Myeloid tumour with complete absorption of the shaft of the humerus, following double fracture--excision--death / by Shirley Deakin.

Deakin, Shirley.

Date:: [1884]

Credit: Myeloid tumour with complete absorption of the shaft of the humerus, following double fracture--excision--death / by Shirley Deakin. Source: Wellcome Collection.

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$Article XI. Myeloid Tumour with Complete Absorption of the Shaft of the Humerus, following Double Fracture ; Excision ; Death. By Surgeon S&ieley Deakin, F.R.C.S. Eng., Indian Medical Department. The following case is one of much interest, and in some points resem¬ bles a case recorded by Norris, in the American Journal of the Medical Sciences, 1842, mentioned by Bryant in his Surgery, vol. ii. p. 532. When I first saw the patient, four months after the accident, there was no thick¬ ening of the left arm. I could distinctly make out the two fractures, fairly transverse ones, at the junctions of the middle with the upper and lower thirds of the bone. The patient was a healthy young man, rather stout. I determined to try Colies’, of Dublin, method of inducing union of the fragments. This plan, according to a note by Dep. Surgeon-Gen¬ eral Norman Chevers, I. M. D., now of the London Hospital, in his articles on fevers and tropical diseases in the Medical Times and Gazette, 1883, consists in putting the limb in splints and administering mercury so as to “ touch the gums.” I accordingly put my patient on Plummer’s pill, gr. v, twice daily ; after a month scarcely any constitutional symp¬ toms had been induced, so I increased the dose ; after a fortnight no improvement had taken place, and I applied a small quantity of ung. hydrarg. locally. Nothing beyond decided sponginess of the gums was induced. The upper fragment appeared to be joining, and I hoped that the treatment would be successful. The fixity was, however, probably due to the tension caused by the growth of the tumour, for, eventually, I found that the fragments were as far from union as ever. Shortly after this, as the patient began to lose flesh, he asked me to admit him as an in-patient to the civil hospital, which he entered on the 28th of September. At this time I had not a suspicion of the growth of any tumour ; the enlargement and tense, doughy feeling I attributed to oedema. The steady increase in the size of the limb and the gradual im¬ pairment of health now struck me; the mercurial treatment had been exchanged for ammonia, iodide, and bark. The question was : What was the nature of the tumour ? The youth of the patient, the oblong outline of the tumour, the absence of any bony hardness, the “ semi-elastic feel, and yielding to the touch, an unequal sensation as to density,” the position on the shaft of the bone, the integument covered with large full veins, suggested periosteal cancer. The absence of a bone shell, as far as could be determined by external ex¬ amination, notwithstanding, from my previous experience during the past two years of three myeloid tumours, I was of opinion that the tumour was myeloid. I therefore determined to try and remove the part of the bone$