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C.D.-This was a similar case of rodent ulcer, diagnostic point of view, but a lucky thing for in the left side of the nose, extending to the
the patient. What I do feel keenly is this: corner of the eye. His age is 42, and the the sad, hopeless cases that are sent to me of ulcer had existed for over six years.
He did advanced cancer being operated on once and not receive more than a dozen applications recurring badly-these I look upon now as from me in all. It healed without any difficulty; quite hopeless, yet, perhaps, 12 months or two the only thing that occasioned him
trouble years ago what a very different result this at all was the remedy, and you will see the treatment would probably have effected. A effects in his case. Although he has quite
Although he has quite | case of cancer cannot possibly be treated too recovered now, I would like to direct your early by X-rays, and if well advanced I must attention to the present condition of the skin tell you it is well-nigh hopeless. on that side of his face. This case should act G.H.—This patient, a man of 65 years, had an as a warning to anyone who may imagine that ordinary epithelioma on the end of his nose X-rays are a mild sort of remedy.
completely removed by Dr. Schlessinger about E. F.—The patient, an old man over 70,
two years ago.
It returned in last December, came to me with a small suspicious growth
and grew vigorously. His brother died of cancer, forming just under the front of his tongue in
and he has a bad family history in this way. the frænum. It was just in that doubtful When sent to me by Dr. Schlessinger, at the bestage that no one would care to say what it ginning of July, he had an epithelioma growing was, except, taking all the symptoms and facts strongly, although being treated with escharotics; of the case into consideration, it seemed most the surface was partly burnt down, but it was probably malignant. I only gave him one
still the size of half a walnut. It presented strong application of the rays, and that is more such a striking appearance that I asked him to than a year ago, and not having the confidence have it photographed, which unfortunately was in it then that I have now I did not care for done by an amateur, and I fear the result a the patient to run any risk, but sent him back failure. I forgot to mention there were nodules to his medical adviser, Mr. Rudall, with a view
of the disorder disseminated through to skin to having it removed, intending to apply the nearly over the nose, and barring the X-ray X-rays again afterwards. Mr. Rudall took
treatment there was no other course left but such a serious view of the case that he was
the removal of the entire nose, which probably inclined to remove the whole tongue, as he told
would only postpone the usual inevitable end. me in his experience these partial operations
In one or two ways it was not a favourable case, on the tongue were always failures. The patient and was a recurrent case. On the other hand, was so strongly adverse to losing his tongue it was most favourably situated for this that he consented merely to remove the growth,
treatment. I applied the rays and he did so. I have never seen the patient average about three times a week, and at first since, but I learnt on enquiry a few days ago
for ten minutes each time, gradually reducing that there has been no return of it. I attached it as the desired reaction was acquired. It has but little importance to it at the time, but I behaved in the usual way of diseased tissue ; have had two very similar cases since, which, the cancerous growth broke down, and, as having only recently occurred, are not so suit- you will see, now has gradually perished. In a able for my illustration ; but in both these short time nothing but healthy tissue will be cases two or three applications seemed to quite left, and I shall then allow it to heal up. I clear up all appearance of the malignancy, and regard it as practically cured now. it quite disappeared, and I now can see nothing II.1.—This is a woman, aged 45, from whom impossible in one strong application of X-rays Dr. Cooke removed a small epithelioma on the to an early and doubtful malignancy and end of her tongue in February of this year. It acting in this manner, especially if the growth started to return about June, and I saw her was removed at the same time. Now, my moral first on July 12th. The scar of the former is this, and this I take to be the key of the operation had healed well, but evidence of whole difficulty :
I believe all cancers have recurrence in this scar was unfortunately an early stage in which the growth is very apparent, and the patient felt a return of the small and malignancy is in an undecided state, uneasiness in the tongue. I gave her a few or rather, I mean, cannot be determined posi- preliminary exposures, and Dr. Cooke operated tively in diagnosis. Now, I am convinced that again in July, removing only a very small in all these cases where it is so situated that portion--nothing appreciable--and since then I the X-rays can be effectively applied that an have been treating her with the X-rays. Giving easy cure could be effected and the patient it her rather strong, the reaction has been somewould never know for certain whether it was what severe, and it is too soon yet to be able to malignant or not; very unsatisfactory from a pronounce on the success or otherwise of the
treatment. I quote this as a typical case of by Dr. Kelvington. In his report both the what
may be done if we can only succeed with tongue and glands give evidence of epithelioma this treatment; that is, instead of a serious of long standing, which exactly corresponds operation of removal of the whole tongue, a with his unfortunate history. comparatively trivial one of this nature. I will
J.K.—This is another similar case. A man take this opportunity of saying that I do not at
aged 53 originally sustained a crushing present take a too hopeful view of tongue cases;
accident on his head, and last year a small they are not the class of cases that I prefer
malignancy formed under his tongue, for which for this treatment.
