Case of sloughing of a malignant tumor which contained the femoral vessels : cicatrization of the wound, death from the return of the disease / by J.A. Kingdon.

  • Kingdon, J.A.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Case of sloughing of a malignant tumor which contained the femoral vessels : cicatrization of the wound, death from the return of the disease / by J.A. Kingdon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    knife was followed by a sudden and voluminous gusli of florid blood, as from a wound of a large artery; the bleeding orifice was soon seized, and secured by ligature; yet much blood was lost. Owing to the deep and obscure attach- ments of the tumor, its extreme vascu larity, and probable malignancy of cha- racter, it was deemed inexpedient to pursue the operation farther, as that step would have involved tbe necessity of tying the femoral vessels close above the morbid growth,—a course which, in the exhausted state of the patient, seemed to be very dangerous. He was removed to bed in a very low state; he vomited much, and complained of pain in tbe region of the knee, but not in the seat of the disease. 4& p.m.—Still continues sick, but is free from pain ; complains of chilliness, although he is perspiring freely; pulse 90, small and feeble. There has been no haemorrhage since the operation: the edges of the wound were approxi- mated by sutures, and water dressing applied. An effervescing saline draught was given. 14th.—Slept but little last night on account of sickness: the vomiting and nausea still continue : the wound looks well, and he states himself to be free from pain. 15th.—Sickness again prevented his sleeping; he feels hungry, but can re- tain no food; there is no perceptible difference in the temperature of the feet; skin warm and soft; pulse 114, small and feeble; tongue pale and moist; bowels not open; thex-e is slight redness around the wound, which is otherwise healthy; the stitches were x-emoved. Ordered, of Scheele’s Hydrocyanic Acid tt|iss. to be taken in an effervescing draught three times daily. 16th.—Continued voixiiting pi-evented sleep ; but in other i-espects he i-emains in the same condition as yesterday; the redness of the wound has slightly in- creased, and suppuration has com- menced feebly. Oi-dered a mustard poultice to the epigastrium, and a bi-ead and water poultice to the wound; to continue the drops. 17th.—He was much relieved by the mustard poultice, and slept for five or six hours last night: he has had but little sickness this morning; the wound looks well, and is suppurating freely; the surface of the tumor, as well as the rest of the wound, is red and granu- lating. 18th.—Slept tolerably well last night, and is no longer sick: he has taken some bread and cheese and porter (for which be craved) with relish: pulse 112, soft; tongue thinly furred and moist; bowels not open. 20th.—The bowels were fx-eely relieved after a dose of the ordinary house medi- cine ; axxd in consequence he reports himself as feeling much better to-day. A pint of porter daily. 22ixd.—He has not slept well for the last two nights: there is an erythema tous blush on the upper and oxxter side of the thigh, and slight enlax-gement of the limb below the knee, with pain in the ankle; the wound looks well, and the secretion is copious and pxmform; skin hot; pulse 120, small axxd weak; tongue pale and moist: he has no ajxpe- tite, and is thirsty. 24tlx (twelfth day after operation).— Dozes occasionally, yet gets no sound sleep : he moans continually, but not froxxx pain; the redness of the thigh has extended somewhat, and is rather more intense; the cut edges of the woxxnd are looking well, and suppurate healthily; but thex-e is a black spot in the centre of the tumor, and the granulations around are pale and indolent. 29th.—The erythema has greatly sxxb sided, and he is now able to sleep com- foi-tably; the leg is less cedematous, and quite free from pain; the wound sup- piu-ates freely; the whole of the tumor is convex-ted into a black, ragged, and sloughing mass, embedded in, and partly overlapped by, the healthy gx-anxxlating suifiace of tbe sxxrrounding parts: it is without sensation. 30th.—He was ordered to take half a drachm of Battley’s Liquor Cinchonas Cordifolite three times daily: a mutton chop daily. November 2nd.—He eats his mutton chop with relish, and says that he feels better; he sleeps well, and is free fronx pain; the wound looks healthy; a bent probe passes down three inches on either side of the blackened mass; there is a snxall bed sore over the sacrum. LC-tli (twenty-eighth day after opera- tion).—For the last week he has been gradually improving: pulse 100, still feeble; tongue clean and moist; bowels open; his appetite is good; the wound discharges healthily; tlxe slough is sepa- rating. At this day’s visit Mr. Lawrence x-enxoved, without using vxolence, the mortified tumor, by elevating the mass