August 30, 7 p.m.-Had a comfortable night; nearly free from pain, and slept for a considerable time; two doses of sulphate magnesia were taken, which produced two evacuations; he complains of some nausea, and slight difficulty of deglutition, and of considerable pain in the leg, but none in the neck; skin moist; to repeat the anodyne at bed-time.

He continued to go on very favourably, taking nourishing diet. On the third day after the operation the sutures and greater part of the lint were removed, and the wound was looking remarkably healthy. The remaining portion of lint was removed on the 5th day. On the 6th day a slight attack of erysipelas of the head and face came on. This was combatted by fomentations, punctures, and antimonial salines, and entirely disappeared in four days. The wound rapidly healed, being dressed in the centre with charpie, and with simple dressing at the edges. The man was discharged perfectly cured on the 17th of October. The sciatica, however, still continued to trouble him much, and there appeared little prospect of his being entirely relieved of that affection.

TWO CASES OF

OSTEOSARCOMA OF THE THIGH

BONE,

REQUIRING AMPUTATION OF THE LIMB IN

BOTH INSTANCES.

By R. A. FROGLEY, Esq., OF HOUNSLOW.

COMMUNICATED BY SAMUEL LANE, Esq.

READ MARCH 28TH, 1843.

CASE I.

MP, a young female, æt. 26, of apparently healthy constitution, was the subject of a tumour of an enormous growth, evidently connected with the thigh bone. The tumour was not of an osseous hardness, but appeared to the touch to be composed partly of solid, partly of fluid substance. It extended from the knee joint to within an inch of the trochanters, and measured, in its greatest circumference, 35 inches. Its principal projection was inwards; its growth outwards appeared to have been restrained, in some degree, by the fascia lata; the tumour might be felt, however, to extend all around the femur. On the posterior aspect of the limb the increase upwards was not so great the hand might be placed between

:

the tuberosity of the ischium and the tumour. The integument covering the tumour was free from discoloration, and appeared in other respects healthy. A few enlarged veins were apparent on the surface. Progression was but little impeded, except by the weight and bulk of the limb; the leg and foot had been free from oedema, until a short period previous to the operation. The patella might be felt moveable at the lower part of the tumour, a little to the outside of the median line, and the knee might still be partly flexed. The patient had suffered but little pain or inconvenience at any period during the growth of the tumour. The first intimation of this formidable disease (which could not be traced to any injury) occurred in the summer of 1829, when the patient was attacked (while taking a long walk) with rather severe pain over the inner condyle of the femur. This, however, readily gave way to rest and remedies, but returned upon any unusual exertion. It was not however till May of the following year that any swelling was perceptible, and in June she came to town to consult Mr. Lawrence. At this period a tumefaction was perceptible just above the inner condyle, projecting but little, and of the size of the half-closed hand. Mr. Lawrence gave no hopes of relief from remedies.

I did not see the patient till about the middle of February 1833. She had been previously under the care of Messrs. Tothill and Huntly, who tried various remedies, both local and constitutional: the tumour, however, had progressively increased, and

at the time of my first visit had attained about half its ultimate size, occupying the lower half of the thigh. I recommended the immediate removal of the limb, explaining fully the increase of danger from further extension of the disease upwards. It was not, however, till the following year, that the patient could make up her mind to submit to an operation of so formidable a nature.

In the latter part of February 1834, the rapid increase of the tumour upwards, accompanied by oedema of the leg, and other symptoms of imperfect circulation, rendered it necessary to explain to the patient that no further delay could be admitted if any endeavour to save her life was to be made.

The patient at length consented, and on Saturday, March the 1st, I performed the operation in the presence of Messrs. Walker, Lane, Huntly, Emmott, Patten, and Ridout. The extent to which the disease had increased towards Poupart's ligament, gave rise to the important question whether sufficient sound bone remained to allow of the removal of the limb below the trochanters, or whether it would be necessary to disarticulate at the hip joint.

It was determined, however, to make the incision so as to provide for all emergencies.

The external iliac artery being compressed above Poupart's ligament by Mr. Lane, a long narrowbladed knife was passed through the limb from before backwards, entering about two inches below Poupart's ligament, and about an inch to the outside

of the femoral vessels. The instrument having touched the bone, was passed on its inside, and made to pierce the limb directly opposite to the point of entrance; the inner flap was then cut, by dividing the soft parts obliquely downwards, and towards the surface. The bone was now fortunately found healthy for at least an inch below the trochanters, and the after steps of the operation were conducted accordingly. The knife was again brought to the upper part of the wound, and passed a second time from before backwards, between the remaining soft parts and the bone, and thus an outer flap was formed, by cutting obliquely downwards and outwards. In doing this, some little difficulty was experienced, from the force required to cut through so large a mass of flesh with one stroke of the knife, which, indeed, scarcely appeared strong enough for the purpose; the bone was now more completely exposed, by a scalpel applied to the muscles immediately connected with it, and was sawn through just below the trochanter minor. There was scarcely any arterial hæmorrhage. What little occurred, was immediately arrested by one of the gentlemen present grasping the flap, so as to compress the bleeding vessels, until as many as ten ligatures were applied.

The patient, who bore the operation extremely well, now became faint; two or three terrific gasps followed, and she appeared to all present in articulo mortis. She was carried immediately to bed, when, to the great satisfaction and relief of all present, she