A TUMOUR
SIMULATING SPINA BIFIDA.
By KAILAS CHUNDRA
BOSE, L.M.S. Manvaree gentleman, at. 35, came down to Calcutta for treatment. He had a big cystic tumour occupying the lumbro-socral region of the size of a large watermelon. The tumour looked more like Spina Bifida than a simple cyst. The history of the case as gathered from the patient and his friends, runs as follows: The patient enjoyed excellent health from his childhood up to the age of 21, when he felt a peculiar sensation of heat and burning over his waist. On rubbing his finger over the part, The pain and the he felt the skin a little raised. swelling lasted for a fortnight or so when it was Three months cured by a hakim of his place. after the alleged cure, he noticed a fluctuating tumour about the size of a playing marble rising from the body of the 5th lumbar vertebra. He did not think much of it, and allowed the tumour to grow to the size of a foetal heat}. He had no other trouble to complain of except a The cyst sensation of weight over the part. was permitted to grow undisturbed until very lately it has resumed its present size. At present he cannot lie on his back, and feels great He is a family man, tension over the tumour. and his children whom I saw in Calcutta were When he came to me, I examined all healthy. the cyst,, and it was 24 iuches in circumference ; the border was well defined and raised half an inch above the level of the skin ; there was no
Koonjo,
a
?
THE INDIAN MEDICAL GAZETTE.
u
011 pressure. He had perfect control over the co-ordinating muscles of the lower limb, and could walk without being tired or fatigued. I tapped the tumour with a fine trocar, and out came nearly four pints of serous fluids. The cyst wall collapsed. The patient felt comforttable and easy ; he slept well ; he did not complain of pain over the part; there was no rise of temperature. The next morning I found him happy and lying on his hack?a comfort which he had not enjoyed within the last three On the third morning, symptoms of years. fresh accumulation commenced to appear, and in another couple of days it resumed its former size ; he could no longer lie on his back, and all The his cheerfulness, was hopelessly gone. tumour became very tender to the touch, his temperature rose to 103? F., and he had no rest during the night; pulse 120; tongue dry ; urine scanty and of high colour. On the morning of the 9th day after the first tapping, I suspected purulent accumulation within the cyst. To make the diagnosis positive, I invited Dr. K. McLeod to see the patient. He kindly came and examined the patient most carefully ; he was quite positive as to the presence of pus, and instructed me to aspirate the tumour under antiseptic precautions. At my request Dr. McLeod promised to be my guide, and it was arranged that we should see the patient the same afternoon. We attempted to aspirate the tumour, but the matter which came out was so offensive in its character that we at once withdrew the needle and plunged the knife into it to make the opening sufficiently large to admit the introduction of a half-inch size drainage
pain
tube;
a
counter-opening
was
similarly made,
and we washed the cavity with Condy's fluid, and dressed the wound with antiseptic gauze. On introducing our finger into the cavity and exploring most carefully, we could not find any deficiency in the bony construction of the vertebra), and we were conclusively of opinion that it was not a case of Spina Bifida, although it resembled it very much in position and form. The next morning the dressings were all soaked with dirty thin offensive puriform matter. The cavity was thoroughly washed and dressed with antiseptic gauze and tow. In the evening of the same day the dressings were changed. The temperature of the patient never came down, and his condition did not improve much after the operation. On the 7th morning the discharge was seen much altered in its character; it became thick, less in quantity, less offensive than before; the patient was more lively, his temperature 100? F., and he could sleep pretty well. I did not make any alteration in the dressings. On the 7th day after the operation, healthy pus was visible, and the general condition of the patient very much improved. There waanomoretever; hisiippetite was better; his look
[Feb.,
1888.
brighter than before. The sulpho-carbolate of soda mixture which lie was taking from the date of the operation was now discontinued, and lie ordered to take Quinine and Iron three was times a day. From this day up to the 15th day after the operation, his condition was very promising ; the cavity was rapidly filling up with healthy granulations; the discharge little and perfectly sweet. He was so far improved that he dared to walk in the veran dah of his house. One night he exposed himself a little and got fever the next morning ; his temperature went high; his appetite gone ; he was troubled with obstinate pain on his back; and in two days the poor fellow had double pneumonia which, notwithstanding our most careful attention, carried him in seven days. The diagnosis of Dr. McLeod was correct beyond question; the patient had no convulsion or paralysis of his limbs before or after the operation. The unfortunate man, although at times slightly delirious, retained all bis senses till the last moment of his life, which certainly could not have been the case if it was one of Spina Bifida. Besides, his age was a sufficient ground to preclude all idea of the spinal defi-
ciency.
