New-York tribune. [volume] (New York [N.Y.]) 1866-1924, 1885-07-31
REVIEWING THE CASE.
pR.sHaADY oNGENERAL GRANTS DISEASE
ITS PROGRESS AND TREATMENT-PRoBABLE CAUSE
OF THE CANCER.

ITS PROGRESS AND TREATMENr-PRoBABLE CAUSE
OF THE CANCER.
The following article on "1he Surgical and Path
illogical Aspects of General Grants Case" by DIR.
George F. Sbrady, one of the consulting physicians
will appear IN to-morrow's issue Of The Medical
Record:
No case has excited greater Interest from
medical point OF view than that Of General Grant ASIDE
from the disease attacking patient widely known
and 40 universally beloved has shown some features
which ire Of surgical as we'll Of pathological sIgn
canoe II ia not the purpose OF this article TO treat OF
details OF description OF treatment, as such VIII
properly 10 left for elaboration by DR. j. H. Douglas,
whose constant attendance upon the patient best quail
fes him for the performance of such duty.
1t is not definitely known when the throat trouble
commenced but probably early IN June 1854. as
al that time Grant first complained OF soreness
In the right tonsillar region
Branch, OF the Emphatic glands under the right
angle OF the lower jaw became enlarged and he CON
suited his family physician, DR.. Fordycc Barker who
after satisfying himself the OF the trouble
referred him DR.. j. H. Douglas for special treatment
Tie latter gentleman also Ognzng the nature
OF the maady, made the diagnosis Of cpltheal cancer
aud began the use OF palliative app'icatlons Win
the view OF preventing the spread OF the lucrative
process then just beginning In the right
porterior faucal pillar For time his , en-
IDENTITY however. with severe mental strain occasioned
by pecumary embarrassment aud attended with great
physical prOstratOn II was noticed mat carry In prcen
Der disease fresh start aud spread In upward
and war. directions. that In the course OF the
two months following, the posteri0r pillar OF the iaucos
was almost entirely destroyed the tonslar space nn
tratcd OF the anterior pillar perforated and the
right dc the base OF the tongue indratcd and super
ciay liberated THIS was the condition of affairs when
on February 10. Drs Barker and Douglas held consul
taton with Drs T. VI. Msrkoe and ii. Ii. Sands. The
diagnosis OF epithelioma then unanimously con-
rmed. and the Iudciousy conservative treatment Of
Drs. Barker aud Douglas was fully Endorsed; ..,,..
On March 7. when first saw the patient, In consulia
ton with Drs Barker Douglas and Sands 1t was found
that the perforaton AT the base or me anterior pllhr
had extended that It's Internal edge was converted
into bride Of tissue The entire soft palate was
unifC rmy Redeemed and swollen from inammatory in
raOn and the surfaces OF tue right tonsillar region
and adjoining portion OF the vault OF the pharynX we're
covered with thick. consistent. yellowish cXu1atisn
resembling slOughng tissue This deposit was evidently
the result OF All acute process, engrafted upon the
original disease. ana partooE IN its chcal as wen as
physical features OF many or the Characters OF adp
iheritic membrane The enlarged and hardened gland
under the ahsle OF the Jaw was then freely movable
This OF the complication explains many OF the
grave symptoms which were subsequently associated
with great prostraton, but Which were not directly
traceabe to the progress o. the epheomaous dcgener
alton.
Subsequent to this consultation visit an opportunity
was offered stan for cxamn itiOn OF The microscope
specimens previously removed from tho liberated edse
prepared by DIR. George Il. Elliott Inspected tho
specimens common with Drs. Barker, Douglas. aud
sands and agreed with them nexpreSsng due appf-
OF the significance OF the appearances presented
In other words the microscope examination showed the
disease To bo eptheoma. The appear are correctly
summarized by Dr. Elliott In his recent paper. and are
In brief less obuatcd appearance Of the epi-
thela mass. with great diversity IN the shape OF cell
uon; but above all there wefo present distinct cen
Nests. and tendency OF the new cell formation To bur
OF blood asv found In tho diseased
specimens
sURGIcAL OPERATION DISCUSSED
The expedency radical surgical operation for the
OF the growth discussed carly In the
II was considered that such would have in
yolyed the division of the lower Jaw in front OF the
ramus the c1tirpauen Of tho entire tongue and
the greater part OF the SOFT palate. together
trnted fauccs and the lnduted giandular structures
under the right angle OF the lJwcr jaw. This cDn
ity aud propabe Involvement OF the tissues al Joining
the large arteries and VEINS In the nelghborhOOd OF the
patient the surgeons did not feel inclined To recommend
the procedure. Even by such means there could 100 no
ton that limits of the disease could be- reached
without Immediate risk To life by the severe shock TO
constitution already much cnfcebled .
