Journal : Photographic review of medicine & surgery ; vol. 2., no. 4.
Philadelphia : J. B. Lippincott & Co., 1871-72.
Description : pp. 29-31,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Hip joint — Encephaloid tumor.
I am indebted to Professor Gross, of the Jefferson Medical College, for the opportunity of describing the case represented in the accompanying photograph.
Although a portion of the history of this case, as well as an account of the subsequent operation for its relief was given in the American Journal of the Medical Sciences, vol. lii. p. 31, yet it may not seem inappropriate, while presenting the photograph, to give a short account of the operation, as well as a description of the tumor.
The patient, Patrick Gilfoil, aged 54, a laborer, and temperate in his habits, applied at the clinic of the Jefferson Medical College for relief, suffering from a tumor of the thigh, the history of which is briefly as follows :
His health had always been very good, and he had never suffered from disease of any kind until about four years ago, when, without having previously, so far as he knows, experienced any injury to the part, a small lump appeared on his thigh, which was painless ; it continued growing slowly until it reached the size represented. It measured nineteen inches in its long diameter, and about thirty in circumference at the widest part. It extended upward to within two and a half inches of the groin, and downward to the popliteal space.
The integumentary covering of this tumor was quite natural in color and general appearance, and showed no signs of commencing ulceration. Underneath the surface the course of the enlarged superficial veins could be distinctly traced.
To the sense of touch the mass was firm and brawny in texture over the greater part, though softer in some places than in others. It was indistinctly lobulated, moreover, and on pressure gave a sensation of semi-elasticity.
Its size and weight were so considerable as to cause lameness after even a moderate amount of exercise. A microscopic examination of a small portion of the firmer part of the tumor showed numerous cells, with an increased proportion of fibrous stroma. In the softer parts, however, the cellular element predominated. Of the tumors for which the one under consideration was likely to have been mistaken, it could be discriminated from enchondroma by its comparative softness and noncartilaginous character, while from fibroid, its lack of uniform consistency, as well as the comparatively short period of its growth, served to distinguish it. Fatty tumors seldom occur in this part of the body, and their consistency is so peculiar and different from all other growths that it could not be supposed that one existed in the present instance. Moreover, the microscopic appearances settled the whole question, and the conclusion reached was that there existed here an encephaloid or medullary sarcoma.
As the tumor appeared entirely too large and vascular for excision, and as it seemed probable that the femoral artery was imbedded in its substance, it was evident that the only available procedure was amputation at the hip-joint.
This operation was consequently performed by Professor Gross before the class of the Jefferson Medical College, on October 14, 1865, in the following manner:
The leg having been elevated for some time, in order that as much venous blood might drain out as possible, the whole leg was firmly bandaged from the toes. The patient was then put under the influence of chloroform, and the circulation being controlled by a Skey's abdominal tourniquet, the incision was made, contrary to the usual rule, from without inward, on account of the scanty material for flaps. The muscles were divided by a circular incision, and the muscular flaps being grasped firmly by assistants as soon as they had been made, pressure was thus exerted on the numerous smaller arterial branches with the result of an exceedingly small loss of blood. The vessels were then secured by seven ligatures, and, after exposing the surface of the flaps to the air for about two hours, these were united by acupressure pins and adhesive strips, a dry compress and roller being afterwards applied.
The patient reacted well, and passed a comfortable night, and progressed without an unfavorable symptom to complete recovery, union by the first intention taking place along a considerable portion of the wound.
At the end of a month only a small point remained unhealed, near the acetabulum, and the man returned home, a distance of one hundred miles. When last heard from, he was doing well.