Sarcomatous Cartilaginous Tumours. 349 



way through that ulcerated part of the surface which is studded with 

 the fungous excrescences represented in the drawing. 



"This bursting out of the matter brought relief from the pain, and 

 he now lay in a state of extreme languor, moaning and slumbering. You 

 found it painful even to question him, he was so feeble ; he fell, after a 

 few broken answers, into a slumber of mere debility, and closed his eyes 

 as exhausted ; and while I took the sketch of his posture, and of the 

 proportions of this prodigious tumour, he slumbered continually. His 

 extreme weakness precluded every practical experiment, and left for our 

 discussion the speculative question only : ' In a case so deplorable and 

 hopeless, what should we have done at an earlier stage, when the 

 patient's strength was more entire, and youth and vigour (for he was 

 but 21 years of age) on his side 1 ' 



"Here, for the first time, I felt that a bony tumour might, by 

 advancing to the trunk of the body, preclude amputation as entirely as 

 aneurism of the subclavian artery ! That the question here to be 

 resolved was not whether we might dare to amputate at the shoulder- 

 joint — the question was of amputating the scapula also, and along with it 

 a tumour exceeding in size even the trunk of the body ! and the accident 

 mentioned by Cheselden (an accident which has often happened since) of 

 Wood, the miller, whose arm, scapula and all, was rudely and suddenly 

 torn from his body, could not but come into our recollection. There 

 was hardly left us even a choice to exercise our discretion and skill upon ; 

 for, from the state of the veins — large, tortuous, and already ulcerating, 

 and so numerous as to give a livid colour to almost all the surface of the 

 tumour^t was plain that he was in daily peril of haemorrhage, and that 

 this was at no remote period, certainly within a few weeks, to put a 

 period to his life ! Could there then be a question whether to wait in 

 fear of that haemorrhage which was assuredly to end in death ; or to risk 

 by operating that htemorrhage by which he might be saved alive ? For 

 my part, I had not the shadow of a doubt. What should determine us 

 in any deplorable case to do desperate things ?j Surely the possibility 

 of safety through operation, the certainty of death. I saw it possible, 

 by tying first the subclavian artery, the root of all the circumflex arteries 

 of the shoulder and scapula, to prevent any alarming degree of haemor- 

 rhage ; by sawing across the outer end of the clavicle to get command of 

 the scapula, and turn it back, as easily as the flap from an ordinary 

 stump ; to tie, when it was cut, the arteria transversalis humeri, and 

 certainly to separate the whole without immediate death. But had this 

 been an enterprise as certainly fatal as the Ciiesarian section itself, still 

 it gave some chance for life. Confident in the justness of this reasoning, 

 moral and physical, I should have urged him to this 'awful trial, and 

 devoted myself to the task ; but he was sunk too low for any trial, and 

 to be regarded only as an object of charitable care. He died in the Royal 

 Infirmary of haemorrhage, about three weeks after his admission, and 

 these are the notes of the dissection. 



^'Dissection — July 13th, 1S06. ^Having divided the integuments, 