From the time that the exudatiOn appeared In the
throat there noticed for several days markell de-
preston OF the vital power Of tho patient owing
partly the OF The cancer and partly to tho
ertra-iuhammatnry condition Of the throat there was
pectorniion OF which attended with occasional
attacks OF choking The latter OF themselves had ten
dency exhaust tho patient, and on more than ono
occasion alarmed his family and tho public Tho most
serious attack OF the khd occurred about a. Ia. OF
posure and believed that he about 20 sufIo-
rate hi. di,tres. wa. extrome DR. Douglas who was
summoned, called for ms way 10 the patient ny
the prompt Swinging OF the throat by DR. Douglas the
mucus was dislodgei when ~ usual I'M
mediate relief Obtained. The apprehension OF
curronce of the difficulty was great on the part OF tho
family that we remained with the General until tho
when another general consultation held.
attended by DIS. Barker. Douglas, sands aud myself
Tho patient was found sone what weaker but was not
considered In dangerous condition. Tho area OF
emulation wa. increased wel n the swelling ~ the
paataI curtain accounting for tho difficulty OF
swallowing and "a thickness Of speech which were palm
fully porceptbe. The pulse was inclined TO bo inter
mitten and decreased In volume but there no
elevation OF temperature This weakened condition con-
tnued. despite the administration Of hcar stimnlants
digtss and coca and the careful regulation OF liquid
diet until the early morning OF April when the patient
was rather suddenly seized with attack Of ainting
and death from hesrt-faurc seemed imminent DR. Doug
my self with him AZ the time The members Of
family around the patient expecting hatevery
moment would bc his last II feared that he could
not rally, and the fare wells said. Finally, hypo-
derme injections OF brandy administered. with tho
gratifying effect OF dng the patient over Threatened
collapse. In the OF the next four hours he
considered out Of Immediate danger. and was able TO
The patient aid comparatively we'll for the neNt few
days. the swelling In the throat gradually diminishing
and the emulation wing tendency 10 become sepa
rated On April 7. however. a homorrhago from tao
throat occurred about midnight which ceased spontano
ousy after about four ounces OF blood had been lest
The occasion for the bleeding the detachment OF
portion OF the slough from the right side OF the phaynx
During the twenty four hours succeeding the hem
orrhage the pulse became more feeble. frequent an In
tertent and the temperature at one time rose to 1922
r. In order 10 relieve pain and procure sleep the patient
was kept mildly under tina ihhusnco OF morphne. the
latter being injected hypodermacay 10 the amount OF
six minms every six hours. The morphine was after
ward decreased to six mnms In tho twenty four hours
and but slightly exceeded that save two
siOns, up TO the timo OF his death.
RALLY AFTER a HTMoRRnAGR.
The separation Of the slough anIiously awaited.
and when 1t occurred the patient was expected be-
raue relieved OF many OF his distressing local
symptoms and OF his depressed bodily condition Then
was by tho press that because the General
had rallied tho physicians had erred In diagnosin. tue
asc and consequently the patients chances OF recovery
good Much as this happy result was to be hoped
Tor the stubborn fact Of the existence OF tho original dis
ease. and OF ts steady progress toward inevitably
fatal ISSUE painfully apparent to the gentlemen
watching the The return OF the patients strength
not surprise to his physicians II what they
aimed 10 bring about by the treatment employed. Tho
general exhaustion, which vasn great measure indie
pendent Of the cancer at this time feared and
The treatment OF that condition naturally OF tho first
Importance. But the gratifying change for the |
better believed be simply OF