CASE I.
William Stirling, without any very evident cause, perceived a small tumor on the top of the shoulder, about midway betwixt the termination of the neck and the articulation of the humerus. This gradually increased for some months, and by the time when I saw him was larger than a goose’s egg: It was spongy and elastic, and attended occasionally with pain.
Although the duration of the tumor was an unfavourable circumstance, yet I undertook the operation. I made an incision through the whole length of the skin, and dissected it off the tumor, (the upper part of which was covered with a coat, or cyst), down to its base; but, when I now began to separate it from the parts below, I found that it had no defined bottom, but penetrated down betwixt the muscles, which were soft, pale, and had lost their fibrous structure. I therefore cut off the tumor close by the muscles, and then separating them with the back of the scalpel, I removed with the finger as much of the tumor as I could observe. Several arteries sprung; but these were pretty readily tied, although the vessels were very tender. A troublesome oozing, however, took place from many points of the diseased muscles. This was moderated by applying the sponge dipped in cold water, after which the skin was laid down, and its lips brought close together.
On dressing the patient on the third day after the operation, the skin was found not to have united; but its lips were red and inflamed. In this state it continued for several days, when the part began to grow tumid, and discharge a thin fœtid matter. The skin then retracted still more, and a fungus protruded, which gradually increased; but it was smooth and regular, and of a pale colour, so that it rather had the appearance of a superficial ulcer, raised up by a tumor from below, than the ulcerated surface of a diseased substance itself. In this state it continued for two or three months, when irregular projections appeared on the ulcerated surface of the new tumor. These soon burst, and a fungus protruded, of a carcinomatous appearance, and bleeding very frequently and profusely. Swellings of the axillary glands succeeded this, and the patient became much enfeebled, and evidently hectic. As I have not heard of him for several weeks, I suppose that he has died.
In this case a second tumor succeeded to the first, owing to the impossibility of extirpating the whole, and this exactly resembled the original one, except in having its surface covered from its commencement with an ulcer; but this ulcer was not the specific one of the spongoid inflammation.
CASE II.
John Overend was attacked with pain in the right thigh and loins, which were considered as rheumatic. Shortly after the thigh was observed to be elongated, and issues were applied over the hip joint, upon the supposition of its being a common case of morbus coxarius. But no considerable relief was obtained by this; on the contrary, the upper part of the thigh swelled, whilst the lower part wasted, his appetite diminished, his pulse was quickened, and he passed sleepless nights. The thigh was rubbed with anodyne balsam, and draughts with laudanum were given every night, but only with temporary benefit. For the course of some months these complaints continued, with occasional remission and aggravation. At last he began to complain of difficulty in making water; and this soon ended in a complete retention. The catheter was attempted to be passed; but although its point was bent, and directed so as to correspond to any deviation of the prostate gland from its right situation, it could not be introduced. By examining per anum, a large elastic tumor could be felt in the pelvis, which was considered as the bladder. A trocar was therefore passed up the rectum, and the bladder attempted to be tapped. A considerable quantity of bloody fluid came away; but he complained of no pain at the glans, which most patients do when the bladder is wounded; and a considerable quantity of high coloured fœtid urine was voided by the urethra, and continued even afterwards to be passed, although with some difficulty. Within a week after this the patient died.
On dissection, I found the hip joint to be completely surrounded with a soft matter, resembling the brain, inclosed in thin cells, and here and there cells full of thin bloody water; the head of the femoral bone was quite carious, as was also the acetabulum. The muscles were quite pale, and almost like boiled liver, having lost completely their fibrous appearance, and muscular properties. On opening the abdominal cavity, the same kind of substance was found within the pelvis; and the greatest part of the inside of the bones of the affected side were quite carious. Large cells were found in this diseased substance, containing bloody water; and it was into one of these that the trocar had entered when the bladder was attempted to be tapped.