Sarcomatous Cartilaginous Tumours. 345 



By 17th December his general condition and blood had consider- 

 ably improved under treatment, and Dr Watson decided to remove the 

 arm, scapula, enter third of the clavicle along with the tumour, as the 

 only possible means of affording relief to the patient's intense sufferings. 

 He was in a state of constant acute suffering, and could not retain the 

 arm for five minutes in one position. The pain prevented the possibility 

 of sleep for more than three minutes at a time, and he had not slept 

 an hour for many weeks. He liad quite a cachetic appearance. 



At this time the tumour of the right scapula rose as a great hump 

 above the line of his shoulder. It was incorporated with the scapula 

 and adjacent parts. It was firm in consistence in some places, and soft 

 and almost fluctuating in others. There were also multiple growths, like 

 small apples and firm in consistence, on the metacarpal and phalangeal 

 bones of both hands. 



The knees were rigidly semi-flexed, and the patient had scarcely 

 any power over his lower limbs, the muscles of which were much atro- 

 phied. The thighs and calves felt brawny. 



Dr "Watson operated on 17th December 1883, and the wound 

 healed without a bad symptom. 



Although he made a capital recovery as to wound, he only slowly 

 recovered the use of his legs, by the use of rubbing, the "battery," 

 and extension at night to straighten the knees. On 6th April 1884 

 his general health was good, but as he was still unable to use his 

 4egs, much the same treatment was continued. On 20th June 1884 a 

 photograph of the cicatrix was taken. He could then walk with help, and 

 his health was good. During July and August he walked fairly well, and 

 went to the country. In September, on his return, he did not look so well, 

 his colour being dusky. In November 1884 Dr Burn Murdoch was 

 called to attend him for pains in his chest on the right side, with short- 

 ness of breath and cough. Some pleuritic rubbing was heard, and a 

 copious efi'usion into both right and left pleural cavities was detected. He 

 died shortly afterwards, in November 1884, from obstruction to respira- 

 tion and increasing weakness. 



Autopsy. — The chest (both sides) was full of fluid, and both lungs 

 were studded over with hard and semi-hard nodular masses. One or two 

 nodules of a similar nature were found on the internal surface of the 

 ribs. (Permission had been given to examine the chest only. ) 



The fingers are disfigured by numerous simple cartilaginous 

 tumours of the usual character. A section of one has been made 

 to show its structure. The firm lobulated cartilaginous substance, 

 interspersed with calcareous and osseous nodules, is characteristic 

 of the slow-growing simple chondroma. A somewhat similar 

 tumour can be seen growing from the outer condyle of the 

 humerus, as well as from the adjacent portions of the bone. 

 The tumour on the scapula has been sliced in one or two places 



