is illustrated in the accompanying photograph, mother of two children, came to the Ghazipur Lady Dufferin Fund Female Hospital on the morning of the 29th April 1894, suffering from a huge sarcoma of the left upper extremity. The great emaciation and weakness added to the great weight of the tumour, which was subsequently found to weigh about 32lbs. avoirdupois, utterly incapacitated her from moving out of her bed without help. She was brought in a dooly. The history of the case as given by the patient is as follows: she used to enjoy excellent health, till August 1891, when she began to have severe lancinating pain in a situation corresponding to the centre of the left humerus. There was no swelling or redness during the first month and a half. With a view to remove the pain, the arm was leeched, cupped and painted with applications of indigenous drugs Then she noticed a hard swellwithout relief. ing, without any change of colour of the skin, appear on the front aspect of the upper arm In the course of about 27 below the middle. months the tumour had grown all round the limb. Then the tumour began to encroach on the forearm, and during the last six months it has rapidly increased till it has attained its present size as shown in the photograph.

A

OF

THE LEFT UPPER EXTREMITY?AMPUTATION AT THE SHOULDER JOINT?RECOVERY. CASE

OF

SARCOMA

By Rajendra Nath

De, Assistant-Surg eon, Ohazipur. Hindu female, by caste Bhagmautia, Bhuinhar Rajputin, married woman, whose case a

Condition on admission.?The tumour mea19ins. in length and 33ins. in girth at its It extends from 3ins. below thickest part. to the shoulder joint, middle of the the forearm. It is fusiform in shape, nodulated, firm sures

2g0

INDIAN MEDICAL GAZETTE.

the feel with the skin adherent. It is very The patient cannot sleep for many hours consecutively on account, of the severe pain. About 10 davs a-^o she scratched the tumour with a splinter of wood to relieve the itching, which was sometimes intolerable. This gave rise to abrasion and ulceration of the skin 011 the posterior aspect of the tumour. From this ulceration (partly also caused no doubt by pressure) there is a constant discharge of pus and She cannot move the limb at all on serum. account of its mere weight, so she is obliged to lie continually 011 her back. She now cannot flex her fingers, nor can she bend the hand at the wrist-joint. She can move the fingers a little. Her face is pinched, and she is anxious; for the last 15 days she has been suffering from constant pyrexia; the evening temperature 011 the day of admission being 104'OF. Her bowels have become loose within the last 8 or 10 days. The axillary and cervical glands have not been affected. The unaffected portion of the forearm aud the hand are slightly (edematous. On the 1st May, after being prepared in the usual way, she was placed under chloroform, and amputation at the shoulder joint performed by transfixion, there being just sufficient healthy skin left to procure suitable flaps which were taken from the outer and inner aspects of the arm. There was little haemorrhage during the operation, the axillary artery being controlled by seizing the inner flap as soon as it was formed. After removal, the arm aud tumour together weighed 15| seers, equivalent to about 32lbs. avoirdupois. On section it was found to be a fibro-sarcoma arising from the periosteum of the humerus, and presented the usual appearances, to It the naked eye, of a tumour of this nature. distinctly had its origin in the periosteum, in the neighbourhood of which it was so dense and firm that it cut witli difficulty. Towards its surface the tumour was of softer consistence with large The spaces filled with masses of degeneration. not were observed. microscopic appearances Recovery has been rapid and uninterrupted, and the relief experienced, from the removal imply of such a heavy weight, has been great. to

painful.

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[Joly

1894.