INOPERABLE CARCINOMA OF THE BREAST TREATED WITH RADIUM
Authors: R. Ward
Journal: BMJ (1929)

§1I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~MxL)ICAJ.. JoUisNAJL I'rCLious llnces3cs.-Hewas born at full, time, was bottle-fed, ni-id was niot looked upon as a. delicate child.Wheni 2 months old he" had a slight attack of bronchitis or broncho-pneumoniia lasting two.weeks, from whiclh he made a full recovery and had no complications.At the age of 7 years he developed measles, auid again there were no ill effects.Ho has suffered from, oceasional colds in the head and slight rheumatic pains in tho rVists in winter, but there is no history of tonsillitis, chorea, or acuite lheumatism, and no record of pleurisy.At the age of 1;2 hle slipped off a 4-foot wall to the ground anid landed with hiis knee pressed against his chest.He was at once slhort of blcath, and had pains across the chest which lasted three hours, atter which he felt quite well and returned to school the next dayI.-Sincemeasles at the age of 7 he has not missed school atl enidance.The family history is not important, the parents being alive and healthy, three brothers alive all healthy, and no deatlhs in tho family have occurred.There is no tuberculous history onl eitlher side.Symnptoms on 4dmission.-Fullness of the abdomen and tllrobbing of the neckc were the obvious symptoms.Occasional pain across the chest and in the left shoulder and slight indigestion were further admitted..No cough was, complained of, and no record cotuld be obtained of swelling of the legs.Condition on Examination.-Hisheight was 5 ft.1k in., his weight 7 st.10 lb.He did not look a robust boy, the complexion beinig somewhat sallow, but there was no cyanosis and no obvious shortness of breath.Undue venous pulsation was noticed in the nieck, especially on the right side.No clubbing of the finger-nails was present and no oedema of the legs.The abdomen was distended by free fluid the circumference at tho umbilicus being 32 inches.The free edge of the liver could be felt three inches below the costal 'margin, the liver itself feeling smooth but firm.Scanty pubic hair was present, but there was no hair in the axillac.A few small glands were present in the axillae.The teetlh were good, the tonsils not enlarged, tongue slightly coated.Onl July 8th pariacentesis was performed 96 ounces. of a clear.straw-coloured fluid being withdrawn.Culture was negative, and xery few lymphocytes were found on staining.Injection into a guiinea-pig had no ill effects on the latter.-Afterwithdrawal the lower pole of.the spleen was just palpable.No enlarged glands or tuberculous masses could be felt in the abdomen.The chest was hyper-resonant in the upper lobes.The lungs expanded freely.The breath-sounds throughout were harsh vesicular in type.No adventitious -sounds were heard except a fine friction o-er the splenic area.The chest was z-rayed on June 26th by Dr. J. Bromley of Stoke-on-Trent, who reported as follows:"'Both diaphragms are raised, doubtless due to the amount'-of free fluid in the abdomen.There is no marked increase in theo extent of the hilum shadow and no impaired air entry into the chest."The uirine was free from albumin and sugar, and the urea concentration test was normal.Blood' urea did not exceed 13-.5' mg.. per 100 c.cm.The Wassermann reaction of the blood was negative.-.A fractional ..test meal revealed no-abnormal feature,.-The levulose tolerance test increased the amount of sulgar~in the~blood from-0.12 to 0.22 per cent., and no sugar was passed in the urine.The' blood count on June 26th showed red' blood cells 3,700,000, white blood cells -11,500, haemoglobin 75 per cent.Differential count: Polymorphs 80per cent., lympho, cytes 18 per cent., eosinophils 1 per cent.No abnormal cells were found.