health, never having been troubledwith rheumatism, sore-throat, ulcers, specific nodes, norsores on penis. Has always been steady, but has smokeda great deal-five or six ounces of tobacco weekly-generallyusing a short clay pipe. Two years and a half ago, with-out any apparent exciting cause, a small hard lump, aboutthe size of a pea, formed on the upper surface of the lefthalf of tongue, midway between the base and apex, and overthis he noticed a little white patch. The whiteness soondisappeared, but the small tumour remained, giving nopain up to four months ago, when it began to increase, andcontinued to do so until May 21st, 1872, at which time itwas about the size ot a bea.n. He showed it to a friend,who applied some burning fluid to it, which converted itinto an open sore, and caused it to spread very rapidly. Hehas had it touched with the fluid several times since, eachapplication giving him great pain and causing the surfaceof the sore to have a white appearance. He then consultedMr. White of Doncaster, who, recognising the nature ofthe case, advised its removal, and immediately sent him toMr. Jessop for that purpose.The patient was accordingly admitted into the Leeds

General Infirmary on the lst of June, at which time therewas an open sore on the left half of the upper surface ofthe tongue, measuring one inch and three-quarters antero-posteriorly by one inch and a half laterally, and raisedthree-eighths of an inch above the surface of the mucousmembrane. The elevation consisted of small granulations,raised in cauliflower-like excrescences, which had spread tothe apex and down the left side of the tongue, but had notencroached much on the right side. It did not give muchpain when at rest; but on moving his tongue, as in masti-cation or deglutition, the pain was great. There was no

enlargement of glands nor cachectic appearance, and heseemed to be in good health, having a good appetite, butonly being able to take liquid food, on account of the painhe had in mastication.The following operation was performed on June 6th :-

An incision of about an inch was made through the skinand cellular tissue, immediately above and parallel withthe upper border of the byoid bone. Into this a needle-broad, flat, and curved, with an open eye, and having ané,:ra.sel1r wire attached in the form of a loop-was insertedand passed into the noor of the mouth by the side of thefrænum linguae. The loop having been brought through,and the needle released, the wire was passed over the