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]
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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![with forceps, and separating the more firm attachments with the scissors. On minute inspection, the slough, the size of an ordinary orange, was found to be perforated by a very large artery ; and more towards the centre of the mass another canal with less distinct coats lying parallel to it: these, from their size and relative position, were evidently the femoral vessels.* 12th.—The wound is filling rapidly ; his appetite has increased. 21st.—The limb has been rolled from the foot to the groin for the last week, and is much diminished in size: cica- trization advances. December 13th.—Walks about with the aid of a stick: the wound has nearly closed. 19th.—Discharged well. On leaving the hospital, he went to his house in the north of Wales; and in a letter received from him a fortnight after his dismissal, he stated that he had borne the journey well, but that be had not left the house since his arrival, in consequence of return of pain in the thigh. Tidings of his death were brough t to the hospital at the expiration of six weeks, accompanied with sections of the disease, which had reappeared in his thigh, and shewn itself in the lungs also. A post-mortem examination was made; but as the gentlemen who con- ducted it were not fully aware of the circumstances of the case, the chest and thigh only were examined. The lungs on both sides were studded with masses more or less considerable of a yellowish- grey substance, which presented the appearance of firm medullary cancer; the diseased mass which had returned in the thigh yossessed the same cha- racters as those found in the lungs. It is much to be regretted that neither the i condition of the femoral artery, nor the i extent or attachments of the tumor, were i investigated. Among the many points of interest ] presented by the foregoing history the i following appear to be more especially ' worthy of notice :— Diagnosis.—The subject of the dis- ' ease was a man who had all the ap- 1 pearance of robust health; his face was ■ruddy, and free from that tawny-yellow tinge that so often accompanies a ma- lignant diathesis. The tumor, situated * The preparation is in the Museum attached to the Hospital. rather above the middle of the thigh, did not cause much uneasiness, although lancinating pains were sometimes felt shooting towards the ankle. It was deeply seated, but moveable, bard, and not materially tender when touched: there was no distension of the veins of the skin over it, nor any enlargement of the limb below; the inguinal glands were unaffected. These symptoms could scarcely be said to indicate a malign nature; the locality of the disease (the bone being unaffected) was not one in which such tumoi-s gene- rally occur, although perhaps the depth might have favoured the supposition ; and the lancinating pains were thought to be occasioned by the pressure of the mass upon some branches of the ante- rior crural nerve. Most patients are apt to ascribe the commencement of then- maladies to some special cause; but the value of their theories is often very questionable. In the present in- stance the origin was attributed to a blow, which (granting the patients to be correct in their assertions) is cer- tainly a very common cause for many local affections; yet there are many surgeons of eminence who consider it a matter of diagnostic importance, more especially in doubtful mammary tumors ; for it is well known that in cancer of the breast the patients almost invaria- bly attribute the commencement of the disease to some local violence, while in other affections of the organ such an origin is neither so frequently nor so positively stated. Operation.—From the free lateral mo- bility of the tumor, and from its seem- ingly well-defined boundary, no great difficulty was anticipated in its removal, although the neighbourhood demanded caution. But when a free exposure of its anterior surfaces was made, and small nodules of disease were found stretching up towards the crural ring, and when the depth of its attachment was ascer- tained by dissection, then was the seve- rity of the undertaking in some measure appreciated. The case was not even at that time thought to be desperate; and, although it was considered somewhat strange that the femoral vessels had not become apparent, still further was it from the mind of the operator to con- ceive that the pulseless mass which he was handling and dissecting out was permeated by them. When, however, at length this truth was discovered,](https://iiif.wellcomecollection.org/image/b22424581_0005.jp2/full/800%2C/0/default.jpg)
