Sarcomata following Fracture. 387 



It occupies the middle of the thigh, and surrounds the femur, and projects 

 nearly in an equal degree on all sides. 



"There are here some peculiar circumstances, and a distressing 

 alternative is offered to us. The tumour has all the appearance of fungus 

 hfematodes, or soft cancer. To the feeling it conveys the notion of a soft 

 spongy mass, distending the fascia of the thigh. It is evidently under 

 the muscles, and the vasti rectus and sartorius muscles bind it so as to 

 give it a peculiarly irregular surface. The pain is very great, an incessant 

 dull pain. AVhile he describes his pain as a dull sensation, and in this 

 expression distinguishes it from the occasional sharp and shooting pain of 

 some tumours, yet his sufferings must be great in degree, since he expresses 

 a desire to lose the limb. He is a steady man, and although not obtrusive 

 nor loud in his complainings, he expressly wishes to lose his limb, 

 although he sees that in order to do this it must be cut off close to his 

 body. The skin has already assumed that light jaundiced colour, which 

 on former occasions I have found to mark that the constitution is tainted 

 with the disease. 



"On the other hand, here is a tumour arising distinctly from 

 an accident, and there is a possibility that the tumour so arising may not 

 be that formidable disease which we apprehend. In the meantime the 

 growth of the tumour is so rapid that an operation will soon be quite 

 impossible. If it should prove to be tumour of the bone, possessing no 

 malignant character, of which we see examples, amputation will save his 

 life. Even if the disease be of the nature of soft cancer, the operation 

 affords him a chance of life. No condition can be an aggravation of his 

 present state. 



"A consultation having determined on the operation, it was per- 

 formed in the following manner." 



(The leg was amputated, and on the tenth day after the patient 

 ■died from secondary hemorrhage. ) 



""When the muscles were dissected off, the tumour was found to 

 surround that part of the bone which had been fractured. It consisted of 

 a cartilaginous substance, which, when cut through the middle, exhibited 

 a well or cavity containing blood. The rest of the tumour was a soft, 

 ^ulpy, greyish mass, too delicate in its texture to be preserved in spirits. 

 A section was made of the bone and the tumour ; and when the parts 

 were some days macerated, it was found that the bone was extensively 

 diseased, and a peculiar semi-transparent matter of a grey colour filled all 

 the cells of the bone ; and now it appeared that the bone had been first 

 diseased at the fractured part, and that from thence the disease had 

 propagated itself in all directions. 



" Examination of the Stump and Body. — On opening the face of the 

 stump, both the femoral artery and the profunda were found secured by liga- 

 tures ; a firm clot was found in the femoralTartery, and the cause of haemorr- 

 hage was nothing in common with ^vhat is called secondary hsem.orrhage. 

 On tracing one of the branches of the profunda, it was found to open, and, 

 as it were, expand into a cavity containing blood. The substance surround- 



