Professor B. von Langenbeck's Clinic, Royal University at Berlin
W. B. PLATT
1878
Boston Medical and Surgical Journal
The patient, Gottlieb Gallien, fifty-five years of age, by occupation a farmer, residing at Wittenberg, was said to come of healthy family ; his previous health had been good ; there was no history or indication of syphilis or of trauma. The tumor first attracted attention about eight years ago as a hard swelling in the left side upon the ramus horizontalis pubis. He was a man rather below the average height, of dark complexion, sallow, rather anaemic, and with poor general muscular
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... The tumor arose from the crest of the left side of the pubes apparently, and probably also from the ascending ramus of the ischium. It was hard, slightly elastic, immovable, irregular in outline, and nodulated on the surface ; as a whole ovoid in shape, and as large as an infant's head. The greatest vertical diameter was also over the pubes. It projected upward and forward toward the abdomen, extending also downward over the front of the thigh, and inward toward the median line, sloping gradually until it disappeared at a point not quite midway between the symphysis pubis and the internal condyle of the femur. The growth did not apparently implicate the femur or hip-joint. The thigh admitted of but slight flexion or rotation inward. The femoral artery could be felt pulsating to the outer side of the tumor, between it and the anterior inferior spinous process of the ilium, being pushed far out of its normal course. Upon the outer and lower aspect of the tumor was a sinus, large enough to admit a knitting-needle. From this a small quantity of a transparent, synovia-like fluid escaped. Operation took place January 9, 1878. The patient being placed in the horizontal position and anaesthetized, a semilunar incision was made upon the anterior and lower surface of the tumor, at an angle of about thirty degrees from the horizontal plane, commencing three centimetres from the spine of the pubes, and ending near the anterior inferior spine of the ilium. The skin, being made free above and below, retracted, especially that of the thigh, carrying the inner end of the incision half-way down the scrotum. The upper portion of the quadriceps femoris, the pectineus, aud the upper portions of the adductor muscles seemed to melt into the tumor, stopping short at and adherent to its surface. It was necessary to sever the obturator internus, externus, and gracilis muscles on account of their firm attachments to the growth. All the femoral muscles coming into view were atrophied, and fatty degeneration had taken place to some extent. There was very little arterial haemorrhage, the obturator vein only giving some little trouble. Silk ligatures were used, but no spray. The tumor was seen to arise from the entire anterior circumference of the obturator foramen, the surface of which was removed with chisel and hammer until healthy bone was reached. The edges of the wound were now approximated by numerous silk sutures, and drainage tubes were inserted at the inner and outer angles of the wound. Professor von Langenbeck remarked that he had never before seen an enchondroma where
doi:10.1056/nejm187806270982611
fatcat:j3m5l7mvfbeytbzmmfmpfymyse