TRENCH "FROST-BITE.": Some Observations on Cases Admitted to the Duchess of Westminster's War Hospital
Authors: C. G. Watson, C. S. Myers
Journal: BMJ (1915)

~ICAL413TRENCH 'i FROST-BITE.' BRITISAL 413 of the leukaemic synmptonms was ever brought about.At the post-mortemn examination excess of lymphocytes was found in several org,ans, and the blood throughout retained its leulcaemic aspect as far as the differental count was concernied.At the same time the patient undoubtedly improved enormously coincident witlh the fall in total numlber of hiis wllite cells, and it was not till the septic infection alluded to hiad set in that hiis progress towards apparent recovery was interrupted.CASE III.-Lymtipho-sarcomlia. P. G., aged 65, a farmer, was admitted oni May llthi, com- plaining of lunmps in his neck and of 'difficulty in breathing and swallowing(.He stated that he had always been a healthy man unitil about seven montlis previously.He then noticed a swell- ings on the right side of his neck, and shortly afterwards found that his breathing at night was troul)lesome so that he had to sit up in a chair.He also began to be troubled with a !cough,- without expectorationandd by hoarseness, and, before admission to hospital cougled inicessantly day anid night.Early in April he found difficulty in swallowing, and couild only get down fluids.On admission enlarged glands were found on both sides of hiis neck.On the right side these were very big, and practically filled up the entire space between the clavicle and the lower jaw; on the left side they were smaller.The veins on both sides were distended.InI the thorax there was an area of dullness over the manubrium sterni, and extending slightly out on each side beyond the sternal margin.This dull area merged below with the cardiac dullness.The breathing was slightly stridulous, and oni auscultation seemed very harsh all over the upper l)art of the thorax.An x-ray examination showed that the superior mediastinum was opaque to the rays, presumably due to the presence of a growth, and also showed an area of opacity extending on each side of the heart.In the abdomen nothing abnorrmial was found except slight splenic enlargement.The glands in the groins and axillae were palpable, and perhaps very slightly enlarged.Laryngeal examination by Dr. Graham showed slight paralysis of tle.right vocal cor(l.The blood examination was as follows: Red cells, 3,210,000; white cells, 11,660; haemoglobin, 65 per cent.Differential coutnt: Neutrophiles, 61 per cent.; lymphocytes, 31 per cent.; hl-aline cells, 7 per cent.; eosinophiles, 1 per cent.Wassermann test negative.The diagnosis made in this case was lympho-sarc6ma.Not anticipating a favourable result, I did not have one of' the neck glands removed for section.In consequence the diagnosis must remain open to doubt; but the picture of an intrathoracic growth, with enlarged glands in the neck and slight splenic einlargement, appears to me practically unmistakable, and in my own mind I have no doubt that the diagnosis was correct.Some may, perhaps, tlhink that the case was one of Hodgkin's lisease.Oii May 13tlh benzol was started, and 60 minims were given daily up to June 2nd.The dose was then increased to 90 miinims (aily, and this was conitinued until July 3rd,-when the drug was discontinued.Aii x-ray exposure was given every third day from May 13th to July 13th.Duiriin( the first three weeks in lhospital the patient com- plainled much of his breathing and of his coulgh, and felt a sensation of choking immediatelv on lying doWn.It was neces- sary to givne nmorphine each night to give hiim relief.After the lapse of three weeks the glands in the neck were much smaller than on admission, and after a nmonth they had completely '.isappeared.The dullness over the uipper part of the thorax began to diminish, and a series of x-rayphotographs seemed to indicate a gradual clearing of the intrathoracic opacity.Symptoms also improved and by the middle of Jtune the patient was quite firee of cough, of lioarseness, anid of difficulty of breathingJ.