Central Sarcomata. 383 



On the 29th July (at 11.30 a.m.) patient was lying on his back in 

 bed, with his left leg drawn up. He was in the act of turning on his side, 

 when he felt the thigh give a great crack in its upper third. The pain 

 was intense, causing him to "roar out " at the time, and it remained severe 

 for some time afterwards. On the morning before the crack, the patient 

 had noticed a slight diffuse swelling of the thigh. After the crack the 

 swelling quickly increased, till in three days it had reached its full 

 size. At this time several injections of morphia were given, and the thigh 

 was rubbed well with a liniment. The pain gradually decreased, and on 

 13th August he was free from pain, except when he gave the leg a jerk. 



On the ISth and 19th August he had slight sciatica pains in his 

 foot. 



On 21st August an exploratory incision was made, and the 

 previous diagnosis of sarcoma of bone was confirmed. 



On 25th August Mr Cathcart amputated at the hip-joint. The 

 patient bore chloroform badly, and had to be stimulated several times 

 with ether. 



Comparatively little blood M'as lost, and the patient did fairly well 

 until 7.30 P.M., when he began to collapse, and died at 11 p.m. 



The section shows that the tumour must have begun in 

 the centre, just below the level of the great trochanter, where 

 the bone is destroyed. It has extended down the medulla, and 

 upwards into the cancellous tissue, but its chief growth has 

 been outside the bone, entirely surrounding it, and infiltrating 

 the adjacent muscles, although at places there is an appearance 

 of a capsule. The upper fracture must have been the spon- 

 taneous one recorded in the history. The lower fracture was 

 accidentally produced in sawing the specimen, but the bone was 

 greatly weakened there by the disease. The substance of the 

 tumour, when fresh, had a consistence and appearance like the 

 white substance of the brain, except that at certain places it 

 was more vascular. Microscopically, this is a large round-celled 

 sarcoma ; formerly it would have been called an " encephaloid 

 cancer." G- C. 3322. 



Presented by Charles W. Cathcart, F.R.C.S.E. 



6. 446. Central Large Round-celled Sarcoma of the Upper 



End of the Femur. — Water-colour drawing of the above 

 tumour when fresh, by John T. Kelly, artist. G. C. 3321. 