he was attended by Dr. Duncan in 1901. In J.K.—This is a man aged 47. I was asked October, Mr. O'Hara operated and removed it, to see him by Mr. O'Hara on May 28. He but it returned so badly that he removed the appeared to be suffering from a cancerous entire floor of the mouth, dividing the jaw at growth, inside on the lower jaw, on the left side.
the symphysis on May 19th. It returned again It was evidently of the nature of an epithelioma, rapidly, and Mr. O'Hara sent him to me at and the glands were considerably enlarged. the end of July. I then found him in a very One point in his favour was that it had only hopeless state, and I hesitated to attempt to existed a few months, but was rapidly spreading. а
do anything for him, it looked so utterly hopeMr. O'Hara contemplated removing a portion less. The whole of the region under the jaw. of the jaw as evidently the best thing to be seemed a mass of malignant disease. Disdone, but before doing so asked me to give the charged large quantities of fætid pus and blood X-rays a trial. Before commencing I took a through the opening in the old wound of the small clipping of the growth, which was kindly last operation, which was breaking down, and examined for me by Dr. Kelvington, and pro- small portions of malignant growth sprouting nounced to be epithelioma, and in a very out through it. Apparently another month or active state. My own opinion is strongly
two at the farthest would see the end of the that, if the case had been left to the
However, at Mr. O'Hara's earnest usual course of events, at the rate it was request I said I would try the effect of the rays progressing all doubts would be very soon
on it, and the improvement was immediate and removed. I gave him preliminary treatment decided from the very first. I started on July with the X-rays, and it progressed most favour- 21st and gave it to him every day. The disably. On June 12 Mr. O'Hara removed the charge lessened, and to my surprise the growth enlarged and infected glands, and also scraped steadily subsided and got smaller and smaller. and curetted the jaw bone, and after a week I Small pieces of bone came away. I took a resumed the X-ray treatment. The case pro- skiagram of the symphysis of the jaw, which gressed most satisfactorily towards recovery, the
you can now see, and the condition disclosed and mouth completely healing up, and the malig- the improved state of affairs encouraged us to nancy disappeared entirely.
think the case was not so hopeless after all. H.I.- This case was sent me by Dr. Hodson, Some days ago Mr. O'Hara again cut down a man about the same age as last, but the on to the symphysis of the jaw, which seemed disease has existed nearly three year, and this to locate the seat of the disease, and removed has made the case almost a hopeless one. It only the silver wire suture, which you see in the was epithelioma of the tongue. About one- skiagram, and a small piece of necrosed bone, third of the tongue on the left side was already both which I have here. That is all that gone, as if cut out by a gouge right down far was done except that whilst under chloroforin back to the root of the tongue. I started the I gave the ends of the jaw a thorough exposure treatment on July 1st, and from the first it to powerful X-rays for about ten minutes, soon began to put on a healthier appearance, that is, right into what appeared now to be the and the foul and characteristic smell dis- seat of the disease, and the wound was then appeared almost entirely. This is a common closed up. So far the result seems to have been and hopeful sign in these cases. I followed a most satisfactory; the wound has healed by similar line of treatment as I did in the previous primary union and has a healthy appearance, case, and on July 24th Mr. O'Hara operated and there has been no discharge from it since; and removed the sub-maxillary glands, tied the and the patient says he feels so much better lingual artery, which was nearly ulcerated that he feels as if he ought to go to work. In through, and merely curetted the tongue. I this treatment one of the most striking facts I resumed treatment a week after, and the have noticed is how directly the advance of the present position is this : The wound has healed disease is arrested, even although the difference well, and the side of the tongue is now nearly cannot be seen by the patient. Now he exhealed up. I have here sections of the tongue presses himself as feeling remarkably well and and glands, kindly made for me and examined different to what he was for a long time pre
viously. It is premature to say much about
There was some difficulty in labour owing to the large size of the child, who was delivered by forceps by Dr. Wigg, the mother having been in labour nine hours.
Beyond observing that he was a very large baby, nothing particular was noticed about the child at birth, but he weighed 14 lb. On the fifth day after birth the right leg was first seen to be rather larger than the left; then it was noticed that his right arm was larger than the left, and the right cheek larger than the left cheek. When five months old the child weighed 28 lb. The child is nursed by his mother, and is carried equally often in the right and left arm. Posture has nothing to do with the deformity.
A CASE OF COMPLETE ONE-SIDED GIGANTISM
WITH ENLARGEMENT OF THE OPPOSITE
SIDE OF THE BRAIN.
M.R.C.P. (Lond.), M.R.C.S. (Eng.), Adelaide.
SEVERAL cases of defective growth of the whole of one side of the body are on record, and these have been found at the autopsy to have been associated with deficient development of the opposite side of the brain.