SIMULATING SPINA BIFIDA.
By KAILAS CHUNDRA
BOSE, L.M.S. Manvaree gentleman, at. 35, came down to Calcutta for treatment. He had a big cystic tumour occupying the lumbro-socral region of the size of a large watermelon. The tumour looked more like Spina Bifida than a simple cyst. The history of the case as gathered from the patient and his friends, runs as follows: The patient enjoyed excellent health from his childhood up to the age of 21, when he felt a peculiar sensation of heat and burning over his waist. On rubbing his finger over the part, The pain and the he felt the skin a little raised. swelling lasted for a fortnight or so when it was Three months cured by a hakim of his place. after the alleged cure, he noticed a fluctuating tumour about the size of a playing marble rising from the body of the 5th lumbar vertebra. He did not think much of it, and allowed the tumour to grow to the size of a foetal heat}. He had no other trouble to complain of except a The cyst sensation of weight over the part. was permitted to grow undisturbed until very lately it has resumed its present size. At present he cannot lie on his back, and feels great He is a family man, tension over the tumour. and his children whom I saw in Calcutta were When he came to me, I examined all healthy. the cyst,, and it was 24 iuches in circumference ; the border was well defined and raised half an inch above the level of the skin ; there was no
Koonjo,
a
?
THE INDIAN MEDICAL GAZETTE.
u
011 pressure. He had perfect control over the co-ordinating muscles of the lower limb, and could walk without being tired or fatigued. I tapped the tumour with a fine trocar, and out came nearly four pints of serous fluids. The cyst wall collapsed. The patient felt comforttable and easy ; he slept well ; he did not complain of pain over the part; there was no rise of temperature. The next morning I found him happy and lying on his hack?a comfort which he had not enjoyed within the last three On the third morning, symptoms of years. fresh accumulation commenced to appear, and in another couple of days it resumed its former size ; he could no longer lie on his back, and all The his cheerfulness, was hopelessly gone. tumour became very tender to the touch, his temperature rose to 103? F., and he had no rest during the night; pulse 120; tongue dry ; urine scanty and of high colour. On the morning of the 9th day after the first tapping, I suspected purulent accumulation within the cyst. To make the diagnosis positive, I invited Dr. K. McLeod to see the patient. He kindly came and examined the patient most carefully ; he was quite positive as to the presence of pus, and instructed me to aspirate the tumour under antiseptic precautions. At my request Dr. McLeod promised to be my guide, and it was arranged that we should see the patient the same afternoon. We attempted to aspirate the tumour, but the matter which came out was so offensive in its character that we at once withdrew the needle and plunged the knife into it to make the opening sufficiently large to admit the introduction of a half-inch size drainage
pain
tube;
a
counter-opening
was
similarly made,
and we washed the cavity with Condy's fluid, and dressed the wound with antiseptic gauze. On introducing our finger into the cavity and exploring most carefully, we could not find any deficiency in the bony construction of the vertebra), and we were conclusively of opinion that it was not a case of Spina Bifida, although it resembled it very much in position and form. The next morning the dressings were all soaked with dirty thin offensive puriform matter. The cavity was thoroughly washed and dressed with antiseptic gauze and tow. In the evening of the same day the dressings were changed. The temperature of the patient never came down, and his condition did not improve much after the operation. On the 7th morning the discharge was seen much altered in its character; it became thick, less in quantity, less offensive than before; the patient was more lively, his temperature 100? F., and he could sleep pretty well. I did not make any alteration in the dressings. On the 7th day after the operation, healthy pus was visible, and the general condition of the patient very much improved. There waanomoretever; hisiippetite was better; his look
[Feb.,
1888.
brighter than before. The sulpho-carbolate of soda mixture which lie was taking from the date of the operation was now discontinued, and lie ordered to take Quinine and Iron three was times a day. From this day up to the 15th day after the operation, his condition was very promising ; the cavity was rapidly filling up with healthy granulations; the discharge little and perfectly sweet. He was so far improved that he dared to walk in the veran dah of his house. One night he exposed himself a little and got fever the next morning ; his temperature went high; his appetite gone ; he was troubled with obstinate pain on his back; and in two days the poor fellow had double pneumonia which, notwithstanding our most careful attention, carried him in seven days. The diagnosis of Dr. McLeod was correct beyond question; the patient had no convulsion or paralysis of his limbs before or after the operation. The unfortunate man, although at times slightly delirious, retained all bis senses till the last moment of his life, which certainly could not have been the case if it was one of Spina Bifida. Besides, his age was a sufficient ground to preclude all idea of the spinal defi-
ciency.
