602

HOPITAL BEAUJON.

MELANOTIC TUMOUR IN THE SUBCUTANE-

OUS TISSUE OF THE HAND.

F. F., a middle aged man, of plethorichabit, and a robust constitution, was ad-mitted on the 28th of March, 1829; hestated that seven or eight years ago, a lividblotch, similar to an ecchymosis, had, with-out any obvious -cause, formed in the

palmar surface of the right hand ; and afterhaving remained stationary during almost atwelvemonth, became covered with a smallbladder which, being punctured, dischargeda reddish fluid ; the blotch subsequently re-assumed its former appearance, but some-what enlarged, and became, shortly after-wards, covered by another bladder, whichdisappeared under the same symptoms asbefore. On the further End repeated re-

currence of these phenomena, the patientapplied to a surgeon, who cauterised theblotch with the nitrate of silver ; afterthe eschar had detached, profuse and un healthy suppuration ensued, and continuedunder several methods of treatment whichthe patient underwent, but of which he wasunable to give any correct account; it ap-pears, however, that caustic solutions ofvarious kinds were applied. In 1828, thedisease assumed a more malignant charac-ter ; two distinct tumours formed, of whichthe one was of a fungous appearance, andcovered with sanious matter, the otherstill covered by skin, but extremely pain-ful. Under a regular course of mercury,and the local application of arsenic, the twotumours gradually disappeared, cicatrisationtook place, and, for some time, there exist-ed no trace of the disease, except a fewsmall livid blotches at the inner surfaceof the hand; within a short time, how-ever, a new tumour formed on the backof the hand between the two first meta-

carpi, but without causing any incon-venience until the beginning of February,when the blotches on the palm became theseat of most violent shooting pain ; thearsenic was now again applied, but not withthe same effect as before ; for after theeschar had come away, a fungous tumourbegan to protrude from the ulcerated sur-face, and rapidly increased to an extraor-

dinary size. On his admission into the

hospital, the whole palmar surface of thehand, with the exception of the region ofthe fifth metacarpal bone, was occupied bya very hard, painful, and almost globular tu-mour, of more than two inches in diameter,of uneven surface, and traversed by a longi-tudinal furrow ; at the circumference, it gra-dually terminated in the skin; its centre was

ulcerated, of a brown livid colour, and charged very fetid sanious matter. lb mour on the back of the hand was small free from pain, and covered by very t:.: ,:;

skin, through which the melanotic colour ofthe subjacent tissue was distinctly the other parts of the hand appeared to behealthy ; there was no swelling, and t?efingers were moved with the greatest fd.

cihty. The general state of the patientbeing very satisfactory, Mill. Marjohn ard,Blandin decided for the amputation of thehand, as the extirpation of the tumou!swas impracticable, on account of the brgesurface which the disease occupied, and of ofthe ill consequences which ulceration mightbe attended with; besides, it was impos-sible to determine how deep seated the dis.ease was. The operation was, on the 5th ciMay, performed by M. Blandin ; a semi.lunar flap was formed of the dorsal surfaceof the hand, and of the skin of the palm j as

much was spared as appeared perfectlvhealthy. Only two vessels were tied duringthe operation, which was performed witbun.common quickness. The wound was united

by adhesive plaster, and a bladder, viiih

ice, placed over it. In order to prevent theaccumulation of purulent matter betweenthe muscles, which is so often observedafter amputation of the hand, graduatedcompresses were applied along the posteriorand anterior surface of the arm. After the

operation, the patient was rather agitated jand, in the evening, his sensibility was so

much exalted, that the least touch causedthe most excruciating pain. On the follow.

ing morning he was still more irritable, sothat M. Blandin, being apprehensive of theaccession of tetanus, ordered the externaland internal use of opium ; the applicationof ice was continued. On the 7th the ex.treme sensibilitv had a little diminished, butthe forearm having become swelled, the

graduated compresses were removed; (lieexternal use of opium was discontinuee,On the 8th, the patient felt tolerably well ;the dressings being removed for the firsttime, the wound was found almost completrhunited. The remedies were continued, andhe was allowed weak beef-tea. During thefollowing days his general state continued tobe satisfactory; and, on the 13th, OMM":ligatures came away. On the Ijth, he wasrather agitated ; and, on removing the dress.ing on the 14th, the wound was found the besurrounded by slight erysipelatous inflam-mation ; it was accordingly dressed withdry lint, over which an emollient poulicewas applied. On the 17th, the erysipelashad begun to disappear, but the patientcomplained of violent pain in the peaer er

surface of the lower portion of the arm,

where an abscess formed, which, ttK:;opened on the 19th, discharged a grea:

603

quantity of purulent matter ; the woundfrom the operation, had almost completelycicattised. On the 24th, erysipelas againtppeared, and rapidly spread over the fore-arm. On the 27th, the whole limb wasswelled, and the erysipelas had extended tothe upper arm ; the poultice was disconti-nued, and linen, with common cerate, usedin its stead. On the 2d of May a blister wasapplied on the forearm, in order to checkthe further progress of erysipelas, which,from this moment, was limited, and even-

tually dispersed under the formation ofsmall abscesses at the anterior surface ofthe lower portion of the foiearm. The

swelling of the arm continued, however,until a circular bandage was applied fromthe cicatrix up to the shoulder, under theuse of which it had, on the 23d, completelysubsided, when the patient left the hospitalin apparent health. i

On examination of the removed part,the subcutaneous veins were found gorgedwith blood, and the cellular tissue by whichthey were surrounded, of a dark-red colour, asif filled with ecchymosed blood. The tu-mour on the inner surface of the hand was

principally seated in the palmar aponeurosis,but had numerous prolongations, which

penetrated between- the interstices of themuscles; one of them extending upwardsthrough the ligamentum carpi ; the tendonsof the flexor muscles of the fore and middlefinger, though themselves not altered instructure, were completely surrounded bymelanotic matter, and the spaces betweenthe metacarpal bones were also filled by it.The tumour itself was of the size of an

orange, but of irregular form, and un-

even surface, except on the ulcerated por-tion ; it was of a slate colour ; its tissue wassimilar to that of steatomatous tumours, and,on pressure, discharged a black fluid. Thetumour on the back of the hand was smallerand more superficial, but of the same colourand consistence.-Journ. Hebdomad.

HOTEL-DIEU.

CASE OF DOUBLE VISION.

C. D., a printer, about 60 years of age, ofs healthy constitution, applied to the H 6telpleu on the 30th of April, on account ofunpaged vision. He stated, that he had forsome months been subject to an oppressivepan across the forehead, buthad never beenaffected with any disease of the eyes, exceptthat the right eye was much more irritablethan the left, and rather subject to epiphora.Towards the end of April last, when walk-leg in the street, he observed that a cloudsuddenly formed before his eyes, so that he

could not distinguish any thing ; at the sametime the light was very disagreeable, andthe pupils much contracted. A bleedingfrom the arm having produced but a slightamelioration, he went to the hospital, wherehe was again bled on the ist of March,with somewhat better effect, for the headachdiminished, and sight became more dis-tinct; the contraction of the pupils, how-ever, continued. He was ordered sparediet, and in the evening four grains of tar-tarised antimony, which induced purging,but no vomiting. On the following morn-ing, the cloud before his eyes was complete-ly dispersed, but every thing appeared dou-ble to him ; one of the images was veryclear and distinct; the other, which wassmaller, more obscure, and, as it were, in-definite, disappeared whenever he movedhis head, or when the objects themselveswere moved; the diplopia also ceased whenone eye was closed. Up to the 5th of Mayno change took place in the condition of thepatient; from this period, however, blistersbeing successively applied over the wholeforehead, the diplopia gradually diminished,and the patient began to see objects single,whenever they were not more than seven oreight inches distant from the eye. On theJ7th, a seton having been put in the neck,the improvement still continued, and objectseven ata considerable distance were perceivedsimple, though rather confused; and when-ever the patient turned round, or when hefor some time fixed his eyes on one and thesame object, double vision returned : thesame happened with all objects seen at agreat distance. Under the use of aperientsand spare diet, the seton being at the sametime made to discharge freely, he graduallyimproved, and within a short time simplevision was perfectly restored.—Journ. Heb-dom.

SURGICAL & OPHTHALMIC CLINIC,OF THE UNIVERSITY AT BONN.

POLYPOUS TUMOUR IN THE LACRHYMAL SAC.

S. GRESIN, aetat. 32, of a delicate con-stitution, having, from her 18th year, re-gularly menstruated, was, in the summer of1823, affected with chromic coryza, which,on the least exposure to cold, became verytroublesome; and, after having continued formore than a year, was accompanied withprofuse epiphora, to which, shortly after-wards, violent inflammation of the lachrymalduct and sac, with an erysipelatous swellingof the face, acceded. The acute symptomshaving gradually subsided, there remaineda very tense and painful tumour of the la-chrymal sac, which, on pressure, was observ-ed to discharge a great quantity of puriformmucus through the nostril and the lachrymal