But the reverse condition, thatofone-sided overgrowth, including enlargementof the opposite cerebral hemisphere, is certainly one of the utmost rarity.
The subject of this condition, which is exhibited At present he shows well-marked deformities to the Branch to-night, is an infant aged seven (they are much more evident than appears from months, a boy, the youngest of a family of three. the accompanying photograph). The left side His mother, who is a healthy woman, and is of the cranium (including the frontal, parietal, present with her child to-night, attributed her
temporal and occipital regions) is much larger child's deformity to a shock which she received at than the right side. The anterior fontanelle is the sight of a friend who had been accidentally widely patent, but it does not bulge externally. killed. This occurred at the time when she The posterior fontanelle is just patent. There was two months pregnant. Her nine months appears to be slight proptosis of the left eye. of pregnancy differed but little from the previous The pupils are equal, and both react readily to ones, with the exception that on this occasion light. The ears are of equal length. The right her abdomen was unduly large-larger than it cheek, jaw and gums are distinctly larger than was during the previous pregnancies. At the the left. There are no teeth. The right side fifth month, and again at the seventh month, of the tongue is very greatly enlarged, and the mother tells us there were some false labour when the tongue is protruded it deviates to the pains, for which she obtained medical treatment. left, obviously owing to the great bulk of
its right half. The right shoulder, arm, but the more homely questions of diagnosis of forearm, wrist, hand, fingers and nails are sore throats, of rashes, of phthisis, the treatmuch larger than the left. Deltoid tubercle ment of broken limbs and so on, and one is of acromion to end of styloid process of sometimes tempted to wish that the years at ulna right side measures 20 cm.;
the hospital had been somewhat differently side, 17 cm. The enlargement appears to spent. Among those common cases that include skin, subcutaneous tissue, muscle, frequently require careful consideration and and certainly also bone. Little difference is to treatment, and of which we see little at a be noted in the size of the two sides of the general hospital, and with which we all have chest : the chest appears to be well formed and to deal, are miscarriages or abortions. normal. There is no transposition of viscera. Doubtless my own experience is similar to The right side of the abdomen is slightly larger that of many others. Shortly after getting my than the left; this is more particularly noticed degree I went to act as locum tenens for a man in the skin and the subcutaneous tissue, which with a large practice. One of my first experiforms a loose fold above the right Poupart's
was to be called to one of his best ligament; not present on the left side. There patients, who was said to have miscarried at is an umbilical hernia. The right buttock, leg, about the second month. I was shown, foot, toes and toenails are very much larger wrapped up in a diaper, what then appeared to than the left. The difference in size of these
me a very extraordinary-looking lump of tissue, parts is very striking. The right leg is not only as I had never seen anything of the kind larger but longer (by about. 5 cm.) than the before. The lady herself, probably more left. The enlargement appears to affect skin, experienced than I then was, said she thought connective tissue, muscle and bone. There is it had all come away.
I readily agreed, and no paralysis of any muscle, and the muscular fortunately for both of us it had, and in a
week's time she was well again. child is, however, more clumsy with the right
On starting practice for myself, I soon found side, and if he attempts to reach out for an
that such experiences multiplied, and I began object with the right arm the movement is less
after a time to make notes of these cases. In decided than it would be if the left arm were
I have collected short notes of 96 cases, used. The knee jerks are present, but are less
a brief analysis of which I bring before you readily obtained on the right side than on the left.
for your consideration to-night. There is then an enlargement of almost the In doing so, I may say that my object has whole of the right side of the body, together not been to make out that my methods and with the opposite (left) side of the cranium, and, results have always been the best, but simply therefore, also of the left side of the brain ; to give my impressions founded upon the and, one may infer, also an enlargement of the experience furnished by these cases, and not right side of the spinal cord. For it is incon- gathered at all from books, hoping to receive ceivable that the enlargement of the brain is many valuable hints from members afterwards due merely to a neurolgia overgrowth; it is far for my better guidance in the future. There more probable that the nerve cells and their
are certain parts of our work of which this is axis cylinders—the upper neurones-are one, such as the giving of anæsthetics and the larged; and, if the upper neurones, probably management of labour, in which we all get also the lower ones.
practice, and form decided (Rend before the South Australian Brunch of the British Medical opinions, even to each one thinking that he
does these things better than most other men,
so I hope to hear many opinions and suggesRECORDS FROM GENERAL PRACTICE.-- tions to-night. CASES OF ABORTION.
