Abbildungen der Seite

I have now freely and without reserve, given my views in relation to the use of quinine in our remittent feversand in lauding, as I have done, its efficacy, I cannot but apprehend that the charge of uliraism will be preferred against me by those who are still unacquainted with its properties. Be this as it may, I fear nothing from the test of time and experience, and will be amply compensated for the temporary odium, if this article will induce any who may have been backward in the use of quinine to give it a fair trial under the circumstances here recommended. It should be borne in mind, however, that we occasionally meet, even in this latitude, cases of typhoid fever, or of enteritic fever, in which quinine possesses no peculiar efficacy. But these fevers do not present the paroxysmal type, and can therefore be easily distinguished from those in which it is useful.- Southern Med. and Sur. Jour.

Excision of the Inferior Maxillary bone for Osteo-Sarcoma. By William H. DeADERICK, M. D., of Athens, Tennessee.-The operation of which I propose to give a very brief account, was performed nearly thirty-seven years ago, and at that period, so far as I am informed, was unknown in surgery. Since that time it has been repeatedly executed, and the claim of having originated it has been set up by a foreign surgeon. By comparison of dates it will be seen that iny operation preceded that of M. Dupuytren by two years.

On the 6th of February, 1810, Jesse Lay, a lad of about fourteen years of age, was brought to me on account of an excrescence which gradually arose from his gums, and which, in consequence of long neglect, completely enveloped the lower maxillary bone of the left side. It filled the inside of his mouth 10 such an extent as greatly lo interfere with respiration and deglutition. Externally, the tumor exhibited the appearance of a wen of considerable size, and as it was daily augmenting it was evident that nothing short of its entire removal, with the portion of the bone it occupied, could save the life of the patient. Accordingly an incision was commenced just below the left ear, and continued along ihe course of the bone to the centre of the chin ; a second one was made at right angles to the first. The integuments were then dissected from the tumor, and the bone sawed off at the angle of the jaw, and half an inch from the centre of the chin nearest ihe angle divided. The integuments were united in the usual manner, and ihe boy had a speedy and perfect recovery. The youth at the tiine of the operation, although fourteen years of age, was not larger than boys usually are at ten or eleven ; but iinmediately afterwards commenced growing, and attained the ordinary slature of manhood. A well trained whisker hides, in a great mea. sure, the scar left by the incision, and at a short distance the effects of the operation would not be observed.

Athens, Nov. Ist; 1846.

Note. Dupuytren is the generally accredited author of the operation above described. This distinguished surgeon removed a portion VOL. X.



of the lower jaw for a cancerous affection of the gums in 1812. The operation of Dr. Deaderick, it will be seen, was performed two years prior to that time. Dupuytren's case was reporied to the Faculty of Medicine at Paris, by Lisfranc, in 1813. The report of Lisfranc is republished in the Dictionnaire des Sciences Medicales, vol. xxix. p. 430. Dr. Deaderick did not give to the public any account of his operation before 1823, when he described it in the American Medical Recorder.

Dr. Mott, in a letter to Mr. Liston, has preferred a claim to priority in this operation. He says, "I claim for myself and my country originality in the operation of exsection of the lower jaw at the temporo-maxillary articulation, and in different proportions for osteo-sarco

I avow and declare solemnly that before my first exsection of the lower jaw for osteo-sarcoma, I never saw, read or heard of any. thing of the kind ever having been done in any country.” He adds, “We repeat and aver, that the exsection of the lower jaw of even a fourth part, much less a half or two-thirds of it, sor any form of sarco. ma involving the whole texture of the bone, has never in our opinion been performed by any surgeon, past or present, until by myself at the time above stated."

The operation of Dupuytren is admitted not to bave been for osteosarcoma, but for a cancerous sore situated over the angle of the jaw, Ribes, in the Dict. des Sri. Med., referring to this operation, has the following words: These facts lead to the hope that fungus, or osteo-sarcoma of the lower jaw, a disease so formidable that it has in many cases been vainly attacked with the iron and fire, will henceforwurd, since the operation of M. Dupuytren be removed by amputation of a portion more or less considerable of the lower jaw without the danger of any accident, and, il' the disease be local, with the certainty of success."

