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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    there remained but one alternative,—to tie the iliac artery, and then extirpate the disease,—or leave the patient as he then was. The operation had lasted about the half of an hour, and the pa- tient had lost a considerable quantity of blood ; it was without much hesitation, therefore, that Mr. Lawrence stayed his hand. Sloughing of tumor.—The prognosis of the many was decidedly adverse to the patient’s well-doing; and certainly so happy a termination as the sloughing of the disease was not anticipated ; for, under the ordinary circumstances of a cancerous growth, such a result is by no means frequent, although occasional instances are to be met with in the works of surgical writers Abernethy* * * § relates the case of a man, aged forty, who was affected with medullary sar- coma of the glands in the left groiu; the integuments ulcerated over the tu- mor, and the mass was separated by sloughing; profuse haemorrhage ensued, which was stopped by pressure ; granu- lations sprang up, and the wound cica- trized. A similar occurrence happened soon after in the opposite groin, but before the cicatrization was complete the patient died exhausted. Traversf speaks of more than one case where cicatrization has been complete after the sloughing of cancerous tumors; and relates the case of a lady who re- mained well for several years after the occurrence. Boyer] gives the case of a Russian princess, who, after having consulted most of the eminent surgeons of Europe for cancer of the breast, at last tried the mineral waters of Bareges as an exter- nal application. While under this treat- ment mortification ensued in the tumor, which was of a large size, and by this process it was entirely separated. The very extensive wound healed completely; but shortly after cancerous tubercles were developed in great number in the vicinity of the cicatrix, and the patient died at Paris eight months after the event, which had inspired her with the hope of a radical cure. Berard§ mentions briefly the case of a woman, in which cicatrization of the ulcer took place after sloughing of the tumor, although the system was gene- * Classification of Tumors, p. 60. t Aled.-Chir Trans, vol. xv. ± Mai. Cliir. t. vii. p. 191. § Diet, de Med., art. Cancer. rally affected, and cancer occupied the internal organs. He relates another case also, where sloughing took place in a large cancerous tumor situated in the thigh of a woman; but that was speedily followed by death. Richerand,* too,affords an example of cicatrization after the sloughing of a cancerous tumor :—A woman, aged 48, of strong constitution, was admitted into the Hospital of St. Louis with a cancerous breast. The very hard mass softened, a violent inflammation of the skin and cellular tissue covering the tumor was set up, mortification followed, and the whole mass was separated: cicatrization was complete in less than two months. Sir Everard Home, and indeed most surgical writers who have treated of cancer, mention similar cases: but of all that have been related the foregoing are perhaps the most complete. In the museum attached to this hos- pital there are two specimens of cance- rous tumors which were separated by slough ing.f The one is the case of a woman 47 years of age, from whom a cancerous breast was removed by ope- ration. The wound healed readily, and remained well for nearly three months; then, however, a tumor began to grow under the cicatrix, which rapidly in- creased, and was separated by sloughing at the end of three months. She died exhausted nine months after the opera- tion. Hard white tumors of cancerous appearance were found in the lungs. The other specimen]; is from a woman 40 years old, in the middle of whose back a large brain-like medullary tumor was situated. The in teguments sloughed over it at the end of four months; and, as she was endeavouring to raise her- self in bed, the whole moss fell out through the slough : it was followed by profuse haemorrhage, and she shortly after died. Now iu all these examples the slough- ing was spontaneous,—i. e., it occurred as a process of the disease, and was not induced by any medical interference; therefore lie argued that their analogy to the case related above was not good. But it must at the same time be remem- bered that the tumor did not at first present signs of death ; it was, on the * No-opr. Chir. t. i. p. 510. | Cat. of St. Barth. Hospital, Anat. Museum, vol, i. series 34, spec. 25. $ Il>iil, series 35, spec. 00.