facilitate the dissection in the axilla. The patient, exhausted, made
some efforts to vomit, and dropped his head from the pillow, pale,
cold, and almost lifeless. Then only the nature of the case became
apparent. The sponge being withdrawn, one rapid incision completely
separated the upper edge of the tumour, so as to expose its cavity;
and, directed by the warm gush of blood, a large vessel in the upper
corner, which with open mouth was pouring its contents into the sac,
was immediately secured. The coagula being removed, by dissecting
under the finger, the subscapular artery was then separated, so that
an aneurism needle could be passed under it at its origin from the
axillary, and about an inch from the sac. After securing this and two
other large vessels which supplied the cavity, the tumour was dissected
from the ribs without further hemorrhage, cutting the diseased scapula
and the under part of the sac. It was then found necessary to saw
off the ragged and spongy part of the scapula, leaving only about a
fourth part of that bone, containing the glenoid cavity, processes,
and half of its spine. The edges of the wound were brought together,
and the patient lifted cautiously to bed. At this time he was pale,
almost insensible, and without any pulsation perceptible through the
integuments in the greater arteries, though the ends of the vessels
in the wound beat very forcibly. Stimuli were employed externally and
internally; in the evening his pulse at the wrist was ninety, and soft.
The sac of the tumour was composed of bony matter, containing little
earth, and arranged in strata of short fibres pointing to the cavity.
Its outer surface was smooth, and covered by a dense membrane; whereas
the inner, to which so equable a resistance was not afforded, was
studded with projecting spicula. The lower part of the scapula,
partially absorbed, lay in the middle of the sac, covered by the
remains of its muscles and coagula. Very large vessels were perceived
ramifying on the surface of the tumour.
The patient made a rapid recovery, and the wound all but healed.
A fungus, however, began to appear in about six weeks, which grew
rapidly. This was removed, and the bone cauterized with little good
effect. The tumour was soon reproduced. It was proposed to remove
the remainder of the scapula with the extremity, as the only chance,
though perhaps a slight one. This was objected to, and he died about
five months after the operation, worn out by hemorrhage and profuse
discharge.
Public-domain text, read in full here on John Shaqi.
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