% Jliiinoii of Hospital |ractii;c. NOTES OP A CASE OF MYCETOMA OF
*
THE NECK. By Surgeon-Major J. Smyth,
Tine
patient
came
Hindu merchant from Tri-
old, and in fair general health. complaining that his neck was stiff and
chinopoly, He
was a
i.m.s.
35 years
enormously enlarged.
He said the disease
began
of the South Indian Branch of the British Medical Association held on the 1st May, 1896. *
Road at a
meeting-
Feb.
1898.]
A MIRROR OP
HOSPITAL PRACTICE.
four j'ears ago in the form of pimples at the margin of the scalp behind the left ear, accompanied with some swelling. The swelling gradually increased, the neck becoming stiffer till it finally became immobile. He was never injured on the skin or elsewhere so far as he knows. The neck is some 22 inches in circumference, and of a brawny hardness. It is studded over with livid blebs, which on puncture are found to contain pus and many roe-like bodies, and to lead by tortuous sinuses towards the spinal column. On examining the throat, a pale bleb is seen on the posterior wall of the pharynx, which on puncture is found "to contain many roe-like bodies. He has never been conscious of anything the matter with his throat. The neck is everywhere very tender, especially over the spine. Where the thickened neck shades off. into the back, pigmented or dark livid patches are seen just beyond the thickened
tissue. On incising these spots, roe-like bodies found with hardly a trace of pas. The purulent blebs on the neck numbered about one hundred and fifty, and varied from the size of a grain of rice to half an almond. Subsequent ?progress of the case.?I opened all the blebs and scraped out the sinuses communicating with them, evacuating many hundreds Of roe-like bodies. I then injected the sinuses under pressure with an emulsion of iodoform in glycerine. I did only half the neck at a sitting, fearing re-action. There was, however, are
little
re-action, and
hi
improvement set in that in about three weeks the tenderness had disappeared, the hide-bound skin had grown soft and moveable, and the patient was able to rotate the head a little. He then left the hospital promising to return; but, though three weeks have elapsed, he has not made his appearance, which is not satisfactory. The microscopic appearance of the roe-like bodies were exactly like those depicted in Carter's great work on Mycetoma, and also identical with those I subsequently obtained from a genuine white Mycetoma of the foot?the sunflower form. I tried to make a cultivation of them in the Hygienic Laboratory of the College, but without It may not, however, have been the success. fault of the fungus, but of the laboratory, where many facilities were wanting for carrying out This is the first a culture to a successful issue. recorded case of a primary mycetoma of the neck. I think it possible that the inoculation of the fungus took place on the posterior wall of the pharynx and spread outwards. In this locality, injury may very readily be caused by a piece of bone swallowed with the food?a very common occurrence amongst this people. at
or no
once,
so
*
THE NECK. By Surgeon-Major J. Smyth,
Tine
patient
came
Hindu merchant from Tri-
old, and in fair general health. complaining that his neck was stiff and
chinopoly, He
was a
i.m.s.
35 years
enormously enlarged.
He said the disease
began
of the South Indian Branch of the British Medical Association held on the 1st May, 1896. *
Road at a
meeting-
Feb.
1898.]
A MIRROR OP
HOSPITAL PRACTICE.
four j'ears ago in the form of pimples at the margin of the scalp behind the left ear, accompanied with some swelling. The swelling gradually increased, the neck becoming stiffer till it finally became immobile. He was never injured on the skin or elsewhere so far as he knows. The neck is some 22 inches in circumference, and of a brawny hardness. It is studded over with livid blebs, which on puncture are found to contain pus and many roe-like bodies, and to lead by tortuous sinuses towards the spinal column. On examining the throat, a pale bleb is seen on the posterior wall of the pharynx, which on puncture is found "to contain many roe-like bodies. He has never been conscious of anything the matter with his throat. The neck is everywhere very tender, especially over the spine. Where the thickened neck shades off. into the back, pigmented or dark livid patches are seen just beyond the thickened
tissue. On incising these spots, roe-like bodies found with hardly a trace of pas. The purulent blebs on the neck numbered about one hundred and fifty, and varied from the size of a grain of rice to half an almond. Subsequent ?progress of the case.?I opened all the blebs and scraped out the sinuses communicating with them, evacuating many hundreds Of roe-like bodies. I then injected the sinuses under pressure with an emulsion of iodoform in glycerine. I did only half the neck at a sitting, fearing re-action. There was, however, are
little
re-action, and
hi
improvement set in that in about three weeks the tenderness had disappeared, the hide-bound skin had grown soft and moveable, and the patient was able to rotate the head a little. He then left the hospital promising to return; but, though three weeks have elapsed, he has not made his appearance, which is not satisfactory. The microscopic appearance of the roe-like bodies were exactly like those depicted in Carter's great work on Mycetoma, and also identical with those I subsequently obtained from a genuine white Mycetoma of the foot?the sunflower form. I tried to make a cultivation of them in the Hygienic Laboratory of the College, but without It may not, however, have been the success. fault of the fungus, but of the laboratory, where many facilities were wanting for carrying out This is the first a culture to a successful issue. recorded case of a primary mycetoma of the neck. I think it possible that the inoculation of the fungus took place on the posterior wall of the pharynx and spread outwards. In this locality, injury may very readily be caused by a piece of bone swallowed with the food?a very common occurrence amongst this people. at
or no
once,
so
