232 Abstracts from Current Medical Literature.

ABSTRACTS FROM CURRENT MEDICAL

LITERATURE.

EDITED BY GEORGE A. ALLAN, M.B., Ch.B.

MEDICINE.

The Thymus Treatment of Carcinoma. By Y. Takaki, M.R.C.S. Eng. (Sei-i-Kwai Medical Journal, 30th September, 1910).?Dr. Takaki only refers to cases of inoperable carcinoma, and after trials with Colley's fluid, chloride of zinc paste, trypsin, and thyroid extract comes to the conclusion that best results are to be obtained from the administration of dried thymus gland. He mentions successful cases reported by Dr. Gwyen of New York. His own cases are as follows :?

Case I. Adenocarcinoma of glands in the neck.?History: Patient, set. 33, noticed a small swelling on the left side of the neck three months previously, which became gradually larger and more glands became infected. There was

no fever or pain. Latterly the patient complained of pain in the throat and some difficulty in breathing.

Examination.?Patient was a well-built, strong man. The neck was greatly swollen in front, especially on the left side. The skin was shiny and tense, with slightly enlarged vessels, and pitted on pressure. Slight pain and tender- ness were present. The tumour, of indefinite size, was soft, and spread across middle line to the right side. The throat M'as slightly congested. The left

arm was swollen down to the fingers and could not be moved. As the patient complained of gradual increasing difficulty in breathing and

swallowing, and the diagnosis was uncertain, an operation was performed which showed the malignant nature of the tumour and the impossibility of its removal. Thymus treatment was started. Two days afterwards the patient did not complain of pain in the throat and seemed easier. The tumour became

softer. Five days after, some pus was discharged, and this continued, the tumour becoming softer and softer. Once a quantity of pus was discharged through the mouth. By that time the patient felt much easier, and the difficulty in breathing had almost completely disappeared. The patient died two months later.

Results.?(1) Disappearance of pain; (2) diminution in size; (3) softening and suppuration; (4) the swelling of the left arm was much diminished and slight power of movement returned. Case II. Carcinoma of tongue.?Ulcer of tongue, of increasing growth of

five months. Examination showed that the ulcer was extensive, spreading almost all over the tongue as far as could be seen. It was painful and the surface was irregular. The whole tongue is thickened and hard. The indu-

ration seemed to extend as far as the root of the tongue. Owing to pain and the size she could not take food properly, and was already showing signs of cachexia. The glands under the jaw were enlarged.

After a few doses of thymus the pain became less and she could take food more easily. After a week's treatment pain occurred very rarely. The

tongue became darker in colour. The treatment was continued up to the

time of her death, six months later. The carcinomatous portion of the tongue seemed to become necrotic, and separated a few days before death.

Residts.?(1) Disappearance of pain ; (2) arrest of the growth to some

extent; (3) the tumour became necrosed.

Medicine. 233

Case III. An extensive, carcinoma of penis and scrotum.?Patient, set. 57, had ulcer on the glans penis for a few months. Its growth was very rapid. Examination showed the penis and scrotum to be destroyed by a large malignant growth. The inguinal glands were extensively involved. Pain

was considerable. Thymus was given, which had the effect of relieving the pain. Case IV. Carcinoma of penis.?This patient, set. 56, was found to have

a carcinoma of the penis, secondary to a warty growth under the prepuce. The tumour affected the whole glans penis and surrounding skin. In the left

inguinal region there were a few slightly enlarged glands. Although there was fear of recurrence, the penis was only amputated for two-thirds of its length, and the inguinal glands were not touched. Thymus treatment was given for three months. There was no sign of recurrence fifteen months later. Case V. Spindle-celled sarcoma of pelvis with secondary growth on left

scapula.?The scapular tumour was removed, and was found to be sarcoma- tous. The pelvic tumour was not touched, but the patient was given thymus. Before his death, four months later, the pelvic tumour became smaller and the scapula tumour did not recur.

In another case of a large sarcoma of the abdomen thymus was given, but beyond relieving the pain no further benefit seems to have been derived from its administration, as the tumour grew very rapidly. Dr. Kishi, acting on Dr. Takaki's advice, gave thymus to a patient suffering from an extremely painful malignant ulcer of the throat. The pain was abolished after a few doses of the preparation.

Dr. Takaki uses the fresh calf's thymus gland dried at a low temperature and powdered. It is given by the mouth in from 0*01 to 0*05 grms. thrice daily between meals. As it disturbs digestion it is best to give it in small doses at first. The effect of the drug on the general constitution must be carefully watshed.

Conclusions. (1) Pain is abolished ; (2) the thymus powder seems to have some power of disintegrating the tissues of the malignant tumour by suppura- tion or necrotic changes ; (3) the size of tumour was in one case diminished and in two cases became smaller by disintegration ; (4) it seemed to retard the tumour growth ; (5) it has more effect on carcinoma than sarcoma;

(6) indigestion is apt to occur. Although the cases are few, yet this treatment might be adopted in those

inoperable cases, because it lightens the course of the disease and makes the final end more comfortable and easy.?D. Ross Kilpatrick.

Arthropathy of the Shoulder due to Syringomyelia. By Drs. Villlard and Alamartine (Lyon Medical, January, 1911).?The patient was a woman of 48 years, with no previous illness, who for the past six months had an arthropathy of the right shoulder, which showed all the signs of a nervous arthropathy, e.g., loss of power, considerable effusion, abnormal movements with true dislocation, very well-marked network of superficial veins, &c. The condition has progressed apparently by very slight traumatisms;

Skiagram shows that the head of the humerus has completely disappeared, just as in a resection of the shoulder. On tapping the joint a clear, faintly citron-coloured fluid was obtained. The patient has not had syphilis. She is not tuberculous. She has no signs of tabes, the knee reflexes being exag- gerated. There exists on the right side, notably at the level of the limbs (particularly the upper), hyposesthesia with hypoalgesia, and a very definite thermo-antesthesia. The patient burns her fingers without feeling any pain. There is no muscular atrophy or any other signs of syringomyelia.

?D. Ross Kilpatrick.