Case of successful amputation at the hip-joint on account of malignant tumour of the femur / by James Spence.

  • Spence, James, 1812-1882.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Case of successful amputation at the hip-joint on account of malignant tumour of the femur / by James Spence. Source: Wellcome Collection.

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    in the right thigh, for which fomentations were applied. About three months previous to admission, however, the mother observed the patient walking as if her right knee was stiff*; she had a con¬ siderable amount of pain in the limb; was sometimes fretful and low-spirited, but her general health was good. On being asked where she had pain, the patient referred it to various parts of the thigh ; and on examining locally, the mother observed an oval lump on the outside of the lower part of the thigh, about the size of a u blackbird’s egg,” and said to be deeply seated. No increase of growth was observed, however, till about ten weeks before admission, when the child is said to have received a blow on the lower part of the thigh (with a chair), and since that time the tumour has been increasing rapidly. Since then, the patient has also complained greatly of pains in the limb, on account of which the part has been fomented, poulticed, and leeched, without any relief. The parents then consulted Dr Thomson of Yetholm, who, recognising the nature of the case, prevailed upon them to send her to the Infirmary. During the last few days, the patient has been losing her appetite, is low-spirited, and complains more of pains. On admission into hospital.—Patient appears to be healthy, but is unusually quiet and reserved. Tongue slightly furred; lungs, heart, and other organs, normal. A tumour, of oval form, inches in length, and about the same in breadth, was found occupying the anterior, outer, and posterior surfaces of the middle and lower part of the femur, just above the condyles. It is of firm consistence through¬ out, and movable along with the femur. The superficial veins are enlarged, but the skin is not adherent. Patient does not complain of pain on pressing the tumour. The inguinal glands on both sides, as also the right cervical glands, are hard, and somewhat enlarged. ls£ June.—P. 86. Sleeps well, and is much better in health. Ordered alterative medicine, followed by tincture of the muriate of iron and cod-liver oil, twice daily. Qth.—P. 96. Has had more darting pains in the limb. General health continues good. Tumour not perceptibly larger since admission of patient into hospital. 1th.—P. 80. Slept well. Chloroform having been administered, Professor Spence made an exploratory incision into the swelling, and discovered it to be a tumour, as diagnosed. The patient’s pelvis was then brought well over the edge of the table, and held firmly by an assistant. Professor Spence next, grasping the soft parts with his left hand, entered the point of the knife at the front of the ischial tuberosity, and passing it obliquely upwards in front of the articulation, brought it out almost midway between the anterior superior iliac spine and the trochanter major, so as to form a large anterior flap. Having opened the joint by this first incision, while Dr Gillespie abducted the limb, the disarticulation was effected, and a posterior flap nearly equal in size to the anterior one was cut from within outwards. Immediately thereafter, a sponge