I take, then, abortion to mean,
" the arrest By J. A. Cameron, M.B., B.C. (Camb.), Ipswich, of gestation, and the expulsion of the embryo Queensland.
at a period antecedent to its viability—that is,
before the end of the sixth month."-Rentoul. During those haleyon days of one's medical And, of course, an abortion is said to be complete career, when one is walking the wards of a when both embryo and membranes are exhospital as dresser, clerk and house officer, it pelled, and incomplete when the embryo is appears to be vastly important to know all expelled and the membranes are retained. about the latest and most wonderful feats of An abortion is concealed when the embryo surgery, and all the curiosities of medicine and perishes in the uterus, and when both it and bacteriology; but when one gets into general the membranes are retained, and expelled practice it is soon discovered that it is not these perhaps some months later. Four out of the things that occupy much time and attention, 96 were of this nature.
Causation. – The causes divide into four The ovum may be expelled in a mass during groups—criminal and maternal, fæetal and the second and third months, but after the paternal causes. I do not, however, propose
fourth month the embryo is generally expelled to enter into them in detail. I think there can and the membrane retained for some time after. be little doubt that the bougie or ladies' I have known women at this stage to walk silent pills account for the greater number. about for three or four days with the placenta Materual causes may
be general, such as fevers in the womb after the foetus has been expelled. and other diseases, and local, for example, In any case the placenta is usually retained fibroids, endometritis following induction, in- longer in abortion than in labour at term. flammation following attempts at prevention, Having during the last five years known of and lesions and displacements of the uterus. three cases, in two of which extra-uterine gestaThe fætal and paternal causes are many in
tion without severe symptoms was at first number, but not so frequently met with as the mistaken for a miscarriage, and another in two former groups. Herman gives 20 per
which a miscarriage was diagnosed by two men cent. as the normal frequency of abortion to as a tubal pregnancy till the embryo came labours at term. An American writer, quoted away, I do not think it superfluous to mention by the Lancet, gives the proportion as ten mis- that we should ever remember the possibility carriages to 27 labours in native-born American of confounding the two conditions; for in extrawomen, and the same proportion among negro uterine gestation, also, bleeding from the vagina
Other authorities variously estimate with expulsion of decidual tissue is often the frequency from 1 in 4 to 1 in 80. My accompanied by the pain of uterine contraction, figures are not sufficiently large to draw any as in abortion. conclusions of value, but I am inclined to Results and Treatment. The two great imthink that 1 in 4 does not over-estimate the
mediate dangers to be apprehended are loss of frequency here. Multiparæ abort more fre
blood and septic poisoning, with its long train quently than primiparæ, as is to be expected. Éleven of my series were first pregnancies.
of possible evils. The more remote dangers,
such as subinvolution of the uterus, I do not The second and third months seem to be the intend to touch upon. period at which most cases occur ; 57 out of 96
Bleeding may be profuse enough to cause took place then.
grave primary anæmia, or if prolonged may in Symptoms.- The symptoms vary greatly with that manner undermine health. Primary severe the stage of pregnancy, and the condition of hæmorrhage cannot always be prevented. Four the foetus and placenta. Shortly after the first of my cases were blanched from loss of blood month the bleeding is not usually great in from a sudden copious hæmorrhage before I amount; at the third and fourth month it was called in. I do not propose even to mention usually continues from beginning to end of the various septic troubles that may arise, or labour; at the fifth and sixth month a dis- their treatment, as I have been fortunate enough charge of liquor amnii frequently takes place, to have very little experience of them, and they and, generally speaking, the more advanced were most thoroughly expounded here not long the pregnancy the more closely it resembles ago. In abortions even more than in labours labour at term. If sudden violence causes at term I believe we ought to be free from the abortion, there is often as a first symptom a supervention of sepsis. Except in a few cases great gush of blood, in which the ovum may of criminal abortion instrumentally induced, we escape, a sharp pain being felt at the time. are free from what I believe is the chief cause
It is well to remember that before the end of puerperal sepsis : the examining finger of a of the second month, the placenta not being dirty midwife. Few doctors nowadays are so formed, hæmorrhage is from the entire uterine careless or ignorant as to neglect proper surface, while at a later period it is from the surgical cleanliness in their obstetric work, but placental site. This point ought to be borne in in country practice, at least, it is almost mind in treating the cases. Hæmorrhage may impossible to prevent the woman in attendance begin before or after the pains, and free from making vaginal examinations before hemorrhage is generally accompanied by sending for the doctor. Fortunately, she does strong contractions.
not often do so in cases of abortion. Three of A fatus may die and be retained for several my cases had a bad-smelling discharge, with days or even weeks. In one of my cases the high temperatures, when I was called to them fetus apparently died at the fifth month and first. I had reasons for suspecting that they was retained till term. I will refer to this case had all been self-induced, but all improved again later. The expulsion of a dead fætus is
rapidly when the uterus was emptied. Only generally slower, with less loss of blood, and one case of the 96 became septic after beginning with slower involution of uterus afterwards. treatment, and that was the case referred to