Saturday, 28 September 2013



Action on Bladder Cancer
I have recently discovered an article which was published in 'The British Medical Journal' of 1892 which I feel should be placed alongside my personal account of 21st Century surgery (see, 'The Tale of a Tumour').  I am cognisant of the fact that the current procedure for bladder cancer has not advanced significantly over at least three decades and 21st century surgeons on both sides of the Atlantic will readily confess to the fact that progress has been slow. (Though as time goes by I might yet be required to remove these words - I hope so!) At the last count, it is still required in the majority of cases that a sharp knife be taken to open up the torso in order to detach the little devils, often casting out important and precious anatomical organs - which we always wanted to retain! - in the process. The reports which I have reproduced from the journal are a spine-tingling example of such procedures which were practised in Victorian times.  They describe the apparently successful removal of bladder tumours (not necessarily cancerous) from both a male and female patient at Manchester Royal Infirmary.  I was considering abbreviating the document but I decided that it should perhaps be read as a whole, not just to make you squirm that little while longer, but to perhaps lay the lie to the fact that no progress has been made and this should perhaps keep your surgeon in some sort of good humour when your turn comes!   For those of a nervous disposition, or if you are personally pending such a visit to your particular local hospital,  I can assure you from personal experience that at least the medical instruments then utilised in the operations are rarely now used and I do believe that much of it would probably be illegal!  I will leave you to look up the unfamiliar, and often archaic, medical terminology used by these often pompous people and as they say in these enlightened days, "Enjoy".




(Under the care of Mr. SOUTHAM.)

CASE 1:   Papilloma in a male: Suprapubic Custotomy: Removal: Recovery. - W.S., aged 56, was admitted on February 29th, 1892 with the following history: About 12 months previously he first noticed the presence of blood in his urine, and since that date ha had suffered from frequent attacks of profuse haematuria, accompanied by any pain or difficulty in micturition.  In the intervals between the attacks, which usually lasted for several days, the urine always became quite clear.  Micturition had latterly become somewhat more frequent than usual, otherwise he was quite free from any evidences of irritation of the bladder, his only symptom being a painless haematuria.

    On admission he was somewhat anaemic, but in other respects in fair health.  The urine, specific gravity 1022, was alkaline and of a brick-red colour, containing in addition to blood, a small quantity of pus.

    A few days after admission  he was examined under chloroform.  Nothing could be felt on rectal examination or on sounding the bladder, but, on washing out the latter with Bigelow’s evacuator, a number of soft particles came away, some of which were twice the size of a pea, and to the naked eye easily recognisable as portions of a villous tumour.  Microscopical examination showed them to be of the nature of papillomata.

    The presence of a growth being verified, it was resolved to remove it by suprapubic cystotomy, but as a preliminary measure, in order to correct the alkaline condition of the urine, salol was given internally (10 grains 3 times a day) and the bladder was washed out daily with boric lotion.  The result of this treatment, combined with rest in bed, was that on the tenth day the urine had become acid, and the amount of blood had greatly diminished.

    March 21st. Suprapubic cystotomy was performed in the usual way,and, on exploring the interior of the bladder with the finger, a soft, pedunculated growth, the size of a pigeon’s egg, was felt springing from the left side of the trigone.  This was removed through the suprapubic opening by scraping through its point of attachment with the finger nail and a Volkmann’s spoon.  The bladder was then washed out with hot boric lotion until the bleeding, which was very slight, had quite ceased, and a tube was left in the suprapubic wound.  As regards the after-course of the case, all went on very satisfactorily, the temperature never rising above 99.8f  The bladder was washed out daily with boric lotion, and the tube was removed on the third day.  For the first few days the urine contained a little blood, but at the end of a week, it was quite clear, and afterwards remained so.  After the 21st day all the urine was passed by the urethra.  The patient left the hospital by the end of the fifth week, the suprapubic wound being quite closed.  He came afterwards on several occasions as an out-patient, and, when last seen in August, his general health was much improved, and there has been no recurrence of the haemorrhage since the operation.

CASE II: Multiple Papillomata in a female: Dilatation of Eurethra: Removal: Recovery.  -  M.M. Aged 51 years, was admitted on January 4th, 1892, with a history of haematuria of two years duration.  Until about six months previously the bleeding had recurred at irregular intervals, the urine between the attacks being quite clear, and micturition being unattended by pain and not increased in frequency.  Latterly the bleeding had become more continuous and more profuse, blood being almost always present in the urine; she had also begun to suffer from constant acute pain in the region of the bladder, over which she had lost control, the urine continually dribbling away.

    On admission the patient was very anaemic and in extremely feeble condition.  The urine contained a large quantity of blood and pus, and was ammoniacal, with a very offensive odour.  To correct this condition the same treatment was adopted as in the preceding case.

