Sarcomatous Cartilaginous Tumours. 347 



The following historv- of the case is taken from John Bell's 

 "Principles of Surgery," vol. iii. part i. page 82 : — 



"Alexander Macdonald, a Highlander, from Fort Augustus— a tall 

 and handsome lad, passing six feet in height, and uncommonly athletic— 

 was put to the Perth Academy for his education in writing, book-keeping, 

 and such other parts of learning as might qualify him for a counting- 

 house. It was intended to send him to America, a clerk to the North- 

 West Company, in the fur trade. In running violently at tennis, in the 

 Academy green, he fell and hurt his shoulder. It was such a bruise as 

 often happens from a fall, without entailing the slightest ill consequence 

 beyond the first pain and swelling ; the skin was blackened by the bruise 

 and the joint was sprained ; he had excessive pains along the whole arm 

 for twenty-foar hours ; but it vanished gradually. He imagined himself 

 well ; he had recovered everything but the strength of his arm ; but after 

 the violence of the pain (which lasted no more than twenty-four hours) 

 was gone, such weakness remained, that though from his great strength 

 he could lift perpendicularly such weights as others could not move, yet 

 he could never raise his arm to his head. 



"I was at pains to question his father, a respectable old man, 

 concerning the part which received the injury, and he clearly and 

 decidedly affirmed that it was not the shoulder-joint, but the middle of 

 the bone of the arm that received the shock. It was along the whole of the 

 arm that he felt the pain, and could distinguish the marks of the bruise. 

 The pain had, after its first violence, totally ceased, as if the part had 

 sustained no permanent injury, and he believed himself well. It was 

 exactly at the end of a month that the pain returned and fixed in the 

 joint, with a very distressing sense of weakness, so that he could not at 

 all raise his arm ; if he meant to put on his hat with it, he had to raise it 

 with the other hand, and when thus raised, if he lowered it again 

 without support, the moment it fell unsupported below the level, it 

 descended like lead. Still, he could lift perpendicularly a very great 

 weight, but from this second period of pain we must date the disease. 

 The whole arm swelled, but especially about the shoulder. His cries and 

 shrieks were wild and melancholy. Living in a remote part of the High- 

 lands, it is natural for the father to express himself in the following words, 

 which he invariably uses when I question him in regard to the degree of 

 pain : ' Sir, there was no hour of the night nor day in which you could 

 not hear his wild cries miles off.' He represented the particular pain by 

 saying it seemed as if he had been bored with hot irons ; and his cries 

 were so unceasing, as well as so piercing, that ' though they lived in a 

 very long house they had no sleep from this time forward.' 



" That such had been his condition no one could doubt who saw him 

 before his death, for the swelling kept equal pace with these dreadful 

 sufferings. At first the arm seemed chiefly to swell from the shoulder-joint ; 

 gradually the whole arm swelled, and the forearm and hand dwindled. 

 His body, before lusty and strong, was wasted with the agony and want of 

 rest. Yet even at this time, when the arm was monstrously swelled, and 

 before it was entirely oppressed, or the forearm wasted, he could 