Many years before these predictions were uttered in Paris, the operation had been successfully performed by a young surgeon in the backwoods of Tennessee.

In a lecture delivered by Dr. Houston, of Dublin, in 1844, and published the same year in the London Lancet, the honor of having originated this operation is claimed for Mr. Cusack, who has performed it twelve times. The lecturer says, "The grand exploit of amputating the lower jaw, even from its articulations, the boldness of which has been only equalled by its success, has now become a standard operation in surgery. Persons aflicted with the distressing and loathsome disease for which this operation is undertaken, were formerly allowed to die, without any idea being entertained of the possibility of saving them; but now ihat a great mind, relying on a sound knowledge of the capabilities of the human frame, has set the example of extirpating the diseased mass in tolo, many surgeons have fearlessly followed in the path thus laid open for them, and have derived honor from the success which crowned the enterprise. The success of this operation, both as regards immunity from danger, rapidity of convalescence, and the useful quality of masticatory apparaius which follows, is almost incredible."


We say

Upon this passage Dr. Townsend, in his edition of Velpeau's Sur. gery, comments thus: “ To whomsoever, therefore, the honour of this great triumph belongs, mutatis mutandis, the eulogium ought to apply equally well in Dr. Houston's conceptions, who, doubtless, would not desire to diminish one iota of it, because a name of different orthography from that of the justly respected Mr. Cusack, should happen to be found by a species of anaplastic substitution, to dovetail more completely than his with the historic facts in the case. cheerfully with all our heart palmam qui meruit feral !

Dr. Deaderick’s is the name which seems "to dovetail" most “completely with the historic facts,” and to him, therefore, must the palm be awarded. True, he operated but once, and his operation was not made known to the world for many years afterwards; but it was undertaken for what appears to have been osteo-sarcoma ; it involved the excision of nearly one-half of the lower jaw bone, and was crowned with perfect success. Dr. Deaderick did not call the disease osteo-surcoma, but, in his account oi bis operation published in the Medical Recorder, described it as “a cartilaginous tumor." In: the brief notice of it given above he applied no name to the affection, and the title prefixed to his communication is ours. Every medical reader knows how vague is the term “ osteo-sarcoma,” and what a diversity of morbid growths are called by that name. From the description of the tumor in Dr. Deaderick's case we have no doubt it would be styled osteo-sarcomatous.

It appears, then, that Dr. Deaderick preceded Dupuytren in the operation of excising the lower jaw bone two years, and ihat he anticipated Dr. Moit by eleven years, although he neglected to publish an account of the operation until after Dr. M. had coinmunicated the results of his to the world; consequently Dr. M. was unapprised of what had been done by his countryman. He may still claim “for his country," if he cannot for himself, "originality in the operation," for Cusack's operations were performed iwo or three years subse. quently to Dr. Mott's first. The operation has been performed by

. Dr. M. seventeen times. In a note appended to his letter to Mr. Liston, Dr. Deaderick's operation is referred to, and this brief, obscure notice is all the allusion to it that we have found in looking through the American edition of Velpeau's great work on surgery. We have deemed it but an act of justice to a modest and worthy member of the profession to give these dates in connexion with the history of his case.- Western Journal of Med. and Surg.

A large Tumour of the Mamma, spontaneously cured. Reported by A. B. GreenE, M. D., of Sumter County, Georgia.-The subject of these remarks is a negro woman belonging to Col. M. A short time after she arrived at the usual age for the full development of the sexual organs, the right mamma was observed to be largest, and inereased in dimensions gradually and continuously, unattended with pain, except what was induced by its suspeusion, when not properly supported. About twelve months preceding her pregnancy, my at

tention was first called to an examination of the enlarged mamma, and I found all the usual evidences of simple sarcoma present, with nothing of a nalignant character. The skin and subjacent tissues seemed as healthful to the touch, and as free from uneasiness when handled, as any other mass of flesh about the body. Its size already amounted to great deformity, and was obvious io any passing observer.

I did not hesitate to advise her intelligent owner, that an immediate operation was the only certain cure; and pointed out the danger should amputation be deferred, that might result from pregnancy and accouchement, in the development of some malignant tendency, or at least, subjection to severe suffering.

