ST. GEORGE'S HOSPITAL.
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oa the 17th he was made an out-patient. The entire woundwas then about healed, with considerable mobility of the limbupon the scapula, and but slight power of the upper arm fromwasting of the deltoid.June 10th.-The patient presented himself to-day with all
the sinuses closed, and the skin sound. He has no pain in theshoulder, and the mobility of the humerus has decidedly in-creased latterly. He has perfect use of the forearm, and canraise the upper arm slightly by rotating the scapula. Thedeltoid is much wasted, and he has little, if any, power in it atpresent. He was ordered to have the deltoid galvanized twicea week, and to exercise the arm by working at a pump.
ST. GEORGE’S HOSPITAL.
LARGE ANEURISM SPRINGING FROM THE ARCH OF THE
AORTA AND FORMING A PROMINENT TUMOUR
OF THE CHEST.
(Under the care of Dr. PAGE.)S. G aged fifty one, was admitted June 1st, 1864. She
had been an in- patient in the previous November. Her historywas that six months ago she tirst felt a beating in the rightchest, together with dyspnoea, and on the least exertion 01excitement pain in the same spot. Never had dysphagia. Is
married, sober, and well-conducted. She improved during herfortnight’s residence in the hospital in 1863 ; the sounds overthe prominent part of the chest became less distinct, and nobruit was ever detected. The right radial pulse was smallerthan the left. She could not lie on the right side, and thechest on that side was full and elevated between the rightnipple and right strno clavicular articulation. Percussion wasdull over this spot. The anterior part of the chest was dusky,and mapped out by distended veins. She died on the 3rd ofJune, two days after her re-admission. Previous to this, forthree weeks she had been suffering from severe persistent painin the right chest, and the spelling had now formed a roundeddistinct tumour, with some pulsation in it, but no bruit. Therewas dulness of the chest on the right side posteriorly, andabsence of breathing. She was supported in the erect position,leaning far forwards. The treatment was directed to easingpain and giving support. The pain was very great, and deathmuch desired.
Autopsy, thirteen hours after deat7t. --There. was a large hemi-spherical tumour on the front part of the chest towards theright side externally, which was as large as an ordinary break-fast cup. When the sternum was raised, the second rib wasfound to have been nearly eroded through; the third to havebeen divided about two inches from the sternum, and the endswidely separated; the fourth to have been displaced down-wards so as to make a sweeping curve round the lower edge ofthe tumour. The right side of the sternum was somewhat
roughened. All the right side of the front of the chest wassomewhat curved, so that the projection was very gradualthroughout. On the removal of the sternum a large cavity,full of coagulum, was laid open; and it appeared that the an-terior wall was formed only by the muscles belonging to thefront of the chest. A large aneurisma-t sac, nearly spherical inshape and of very large size, was connected by a neck (abouttwo inches in diameter) with the arch of the aorta, at the dis-tance of an inch fro’u the semilunar valves. This neck wasattached to the upper and anterior side of the vessels, and oc-cupied the greater part but not the whole of its circumference.It was extremely short ; and immediately on leaving theaorta it dilated into a large spherical cavity which was full oflayers of coagulum. Tne large vessels springing from the archwere unaffected by the disease. The trunk of the aorta was
slightly atheromatous. The uterus contained two small fibroustumours in its substance. The right pleura contained a largequantity of btood ting"d serum, which much compressed thelung at its lower portion.
POPLITEAL ANEURISM CURED IN TEN DAYS BY FLEXION.
(Under the care of Mr. HUTCHINSON.)
THE following cases weie furnished by Mr. Heckf;ird, house-surgeon to the hospital :-On May 7th, a man, aged thirty-six, was admitted with
popliteal aneurism of the size and shape of a large hen’s egg...Patient’s previous health has been good, and he has neitherarcus senilis nor heart disease. Probable cause, a sprain five-months ago ; pulsation has been noticed for about four weeks.only. The tumour steadily increases in size.
Immediately after admission, the leg was firmly flexed uponthe thigh, and retained in that position for six days (in addi-tion, for the first four hours, continued digital compression was.used). At the end of this time pulsation was much less forcible,the walls of the sac being decidedly firmer. The limb was nowallowed to remain extended. The tumour, however, continuedto solidify, and on the tenth day it had entirely ceased tie.
pulsate. The only medicinal treatment was an occasional doseof morphia, although the pain occasioned by the extrem&flexion was comparatively slight, not much more than thatwhich he suffered before his admission. A good diet (but with-out stimulants) was allowed him, and he was, moreover,.directed to drink as small a quantity as possible.Mr. Hutchinson remarked that the administration of lead,
had been recommended in cases of aLe11trÌsru, as tending to pro-mote the deposition of fibrin. It was therefore a point of in-terest in this case that the patient was a plumber, and had awell-marked blue line on his gums. He left the hospital onMay 24th.
SUDDRN DEATH; CLOT IN THE HEART.
A man, aged thirty-six, exhausted by caries of the vertebrseand psoas abscess, on getting out of bed, fell down insensible,and expired soon afterwards. During the day he had com-plained of general indisposition, and had refused his food, butnothing was observed to excite suspicion of approaching death.A large, pale, firm, fibrinous deposit was found in the right
cavities of the heart, extending into the pulmonary artery. Itwas strongly adherent to the appendix of the auricle and apexof the ventricle. From either of these two points the wholeweight of the heart could be made to depend without its tear-ing through. Transverse bands of fibrin passed from the clotto the ventricular walls. So closely was it attached, that evenwhen considerable force was employed to remove it, portions,were loff behind
SCIRRHUS OF THE BREAST ; EXCISION ; CLINICALREMARKS.
(Under the care of Mr. GEORGE LAWSON.)
H. P-, aged forty-nine, was admitted April 5th, 1864suffering from a scirrhus of the left breast. Her father andmother had been healthy; the former died at seventy nine, thelatter at eighty-one years of age. There is no history whateverof cancer in the family. She has two brothers and two sisters-now living, and all robust and healthy. One sister died some-
years ago of a pulmonary affection. The patient was born andhas always lived in London. She has been married twenty-three years, and is the mother of three children, the first ofwhom died at the age of seven weeks; the other two (girls),aged nineteen and seventeen, are still living. For nearly two-years the patient states that she has felt at times pain in theleft breast; but she never noticed anything wrong in its ap-pearance, or on handling it, until about six or seven months
ago, when she observed a puckering-in of the skin about asinch below the nipple.
State on admission.-The breast, though large and fat, is.smaller in size than the right one. It is hard, and has shrunksince she first noticed the disease so as to be nearly one halfless than the other. About an inch below the nipple a hardbut small tumour is felt; the skin over it is much puckered-inand adherent. The tumour can be freely moved, and thereare no enlarged glands in the axilla or neck, and no tubercles-can be felt in or about the fat of the breast. She complainsvery much of darting pains in the breast; indeed, it was thealmost continuous paiu which made her seek advice.
April 6tb.-To-day Mr. Lawson removed the breast. Atthe point where the skin was puckered and adherent there wasa separate tumour, connected with one of the lower lobes ofthe breast, and adherent at one point to the lower edge of thepectoral muscle. On making a st-ctiou of the tumour, the usualyellow fibrous arrangement of hard cancer was seen; and on
cutting into the mammary gland the whole of its substance was. found infiltrated with the same materiaL Before awaking