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REMOVAL OF ERECTILETUMOURS.

W. HENDERSON, M.D.

To the Editor of THE LANCET.

SIR,—I saw an account the other day, byM. Pigeaux, in the " Provincial MedicalJournal," of an erectile tumour cured byvaccination. Three years ago I destroyed asimilar tumour, of large size, on the head ofa child, three months old, by similar means.I made a great many punctures with a

lancet, charged with the vaccine virus, allover the tumour. The consequence was alarge confluent pock, which effected a com-plete cure without farther interference. Ihad previously, at three different times,thoroughly broken up its interior with a

sharp-edged cataract-needle, without effect.At about the same time, by a differentmethod, I removed a large, flattish, broad-based, erectile tumour from the forehead of agirl two years old. I transfixed the tumourat its base, with two needles, armed withdouble ligatures, crossing each other at rightangles. The tumour was thus divided intofour segments; through the centre of eachlower segment, at its base, I introduced acommon steel needle, bringing it out at thecentre of the opposite segment above. The

upper threads were then knotted below the

needle-points, so as to embrace the upperhalf of the tumour. The lower threadswere now drawn firm, and tied below theheads of the needle. Small pieces of lintwere placed below the needles’ extremities,and the whole was covered with a pledget ofdry lint, and secured with a bandage. Thegirl suffered little inconvenience from theoperation, the tumour came off in a few days,and the part soon healed up, was smooth,and looked well; in a short time, however,the tumour gradually again arose, and wassoon as large as ever. No farther operationwas allowed.At the time at which I write (now three

years since the operation) it has decreasedfully a half in size. Should it diminish inthe same ratio, in three years more it willbe entirely gone. This tumour was so flatand broad at its base that the ligatures couldnot have embraced it thoroughly at its rootwithout the needles to keep them down. Ihave frequently tried nitrate of silver, buthave found it useless in such cases. I findthe potassa fusa much more potent and effi-cacious. With it I destroyed, in an infaut,a chain of small erectile tumours, whichstretched from the ala of the nose to thecorner of the mouth. Some of themhave returned, but so very slightly thatI am in hopes they will disappear withoutanything farther being done. I ann, Sir,your most obedient servant,

W. HENDERSON, M.D.Corstorphine, Edinburgh,

Sept.1843.

KING’S COLLEGE HOSPITAL.

CASE OF VASCULAR TUMOURON THE CHEEK.

ERROR IN DIAGNOSIS. OPERATION AND

REMOVAL WITH LIGATURES.

WITH

CLINICAL OBSERVATIONS,By Mr. FERGUSSON, Surgeon to the

Hospital.

DONALD KELLEARD, ætat. 19, admitted29th July, 1843, labourer, a native of Lon.don, where he has chiefly resided. Born ofhealthy parents. When about six monthsold a small white-coloured tumour was ob-served immediately below the left orbit, towhich poultices were applied, when it dimi-nished in size. Some time after it enlargedagain, and again seemed to decrease underthe use of poultices. Subsequently it gradu-ally enlarged, and about eight years ago theskin over it assumed a dark-brown colour.At this time his mother, supposing that itcontained matter, punctured it with a needle,when a small quantity of dark blood onlyescaped. The swelling did not alter muchuntil about six months ago, when it suddenlybegan to enlarge, and has continued to in-crease up to the present date.There is now a prominent tumour over the

left superior maxilla, just below the orbit,about the size of a duck’s egg, which keepsthe eyelid against the eyeball, and begins toforce the nose to the opposite side. Theskin is of a dark-brown colour, and thetouch does not clearly indicate whether theswelling consists of fluid or solid substances.Has occasional pain in the part, of a prickingcharacter. Since he was two years old hasalways enjoyed good health, and now ap-plies to have the growth removed in conse-quence of the increasing disfigurement.August 1. To-day he was brought into the

operating theatre, and Mr. Fergusson pro-ceeded to operate with the intention of dis-secting out the mass entire. Three incisionsthrough the skin, each about an inch and aquarter in length, were drawn from the cir-cumference of the swelling, and made to meetat a point on the centre, where the threeflaps, of nearly equal size, were dissectedfrom the mass. As soon as the knife passeddeeper than the skin, which was of its usualthickness, and considerably more dense, thetissues appeared remarkably vascular; ateach stroke of the knife a jet or gush of bloodindicated the division of an artery or vein oflarger size than is natural to this part, andbefore the flaps were sufficiently dissectedoff, several fingers were required to stem theflow of blood. Instead of attempting to

remove the disease with the continued use ofthe knife, the plan of the operation wasaltered, and the tumour was twice fransfixedwith large curved needles, set in handles,

945

each carrying a double ligature, which werefastened to each other, and drawn tightround the base of the swelling. The bleed-

ing was thus completely restrained, and thepatient was sent to bed, with directions tokeep cold cloths applied to the wound.

