Myeloid tumour with complete absorption of the shaft of the humerus, following double fracture--excision--death / by Shirley Deakin.

Deakin, Shirley.

Date:: [1884]

Credit: Myeloid tumour with complete absorption of the shaft of the humerus, following double fracture--excision--death / by Shirley Deakin. Source: Wellcome Collection.

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$Measurements about an inch below insertion of deltoid, right 12;/, left 141. Pulse 90, equal in both wrists ; temp. 98.8° F. ; appetite good, bowels open ; lungs normal; heart presystolic ; bruit loudest at base and over subclavians; accentuated first sound ; liver and spleen not enlarged ; urine, phosphates in abundance ; no albumen. Treatment, cold applica¬ tion ; rubber bandage twice daily for half an hour. Pot. iod., grs. x ; infus. cinch, f 3j ter in die. Oct. 5th. Arm much the same way ; no pain except on deep pressure ; sleeps well; tongue furred. IP N. O.; loss of appetite ; temp. 98.8° F. right axilla; 99.2° F. left axilla. Treatment: omit pot. iod. and cold application; Ferri sulph. grs. ij ; quinia sulph. gr. j ; ext. aloes com. gr. ss, ter in die—M. Nov. 1st. The arm is gradually increasing in size; general health fail¬ ing; mental depression; loss of appetite; no pain, except on pressure; unable to sit up or walk about for more than a quarter of an hour, as it causes a “tingling sensation” through the forearm ; the bulk of the swell¬ ing is on the outer side of the arm, and at the site of the upper fracture; gives an obscure sense of fluctuation ; the brachial pulsations can be felt conveyed through the outer and upper part of the arm ; the radial pulse is good and equal to the right side; there is no loss of power in the hand or fingers ; yesterday the swelling extended over the scapula and below the clavicle ; this disappeared in a few hours after galvanism was applied ; there has never been an increase of temperature beyond 99° F. since ad¬ mission ; galvanism ten minutes daily. P. Acid, hydroch. dil. npxv; liq. strychnia, npv; decoct, cinchona, sj, ter in die. 14th. There is a decided increase in the size of the arm within the past three weeks ; it measures 1 o| ; heat and redness greater ; general health breaking down ; no rise in temperature ; no difference in radial pulses ; the patient is feeling anxious about his arm, and has passed restless nights in consequence ; lungs healthy ; heart, loud presystolic murmur at base and along subclavians ; accentuated first sound; no evident enlargement of liver or spleen; urine, sp. gr.. 1020 ; no albumen ; no phosphates ; bile present; chlorides in abundance. 1 Gth. As the patient is falling away in health visibly, it is decided to lay the tumour open by a free incision, and remove it. 4.30 P. M. Patient placed under chloroform (Junker’s inhaler); rubber bandage applied from fingers up. After the arm was tied high up at the shoulder with rubber tourniquet, the bandage was removed and a free inci¬ sion was made on the outer side of the arm. The rubber tourniquet con¬ trolled the hemorrhage until the myeloid mass had been scooped out for about five inches. There was free oozing of venous blood ; a firm mass of brain-like substance (large-celled myeloid tissue) welled up from the centre of the incision. I removed the whole quantity with my hands, and found that not a trace of bony tissue remained throughout the whole length of the arm beyond the epiphyses. The shaft of the humerus was wanting. There was no shortening of the limb; the rapid increase in the myeloid tissue constituting the tumour had probably prevented this. The cyst containing the myeloid substance was probably the dilated and thickened periosteum—a dense, firm membrane, with irregular striae over its internal surface, and very vascular. There was a large amount of oozing, though there were no large vessels to tie, and a large quantity of blood, probably not less than two pints, was lost. I had no hot water, temp. 125°, of which I have the highest opinion as a styptic, ready. I plugged the cavity with$