    January 11th.  The urine having become much sweeter and almost free from blood, the urethra was rapidly dilated under chloroform until it would allow of the introduction of the finger into the bladder.  On exploring its interior the base was found studded over with numerous sessile growths, the largest being about the size of a walnut, of such soft consistence that they were readily removed, as in the last case, with the finger and a Volkmann’s spoon.  The haemorrhage, which was somewhat free, was arrested by washing out the bladder with hot boric lotion.  Microscopical examination of the growths showed them to be papillomata.

    Recovery took place without a single unfavourable sympton.  On the sixth day the patient was sitting up in the ward, the urine, though still alkaline, being free from blood.  At the end of three weeks she was sent to the convalescent home, being able to hold her water, which had become faintly acid, for two hours at a time.

    September. She enjoys excellent health, and has regained complete control over the bladder.  There has been no return to the bleeding since the operation, and she is quite free from any bladder symptoms.
(Article reproduced from THE BRITISH MEDICAL JOURNAL of October 29th, 1892)

It isn't like this now, honest to goodness!

Well done if you got this far!

Thursday, 19 September 2013


A Wistful Contribution   

   Recently, I came across a passage of correspondence within a collection of 'Letters to the Editor' in an archived newspaper and was immediately struck by the nostalgic tone of its writer and especially, of the subject being addressed.  As I scanned the long newspaper column I discovered that it was a wistful contribution from a retired 'gentleman' resident in Scotland who was now in his seventies and probably retired from a long life of work: It proved to be a beautifully crafted effusion of the writer's still-vivid memories of childhood days spent in Melton Mowbray.  I pinched myself when I realised that he was recollecting an era now two centuries past, when he wrote of his observations on the gay celebrations held on the day of the coronation of the controversial King George IV on the 19th July 1821. 

   Those interested in the history of Melton should especially find the piece interesting and I resurrect and reproduce it for your perusal, verbatim, unedited and complete!  As a post-note, I have briefly researched the letter writer's biography as I was initially puzzled at the circumstances of his leaving Melton home for the then distant wilds of Fifeshire.  A short synopsis of this is at the end.

Thursday, 12 September 2013


Blackberries and Prose

There is nothing more likely to indicate to us folks in the temperate climate of middle England that Summer (if we have been lucky!) is coming to an end, than the arrival and full ripening of the wild blackberries (rubus) growing in public - usually neglected - spaces.  This particular Summer has borne a plethora of green growth and a lot of excellent fruit has followed due to the wonderful combination of extremely rainy days interspersed with more than its usual quota of hot and sunny ones.  I was out in the fields near to my house just the other day and saw that the blackberry brambles were absolutely rampant and overborne with fruit. Their heavily laden stems are reaching far above the grasp of the average picker and offer a challenge to those acquiring the supreme prize of gathering in the fattest and most luscious berries, whilst avoiding the ever pernicious and unforgiving thorns!

As the ripest and juiciest black specimens are carefully plucked and taken away, many more are maturing to provide an eclectic and eager queue of people, young and old who are ever-present to take home all they can carry.  These 'hunter-gathers' mostly end up in a very sorry state having had their skin torn open and legs usually stung by nettles which are also prolific at this time of the year.  Very often they have also sustained soaking wet feet from the boggy undergrowth into the bargain; but they will all claim that the prize is worth the pain.

Seamus Heaney
(13 April 1939 – 30 August 2013)

In Memory

Related to this annual indicator of the oncoming Autumn season (or 'Fall' as you would perhaps say in Mountain View, CA), I would like to share my observations with the recently deceased Irish poet, Seamus Heaney who wrote of just this subject from his childhood memories.  I present this small poem as my contribution to the celebration of his past life.

"Blackberry Picking" by Seamus Heaney

'Late August, given heavy rain and sun
For a full week, the blackberries would ripen.
At first, just one, a glossy purple clot
Among others, red, green, hard as a knot.
You ate that first one and its flesh was sweet
Like thickened wine: summer's blood was in it
Leaving stains upon the tongue and lust for
Picking. Then red ones inked up and that hunger
Sent us out with milk cans, pea tins, jam-pots
Where briars scratched and wet grass bleached our boots.
Round hayfields, cornfields and potato-drills
We trekked and picked until the cans were full,
Until the tinkling bottom had been covered
With green ones, and on top big dark blobs burned
Like a plate of eyes. Our hands were peppered
With thorn pricks, our palms sticky as Bluebeard's.
We hoarded the fresh berries in the byre.
But when the bath was filled we found a fur,
A rat-grey fungus, glutting on our cache.
The juice was stinking too. Once off the bush
The fruit fermented, the sweet flesh would turn sour.
I always felt like crying. It wasn't fair
That all the lovely canfuls smelt of rot.
Each year I hoped they'd keep, knew they would not.'