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tumour. It is difficult also to say whether any lobes dip down behind the fascia of the neck.

Not being in a good state of health when admitted, he was kept in the house till the 29th, before anything was done to the neck. During this time he had some antimonial ointment applied over the sciatic nerve as it emerges from the pelvis. He had also occasional warm baths and opiates to relieve pain. From these measures he experienced some little relief, and having made up his mind to have the tumour removed, the operation was performed on the morning of August 29.

The operation was commenced by making an incision about two inches from and to the inner side of the acromion upwards to the middle of the ramus of the jaw, and another in the course of the sternomastoid, crossing the other at right angles about its middle. The flaps thus formed were dissected back, and the lower origin of the sterno-mastoid divided, this muscle being incorporated with the tumour. The dissection was very difficult, tedious and protracted, in consequence of the firm adhesion of the parts, and of the close vicinity to parts of great importance. The sheath of the vessels of the neck was denuded for at least two inches, and the cervical nerves exposed, and some of them divided. A lobe of the tumour dipped behind the clavicle : this was carefully dissected from the neighbourhood of the subclavian artery. Above, the tumour was attached to the inferior margin of the parotid, and more internally very firmly to the hyoid bone. In

removing it from this last point, a branch of the superior thyroid artery was wounded, which it was found very difficult to secure, and this could only be done by passing a tenaculum behind the vessel, including the artery and a quantity of the surrounding substance, and then cutting the tenaculum in two, leaving a small portion of it thus fixed.

There was a considerable quantity of blood lost, chiefly venous, perhaps l] or 2lbs. Five vessels were secured, the ends of the ligatures being cut off close. The upper angles of the wound were brought together by three sutures, and the lower part filled with lint, at the same time that pressure was made by means of a roller passed over the shoulder and round the waist.

On being raised to be carried away he fainted, but was speedily restored. He was immediately put to bed. A cold perspiration soon broke out, and he complained of his feet being very cold. Warm bottles were applied, and 40 drops of solution of morphia given.

Three o'clock, p.m.-Heat of body returning, and is on the whole as well as could reasonably be expected; he has no very severe pain ; pulse rapid and small; no hæmorrhage, but some weeping or serous discharge.

Six o'clock, p.m.—Continues improving ; bowels have not been opened since yesterday ; ordered to take some tea and eggs; to repeat the anodyne at bed-time, and to have zss of sulphate of magnesia to-morrow morning, to be repeated if necessary.


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.








READ MARCH 28Th, 1843.


M- P— , 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, 351 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 ædema, 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

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