A successful case of removal of a large brain-tumor from the left frontal region : opening and packing of the lateral ventricle with iodoform-gauze / by H.M. Thomas and W.W. Keen.

  • Thomas, Henry M.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: A successful case of removal of a large brain-tumor from the left frontal region : opening and packing of the lateral ventricle with iodoform-gauze / by H.M. Thomas and W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    patient had been taking the treatment about three weeks. At that time there was a considerable quantity of albumin. On the next occasion, about four (lays later, there was less albumin; the third time, only a trace; and at the fourth analysis, which was made for me at the Johns Hopkins Hospital, there was no albumin. Tube-casts were looked for at each examination, and were not found. There was never any -agar present. Ou April 17th, at which time the patient was taking 80 minima of iodide of potassium three times daily, he became sick at his stomach and vomited frequently. The sickness lasted most of that day and was unaccompanied by any severe pain in the head. This was on Friday ; he was better on Saturday, Sunday, and Monday ; on Tuesday he was very restless, always moving about. He took a long walk on that day. On Wednesday morning he awoke with sick stomach and vomited a good deal. At this time he Avas in the country under the care of another physician. When I saw him on Sunday, the 26th, he had been in bed since Wednesday. The iodide and mercury had been stopped, but the sick stomach still continued. He was dull and often somewhat delirious, having, on one occasion, endeavored to get out of the second-story window, in the middle of the night, under the idea that he wanted to go to the garden. He several times passed his urine in bed, apparently without noticing it. The sick stomach was almost constant, and he vomited nearly everything that he took. It was noticed that when he sat up in bed he would become dazed and seem to lose con- sciousness. At these times his pulse was said to be very weak. Once or twice, when endeavoring to drink from a cup, his right hand shook a good deal, and he was unable to raise the cup to his mouth. This dis- ability lasted for a few moments, and he was then able to move the right hand normally. Upon examination the only change in his symptoms that I noted were the increased mental dulness; a slight thickness in speech, wrong words having been used on one or two occasions; decided loss of vision in his right eye, he being barely able to see at all Avith that eye ; and a peculiar uneasiness of the right hand. This was constantly in motion, picking the bedclothes, drumming on the bed, etc. When asked to make any movement with that hand he performed it accurately and well. The muscular strength was unimpaired. He said that he suffered very little pain. His pulse was somewhat weak and slow, beat- ing between 52 and 60 to the minute. Temperature was normal, and respiration 14. He was given strychnine and small doses of bromide. April 27th. Dr. Reuling reported : Vision in right eye reduced to quantitative perception of light. Left eye : fingers at twenty feet by peripheric fixation. Ophthal. stat. idem. The exophthalmos of the left eye, the mental dulness, the slight paral- ysis of the right side of the face, and the peculiar uneasiness of the right hand, taken together with the absence of other symptoms, led me to the belief that the tumor was in the left frontal lobe, and I told the boy's parents of my belief and suggested an exploratory operation. Dr. Osier saw him again w ith me, and urged the operation. (>n .May 4th Dr. M. Allen Starr, Dr. Reuling, and myself saw him together. Dr. Starr's examination and opinion, which he kindly allows me to use. are as follows: The general symptoms and course of the case make it evident that Mr. de B. is suffering from a tumor of the brain. The existence of a right facial paralysis, a thickness of speech, of a protrusion of the left