The force of my suggestions was appreciated ; but fearing the operation, and trusting to some happy, fortuitous change, it was neg. lected. She became pregnant, and at the full term of gestation in January last was delivered without any unusual difficulty, and soon felt pain in the enlarged breast for the first time. At the expiration of six weeks, it had grown so rapidly, that while sitting upright the enlarged mamma rested on her lap. It was enormously distended, and of such weight, that however well supported, her chest was strongly inclined forward. I could never detect any circumscribed induration, nor any other evidence of the formation of abscess. She was put upon strict antiphlogistic treatment, medicinal and dietelie. General and local depletives, emollient fomentations and poultices, to relieve turgidity; and the occasional application of the pump and cup to the nipple to encourage a discharge of the milk, should any possibly be secreted.

While these means were being applied, a spontaneous discharge occurred from about an inch above the nipple-in a cortinued stream it incessantly poured out, until one gallon and a half of a milk-like fluid had come away. Immediate and complete relief was expressed, and no appearance of debilily, or other adverse symptom, as a consequence of the sudden and almost incredible quantity dislodged, was observed.

From that time, the breast gradually assumed the size it had artained before her accouchement. Her general health and strength iinproved daily, and in a short time she was out on the farm at labor, though of an easy kind, and self-imposed. While thus employed, she was exposed to a drenching rain, and in a few days I was summond to visit her again.

I found her now labouring under an acute rheumatism, in its most dan ger os and painful form. The pleura was implicated, and a manifest tendency to low typhus rendered her condition very critical.

When we found that she might possibly survive the attack, my altention was again directed to the condition of the diseased breast. Upon examination an ulcer was found, situated near the nipple-ihe breast again greatly increased in size. The ulcer discharged matter of a thin purulent character, and most noisome odour. Other ulcers were formed, and they soon numbered seven, emitting vast quantities


of insupportable horrid pus-like fluid. By patient perseverance in the use of the chloride of lime, charcoal poultices, and a variety of astringent injections, the discharges assumed a more healthy appearance and less offensive odour.

The patient was now a miserable looking object of emaciation; and to every one her death seemed inevitable. It would be needless to dwell upon the treatment here, constitutional and local.

The largest and most pendent ulcer presented a prominence in the centre, which I found to be insensible. Upon raising it with the forceps, I was surprised to find that by gentle traction a considerable mass was drawn out without any pain I applied the scissors and separated that portion. There was not a drop of blood discharged. I then seized the remaining mass with a small tenaculum, and readily drew out in a string-like form, a connected volume of flesh coloured substance, until by the pain produced, I supposed the mass to be too large to pass through the ulcer, and again detached it with the scissors.

I now found a large hollow chasm left under the ulcer, anıl changed the position of the breast to examine the other ulcerated openings, but as they were situated above, nothing unusual presented at them; but when restored to the same situation again, I found the chasm occupied, and another mass presenting. By pulling gently with the forceps at different points, I succeeded in starting another slough through the ulcer, which passed easily, until one entire mass of large size fell from it without the use of any excising instrument. No blood followed, except what escaped from the edges of the dilated ulcer.

There was now an extensive, unoccupied space, left by the large volume of detached slough; and by the aid of the light admitted through the several ulcerated openings, (I fancied,) was seen the original bona fide” gland, bounding the upper part of this space.

As nature had performed the amputation so well, thus far, I determined not to interfere, in the already exhausted condition of the patient, by removing the now redundant skin.

Our next care was to ascertain the amount of the self-amputated mass, which was attached to the hook of a pair of “draw-spring steelyards, (the only means of weighing at hand) and weighed one and a half pounds. The small fragmenis, not weighed, Col. M. supposed would amount to at least a half pound more.

We were surprised, at first, that so much bulk and volume should weigh no more; but upon careful examination, I found it composed of a cellular structure, comparable to honey-comb, interspersed with fine particles of a "coffee-ground" colour. The breast was bathed with infusion of red-oak bark, and covered with a large poultice of the same excellent astringent, moistened with solution chloride of lime, and secured by means of bandages, bound on so as to exert due compression on the now flaccid paris. General directions were given for future management, and I did not see the patient from that time, which

« ZurückWeiter »