XII, B. 6 Manlove: Incidence of Age 245 



History. — The patient is a Chinese male whose age is 41 years. He 

 entered Bilibid Prison on January 18, 1916, for a term of four months' 

 detention and was admitted to the prison hospital complaining of a continual 

 chest pain which had been present for the past two months. The pain 

 was first noticed after performing heavy manual labor, and it has become so 

 severe that the patient breathes with difficulty. (No further description of 

 the pain is recorded.) Upon further physical examination a large pulsating 

 tumor was found in the right inguinal region below Poupart's ligament. 

 The patient had not complained of this pulsating tumor, but had applied 

 some form of dressing, which produced necrosis of the tissues over the 

 apex, and this was accompanied by continual oozing of blood. The entire 

 right lower extremity is osdematous, and the skin is tightly stretched. No 

 definite history could be obtained concerning the length of time that the 

 tumor mass was present nor concerning ss^philitic infection. 



Laboratory report. — A Wassermann test performed by the Bxireau of 

 Science, January 24, 1916 (37931-C), was negative. 



The urine was normal. 



A tentative diagnosis was made of malignant tumor or aneurism. The 

 surgeon in charge advised an operation to prevent the loss of blood from 

 the tumor mass. 



Operation. — Spinal anjesthesia was employed by using 80 milligrams of 

 stovaine. The stovaine was administered at 3.35 in the afternoon, January 

 24, 1916, and the operation began at 4.15 and was completed at 4.41. 



An incision was made over Poupart's ligament, and the iliac artery 

 was ligated extraperitoneally above the tumor mass. A section of tissue 

 from the apex was removed for histological examination; it showed evi- 

 dences of an arterial wall. The entire right lower extremity was then 

 placed in hot packs. The patient appeared to be in very good condition 

 when seen at 8.30 in the evening, but suddenly died at 9.15, January 24, 

 1916, about four and one-half hours after the operation. 



The autopsy findings are as follows. Anatomical diagnosis: Chronic 

 aortitis with aneurismal dilatation of the aorta (syphilitic) ; chronic 

 parenchymatous degeneration of the heart (syphilitic) ; aneurism of the 

 femoral artery (syphilitic) ; chronic diffuse nephritis; pneumonoconiosis ; 

 chronic miliary tuberculosis of the lungs ; chronic adhesive fibrous pleuritis ; 

 and some oedema and congestion of meninges. 



The body is that of a rather large, poorly nourished, adult Chinese male, 

 aged 41. The skin is yellowish brown. The hair is black, straight, coarse, 

 rather long, and limited to the pubes, axillae, and scalp. The eyes are 

 apparently normal. The teeth are carious, and the mucosa of the mouth 

 is pale and somewhat necrotic over the gums. Rigor mortis is present 

 throughout the lody, and suggillation is present on the dependent portions 

 of the body. Lying in the right femoral region involving an area over 

 Scarpa's triangle there is a firm, bulging, hemispherically shaped mass 

 which measures from 10 to 12 centimeters in diameter; its apex is 5 to 6 

 centimeters above the surrounding skin surface. The skin covering the mass 

 is tightly stretched, but apparently normal, except at the apex, where it 

 has a greenish necrotic appearance, and upon pressure some thin blood- 

 tinged fluid oozes from it. After dissecting the skin from the entire mass 

 and opening it, it is found to be filled with newly formed blood clot, which 

 has the consistence of chicken fat. The walls of the mass are formed by 

 a dilatation of the femoral artery producing an elongated, irregular, ovoid- 