4. There has been no further bleeding,and warm-water dressings have been sub-stituted for the cold; has had considerablepain in the cheek, which has become greatlyswollen, whereby the eye is completely closedup; the parts surrounded by the ligaturesseem to be completely strangulated, and arein a sloughing condition ; wound beginningto discharge matter.

12. Has had a good deal of fever andtaken little food ; has had five ounces ofwine daily, for some days, and been allowedbeef-tea, or any other nourishment he mightchoose. A large portion of the tumourabout to drop away as a slough, but under-neath there still appears a vascular eminence.

16. The old ligatures were withdrawnand others substituted, so as to include theremainder of the vasculai part.

17. Indications of two small abeesses, onein the eyelid, the other in the cheek, belowthe wound, were discovered, and on the 21 stthese were opened. On the same day thepart inclosed within the thread sloughedaway, and a healthy granulating sore wasleft.

Sept. 6. Since last report his health hasrapidly improved, and his appetite is com-pletely restored ; the wound has graduallycicatrised, and he is now discharged, cured.

16. Has appeared at the hospital to-dayin the best of health. The morbid growthseems completely eradicated, and the slightswelling which still remains is apparentlythe result of the severe inflammation on thecheek subsequently to the operation. It isless than when he last showed himself, and,from his own account, is rapidly diminishing.Has no pain or uneasiness in the part, andthe cicatrix is scarcely observable at a littledistance.

After the operation Mr. Fergusson statedthat he had been completely deceived iu hisdiagnosis of this case, for he had supposedthe tumour to be one of an atheromatouscharacter. Nothing in its history had ledhim to suspect that it was vascular, andcertainly there was little in its appearanceor character to induce him to think so. Theskin was commonly thinner in such cases,and had all the indications of vascularity;moreover, the presence of pulsation and thecompressible nature of the swelling, as wellas other strongly-marked symptoms, usuallyled at once to the detection of such a form ofdisease. He had not come to a hasty con..clusion in this case either, for he had re-peatedly examined the mass, and had askedothers to do so. He had thought that itresembled an atheromatous growth, but asit was not usual to see tumours of this.No. 1048.

description on the cheek, and as, moreover,its characters were such as to cause him notto be very clear on this point, he had fingeredthe part again and again. As soon, how-ever, as he had begun his incisions he dis-covered his error, and he immediatelyresolved to treat the case with ligatures,according to the method which had been re-commended, and so advantageously put intopractice, by Mr. Liston. He had separatedthe skin from the vascular mass as exten-sively as he could do with propriety, so that hemight include the largest possible extent inthe nooses of the ligatures without inter-

fering with that texture. On such an occa-sion the surgeon might feel himself in anawkward dilemma, and in the midst of snchprofuse haemorrhage some coolness was re-quired to determine on the proper course forfurther proceedings. Possibly, had he beenaware of the real nature of the case whenthe patient came under his charge, he mighthave selected some other mode of treatmeat,although, in all probability, he would havechosen that which he had just followed, asbeing the best, under the circumstances, toeffect the separation and obliteration of thevascular mass.

WESTMINSTER HOSPITAL.

INTOXICATION.—FRACTURE AT THE BASE OF

THE SKULL,

AUGUST 25. A woman, name unknown,fifty to fifty-five years of age, was broughtinto the hospital last night, in a state of £

°

senseless intoxication, by the police. Uponthe affusion of cold water by the house-surgeon, partial restoration to sensibilitytook place. She spoke in a drunken accent,and made efforts to disengage herself fromthe attendants. She was taken away in

charge of the police, but brought back againthis morning on a stretcher, in a state of in-sensibility, suffering from an uninterruptedsuccession of convulsions. She was placedin Dr. Basham’s ward, and at half-past two,p.m., when the daily visit was made, shelay in a state of insensibility; comatose ;low moaning; upper extremities slightlyconvulsed ; pupils dilated ; bowels not opensince admission ; pulse 120, cordy and in-

compressible. While noting the case shewas seized with tetanic convulsions ; opis-thotonic ; muscles of face much convulsed ;during the paroxysm pupils contracted ;as the convulsions subsided stertorous breath-ing and coma continued. To be cupped totwelve ounces from the temples ; blister tothe neck; mustard-poultices to the feet; onedrop of croton oil, in sugar, to be droppedinto the mouth.

She continued comatose, with the recur.rence of convulsions, till four, a.m., of the26th, when she died.

3 P