ROYAL MEDICAL & CHIRURGICAL SOCIETY

1857 The Lancet  
58 she of course died. Two cases of the same disease occurred in Mr. Lawrence's ward, on the same flat ; both died. In consequence of this the ward has been closed for the present. LARGE EXOSTOSIS OF THE FEMUR. THIS was a case of very great interest, from the presence of a bony tumour, the size of a large orange, situated au the lower and inner part of the right thigh-bone, in close proximity to the knee-joint, of a young man in the Royal Free Hospital, aged seventeen years, who was an omnibus
more » ... onductor. It had been growing since he was six years of age, and latterly was enlarging and causing inconvenience, with some pain. Mr. Thomas Wakley considered the case one suitable for operation, and on the 15th June chloroform was given, and an incision made over the tumour from above downwards, and the surrounding structures kept asunder by means of curved spatulse. This was particularly necessary, because it was partly covered by muscles, whose fibres Mr. Wakley did not wish to cut across. With the aid of small saws and the bone-pliers, he succeeded in removing the tumour, which was the size of an orange, and attached to the femt1r by a broad and somewhat flat pedicle. Some care was necessary in this important operation, as the great vessels were situated immediately behind the pedicle of the tumour, the pulsation being distinctly felt during the process of removal, as well as seen distinctly after at the bottom of the wound. There was some bleeding, but no vessel required tying. On examining this growth, its outer surface was covered with a light covering of cartilage, whilst its interior consisted of dilated cancellated bony tissue, with the cancelli filled with fat, possessing the usual characters of the medulla of bone. The boy has gone on most satisfactorily, and will, we doubt not, make an excellent recovery. COMPOUND COMMINUTED FRACTURE OF THE PELVIS; RECOVERY. SEVERE injuries to the pelvis very often terminate unfavourably. We only recently recorded two striking examples, and this result is sometimes not alone due to the injury itself, but to the shock occasioned by the great violence producing it, such as a fall from a height. Now there is a case in the Westminster Hospital at this moment, under Mr. Holt's care, of a workman who was employed at a gas factory, who six weeks ago fell from a height on to the right side, and sustained a severe fracture of the ilium of that side, with a large open wound, the fracture being of a comminuted character. The whole length of the finger could be thrust into the pelvis. He had all the usual accompaniments of such a severe injury, and yet when we saw him last, on the 9th June, we found him convalescent. Mr. Holt, we believe, found it necessary to remove one or two pieces of the broken bone; very free suppuration was established, and now there is a little serous oozing from a fistulous opening, with for the first time a little erythematous blush on the thigh below the wound, the tissues of which are indurated. That this poor man will make a recovery there is no doubt; but as to his enjoying permanent good health is another question. We rather suspect he will be a future sufferer from necrosis of the iliac bone, more especially as the deep tissues surrounding it have been infiltrated with pus. LARGE TUMOUR OF THE THIGH. THE subject of this large tumour in the left thigh, midway between the knee and buttock posteriorly, was a woman in the prime of life, who was healthy in every respect, in whom it had been growing for six years. She was admitted into St. George's Hospital about a fortnight ago, under Mr. Tatum, who found the tumour freely movable, covered with superficial veins, very elastic to the feel, thus resembling a fatty tumour, but less lobular. There were no enlarged glands, and taken with the perfectly healthy appearance which was manifested. Mr. Tatum thought it could not be malignant. Chloroform was given on the 4th of June, when a single long incision was made over the growth, which was then dissected out. There were no adhesions to the surrounding structures, although some of the muscles were spread over it, and slightly adherent to its capsule. It did not extend into spaces or between the structures as a fatty lobulated tumour generally does, but was smooth and oval in shape, and fully as large as an adult head. It partook somewhat of a cystic character; but on section at a distance it looked like the well known sarcomatous growth of Abernethy, but rather more yellow; on close scrutiny, however, it aDneared to be gelatinous in one Dart. fattv-lookinsr in an-other, and of a purplish-grey in a third. The gelatinous portion of it assumed the character of those tumours found in the breast and elsewhere. Mr. Tatum did not say it was milignant, but was rather disposed to believe it so; at any rate, he remarked it should be removed. The wound remaining was one of great magnitude, the edges of which were brought to. gether by sutures, numerous vessels having been tied, for the haemorrhage was rather free. Although the appearance of the tumour was so peculiar and mixed, we think it may not be malignant, and probably is an instance of degenerated fatty tumour, such as is sometimes seen; an example not very dissimilar we saw Mr. Fergusson remove at King's College, on the 21st of March, only it had been twenty years growing, and, strange to say, occupied the same situation in the right thigh of an elderly female, otherwise in perfect health. It was as large as a '.)ocoa-nut, and is briefly recorded at p. 346 of our last volume. Since the above was written, we have learnt that cancer cells and exudation corpuscles were found in the tumour, but, we are happy to say, the patient has made a good recovery. AMBUSTIAL CONTRACTION OF THE KNEE. THE patient was a boy, in Guy's Hospital, who suffered from a severe burn of his left leg in early life, more particularly in the ham and lower part of the thigh, which in the course of healing produced considerable contraction of the cicatrix, so that the knee was bent at an angle, and could not be extended. The gastrocnemius muscle also became contracted, and the boy walked upon the ends of his toes. There were thus two deformities to deal with. Mr. Birkett made up his mind to treat the contracted knee, so as to extend it, on one occasion, and divide the tendo-Achillis ; on another, to remedy the deformity of the foot. The first was accomplished on the 16th of June, under the influence of chloroform, when a very long -incision was made with the apex downwards, and the cicatrized tissues carefully dissected from subjacent attachments; when this was done, the point of the V-flap retracted upwards several inches, and the parts were brought together by the continuous, or Glover's suture. The contracted tendon of the biceps was divided, and the knee straightened. As is usual in these cases, all the tissues were found in a somewhat atrophic condition, the great vessels being smaller than natural.
doi:10.1016/s0140-6736(02)38720-8 fatcat:we5jy2y5nvfdxkja5tfvlgno4i