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A glance back in time

At the turn of the 20th century, the National Hospital had only been established for a couple of decades. In a series of upcoming blogs we’re going to be looking back at some of the earliest case notes and the doctors’ fascinating write-ups about these neurological conditions. These documents are a potent reminder of The National’s legacy of ground-breaking research and treatment which continues to the current day.

Sir William Gowers was a physician at The National from 1870-1910, and kept copious and detailed notes on his patients. Here is the story of a 33-year-old man, a market porter, who had an ‘intracranial tumour’ and was hospitalised from July to November in 1901.

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‘Complaint: Loss of sight, sickness and headache. 12 months ago had retching and vomiting but kept at work. It only lasted a short time. 2 months ago, dimness of vision and headache. He had a grey mist in front of his eyes. 1 month later black spots were dancing around. Pain in frontal area, sometimes severe. Sight has become steadily worse and now quite blind in left eye. Eyes were always prominent but not quite so much as now.’

‘Past history: As a child always healthy… 12 years ago, typhoid fever, good recovery… Drank ale, at times intoxicated. Smokes 1oz a week. Denies gonorrhea. Healthy and robust otherwise.

His treatment did not involve an operation, unlike some of his fellow patients at this time. Instead he was given a boric acid solution for his eyesight issues and ‘antipyrine’ to reduce his temperature. After a few months in hospital he was given  ‘cannabis indica’ three times a day. Cannabis was often used at during this period for neuralgia, migraine attacks and for some forms of epilepsy. Its use went into decline after 1900 as the potency of cannabis preparations was too variable and synthetic drugs, which were chemically more stable, were being developed.

He was discharged in December when his condition was noted as ‘worse’.

In January, it was reported that he had died at home after ‘becoming so feeble he had to go to bed. 1 week later, tremors lasting 2+ hours. After that, delusions and unconscious at times. On Jan 22nd had an epileptic convulsion, followed by coma and death on Jan 23rd.

An autopsy revealed that his ‘right parietal bone had thinned in 2 or 3 places to the thickness of writing paper – and the roof of his right orbit [eye socket] was eaten away, exposing his eyeball and leaving a hollow as big as tangerine orange’. His brain was preserved and sent to The National Hospital for further investigation where it was found that there was a ‘mass of growth involving practically the whole of the right frontal lobe… the difference in size between the two hemispheres was marked. The growth probably measured some 4 inches in diameter’.

The rapid deterioration and decline of this man makes for a heart-wrenching read. No doubt if he’d a similar diagnosis now the prognosis and treatment options would be brighter, and obviously huge advances have been made over the years in the screening and treatment of tumours.

However, the outcome for patients with a brain tumour still lags seriously behind the advances that have been made for other cancers, due in part to the fact that research in brain cancer is seriously underfunded in the UK. Here at The National we are proud to have helped fund the Molly Lane Fox Unit – it’s a unique centre that cares for brain tumour patients and carries out pioneering research into tumours with the aim of discovering breakthrough treatments.

Look out for further case notes over the coming months.

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