The Indianapolis journal. [volume] (Indianapolis [Ind.]) 1867-1904, 1885-08-01
THE GENERALS DISEASE.
Views of DIR. Shrady on the Surgical and
Pathological Aspect of the Case.

Views Of DIR. Shrady on the Surgical and
Pathological Aspect of the Case.
New York Special.
An article by Dr. Shrady on the surgical and
pathological aspect of General Grants case will
appear in the Medical Record Saturday. DR..
Douglas will hereafter describe the treatment
more elaborately. Extracts from DR.. Shrady's
article are subjoined:
1t is not definitely known when the throat
trouble commenced, but probably it was early
in June 1884 as at that time General Grant
first com planned of soreness in the right tonsilar
region. On March Z. when first saw the pa
tent in consultation with Drs. Barker, Douglas
and Sands, it was found that the perforation at
the base of the anterior pillar had extended so
that its internal edge was converted into mere
bride of tissue The entire soft palate was uni
formly Redeemed and swollen from nfiammatory
infltratioD and the surfaces of the right tonsilar
region and adjoining portion of the vault of the
pharynx were covered with a thick consistent
yelowish eXudation resembling sloughing tissue.
This deposit was evidently the result of an acute
process engrafted upon the original disease, and
partook in its clinical as well as physical features
Of many of the characters of d dlphtheritic
membrane. The enlarged and hardened gland
under the angle of the jaw was then freely NOV
able.
This view of the complication explaining many
of the grave symptoms which were subsequently
associated with great prostration, but which
were not directly traceable to the progress. of
the epithelionmatous degeneration. The ex-
pediency of radical surgical operation for the
removal of the growth was discussed early in
the case. It was considered that such a measure
would have involved the division of tho lower
jaw in front of the ramus the extirpation of the
entire tongue and the greater part of the soft
palate, together with the removal of the ulcer
ated and nfiltrated faucps and the endurated
glandular structures under the right angle of the
lower jaw.
despite the close proximity and probable involve
ment of the tissues adjoining the large arteries
and veins in the neighborhood of the ucerations
but in the best interests of the distinguished
patient the surgeons did not feel inclined to re-
commend procedure. Even by such means there
could be no guarantee in view of the extensive
surrounding infltration that the limits of the
disease could be reached without immediate risk
to life by the severe shock to a system already
much enfeebled.
Cured about midnight which ceased spontane-
ously after four ounces of blood had been lost.
The occasion for the bleeding was the detach-
ment of portion of slough from the right side
of the pharynx. No large vessel was implicated
During the twentyfour hours succeeding the
hemorrhage the pulse became more feeble fre-
quent and intermittent, and the temperature at
one time rose to 102 degrees.
In order to relieve pain and procure sleep, the
patient was kept mildly under the influence of
morphine, the latter being injected hypoder
rnically to the amount of six minims every six
hours. The morphine was afterward decreased
to six minims il the twenty four hours, and but
slightly exceeded that, save on ono or two occa-
sions, up to the day of his death. The separation
of the slough was anxously awaited, and when
it occurred the patient as was expected became
much relieved of many of his more distressing
local symptoms. and OF his depressed bodily
condition. Then it was announced by the press
that because the General had rallied the
physicians had erred in diagnosing the case, and
consequently the patients chances OF recovery
were good
The temporary rally of the patients strength
was taken advantage Of in every possible way to
conserve his vital forces and make his last days