Volume 1

Illustrations of clinical surgery .. / with descriptive letterpress by Jonathan Hutchinson.

  • Hutchinson, Jonathan, Sir, 1828-1913.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Illustrations of clinical surgery .. / with descriptive letterpress by Jonathan Hutchinson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    rather greater on the right than left. It involved both buttoeks. Its eireumferenee was fifteen inehes, and from the amis over the top of the tumour to the first vertebral spine wliieh eould he dis- tinguished, was a length of ten inehes. It felt firm, but with fluetuation in eertain parts. The skin over it was thin in the middle and adhered closely, but at its base it was loose. When the finger was passed into the bowel a soft solid mass was felt surrounding the rectum above and on the sides. The tuber ischii was easily felt on the left side, but not on the right. The coccyx could not be distinguished nor the sacrum reached. During the child’s life we had frequently discussed the propriety of removing the mass, and after its death I was especially interested in ascer- taining whether an operation would have been practicable. By curved incisions on each side, it was easy to reflect flaps of skin which would have covered the wound. On approaching the spine the growth was found adherent to the bones, and not wishing to disturb its relations I cut through the sacrum at its lowest part and found afterwards that the coccyx and part of sacrum were embedded between lobes of the tumour. One large mass overlaid the sacrum above, another projected into the pelvis between the bowel and the bone and filled the sacral hollow. This lobe, as large as an infant’s fist, was covered with peritoneum, and although with care I think it might have been dissected out, it is not probable that such would have been the result in an operation. Nearly six inches of the rectum, much displaced downwards, were imbedded in the tumour. The adhesions to the bowel were only loose and might easily have been separated. The removal of the tumour during life would have required a prolonged and careful dissection, and would probably have been attended by mucb loss of blood. In all probability it would have resulted in a large opening into the peritoneal cavity, and a long tract of the bowel would have been exposed. The wound left would have been, in proportion to the infant’s body, an enormous one, and the shock would probably have been very severe. Still there would have been nothing encountered which wholly precluded the chance of recovery, and the tumour might have been taken away entire. Plate XLIX admirably shows the appearances on a vertical section through the length of the tumour. It was composed of cysts of various sizes, from a pea to a chestnut. These cysts had smooth epithelial linings, and contained a glairy transparent fluid. The fibrous dissepiments were thick and strong. The relations of the rectum to the tumour are well shown in the portrait, as also the position of the coccyx, which was cut through and left in sitil.