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719 SMCOMATOUS TUMOUR UNDER THE LOWER JAW. J. 0., aged 34, was admitted April 18, under Mr. Liston. He has good health, and is of regular habits. Twenty-five years ago, a small, hard swelling was observed under the jaw on the left side. It was not painful ; increased but very littleduring the first fifteen years; and was not at this time much larger than a chestnut. About five years ago, it began to increase more rapidly. He applied to a surgeon, who gave him some ointment, which he used externally. It was also leeched, and he took some drops internally. At present he has a large tumour, about the size of the fist, under the jaw, on the left side, extending from the angle nearly to the symphisis, and passing down on the neck. It is hard, lobulated, and moveable, having no connection with the jaw or the surrounding parts. On passing the fingerpas8.4 0 0 3 0 0 xTcoE56 0 0 1001 Tc(the 001 Tc(On0.96.6667 0 is6the5

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719

SMCOMATOUS TUMOUR UNDER THE LOWERJAW.

J. 0., aged 34, was admitted April 18,under Mr. Liston. He has good health, andis of regular habits. Twenty-five years ago,a small, hard swelling was observed underthe jaw on the left side. It was not painful ;increased but very littleduring the first fifteenyears; and was not at this time much largerthan a chestnut. About five years ago, it

began to increase more rapidly. He appliedto a surgeon, who gave him some ointment,which he used externally. It was also

leeched, and he took some drops internally.At present he has a large tumour, about

the size of the fist, under the jaw, on theleft side, extending from the angle nearly tothe symphisis, and passing down on theneck. It is hard, lobulated, and moveable,having no connection with the jaw or thesurrounding parts. On passing the finger

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and other functions natural ; the cough was.attended with but little pain. He did notsuffer much on taking a full inspiration.The expectoration, in addition to being verycopious, was sanious, of a brownish-redcolour, verging in some parts towards agreen. The red colour was so marked, thatit was evidently an exudation from blood-vessels. The odour of both the sputa andthe breath was excessively foetid. Therewas no part of the chest which was entirelydull on percussion, nor could any spot bedetected where the respiration appeared tobe wholly suspended. Strong mucous ralewas audible in most parts of the thorax.The complexion, the state of the pulse, thegeneral strength of the patient, and the ten-dency to hafmoptysis, were all contra-indica-tive of the use of such tonics as might havebeen necessary, had the gangrene been theprimary disease, and a consequence of de-bility, accompanied by extreme depressionand typhoid tendency. Acid mixture wasprescribed with the pill" saponis cum opio"at bed-time, to diminish the irritability of thelungs, and procure sleep.

22. The expectoration is mixed withblood : the countenance rather florid ; pulserather hard ; general state, that of fever. Hewas bled to eight ounces.

After this the general character of theexpectoration continued to improve ; thecolour was less brown ; it had more the

appearance of muco-purulent expectoration,and its odour was less offensive.June13. There was a return of haemoptysis

to-day. He was again bled to eight ounces,and a blister was applied over the scrobicu-lus cordis, at which part he had pain. Atthis period, twenty-six days after his ad-mission, the disease had lost the character-istics of gangrene of the lung, and had thoseof haemoptysis.

29. He again expectorated blood to-day. I

He was again bled, and had a large blisterapplied over the sternum.

July 17. Since the last report there hasbeen no haemoptysis ; there has, however,been a considerable preponderance of mucusin the sputa, and it is now wholly free fromthe colour and odour which were at first so

predominant. The quantity has been gradu-ally reduced to a few ounces a-day, andthe patient continues improving in strength.The treatment has consisted in the occa-

sional administration of mild aperients.Duting the entire period of his illness hehas been kept perfectly quiet, and has beenconfined to rice-milk and brotli diet.

Dr. Chowne observed of this case, thatgangrene of the lung was a disease of com-paratively rare occurrence, even in an idio-pathic form, but still more rare as a sequelof inflammation. When inflammation andgangrene of the lungs co-existed, the inflam-mation was, commonly, a consequence of thegangrene-a resource of nature to separate

and throw off the gangrenous part. Therewas sometimes, aud, indeed, not unfre-

quently, a rector of the breath and of theexpectoration, the consequence of inflamma-tion alone, and resembling both in kind anddegree the foetor of gangrene. In suchcases, however, the sanious brown and

greenish appearance was generally wanting.Although the case, from having proceededfavourably, necessarily precluded the possi-bility of arriving at absolute certainty as tothe existence of gangrene, yet, so far assymptoms could be relied ou, there was notany room for doubt. It might have beenobserved, that the case had been attendedwith less prostration of strength; less generaldepression and anxiety of countenance ; less,indeed, of all the ordinary concomitants ofgangrene than usual; but this appeared tohave been attributable to the nature of theattack and to the stamina of the patient.

MISFORTUNE OF FALLING INTOTHE HANDS OF A PHYSICIANAND A SURGEON.

ROBERT STEVENS.

To lhe Editor of THE LANCET.SiR :-Allow me to submit to your at-

tention the following case. A person is

placed in a hospital, under the care of oneof the physicians, with an enlargement ofthe heart. The physician proceeds to allaythe inordinate action of that organ bv theuse of digitalis, and to diminish the columnof blood by venesection ; but the personwho is entrusted with the operation ofbleeding opens an artery instead of a vein,in consequence of which a surgeon in the

hospital ties the artery, thus Jeaving theheart, with its inordinate action, nearly alimb less to supply, increasing the columnof blood in intensity ; and not only whollydefeating the remedial intention of the phy-sician, but also adding much to the mis-chief,-ending, in fact, in the death of thepatient. Thus betwixt two stools the pa-tient falls to the ground, apparently a sacri-fice to an injudicious division of labour.This is only one case among fifty of thesame kind that are equally possible. If thephysician and the surgeon could be in com-plete and intelligible correspondence witheach other, the result might be otherwise;but this intercourse is impossible. As wellmight one man, a geometrician, with an-other, an arithmetician, attempt to makebetween them one mathematician. Absurdas would be the experiment, yet its parallelis precisely found in the profession of me-dicine. The distinction between surgeonsand physicians is not more ridiculous thanit is, in many cases, fatally mischievous.I am, Sir, your very obedient servant,

Kennington Common, July 27, 1840.