William Guybon Atherstone: his 8-day and 1600 km house call to Oudtshoorn in 1890.

William Guybon Atherstone: His 8-day and 1 600 km house call to Oudtshoorn in 1890 To the Editor: William Guybon Atherstone (1814 1898) became well known because for six decades he and his father, John Atherstone, practised medicine in Grahamstown in the Eastern Cape during the turbulent Frontier Wars. When not attending patients, he pursued his interests in geology and botany. He is best known for having performed the first successful surgical procedure under general ether anaesthetic,[1] and for having identified the first diamond found in the Cape Colony.[2] I describe the professional visit of Atherstone to attend a patient with a tumour of the lip and mass in the neck. On 25 August 1890 Atherstone received a telegram from Johannes Hendrik Schoeman asking him to visit because his own doctor was ‘dangerously ill’; Atherstone took the 20h05 train to Prince Albert Road Station, arriving at 23h30 the next day, and then travelled by horse and cart to Prince Albert and over the Swartberg Pass, arriving at Schoemanshoek, Schoeman’s residence near Oudtshoorn, at 17h30 on 27 August – a trip of 800 km and 451⁄2 hours. He took a history, and examined Schoeman and recorded: ‘... I diagnosed the case as one of colloid glandular cancer from a pipe. I measured round Schoeman’s neck over the lobular tumour – one foot five and a half inches [44.5 cm] from the inside of the tumour, over the large colloid projection six and three quarter inches [17.2 cm] across and three and three quarter inches [9.5 cm] across and three and three quarter inches [9.5 cm] vertically! ‘History – two years previously a dry scaly pimple appeared on the lower lip near the angle of the mouth; in six or eight days the crust came off, and then formed again and became like a moist wart for eight to ten months. It would not heal. Dr. Russell burnt it with “No. 5” – it stank because of the discharge. Twice more he burnt it, and it became a sore which he excised together with a wart on the chin. It then healed, but the left gland was slightly swollen; a lump appeared on the left side of the neck, about the size of a walnut and grew steadily. ‘Mr. Schoeman had always been strong, active and healthy until the sore appeared on his lip where he had been accustomed to hold his pipe. He had not however smoked a pipe for a very long time, only the occasional cigar, but confessed that the cigar was also put on the left side, where the pipe had been and where the sore was.’