Patient Case Study: Hibbs, James

In-patient, 1858

HOSPITAL ADMISSIONS RECORD

Hospital Dorset County Hospital Patient type In-patient
Number 4226 Date admitted 29 Apr 1858
Name Hibbs, James Renewed
Age 20 Under whose care Mr. Tapp
Occupation Labourer Disease Tumour of thigh
Parish Winfrith Discharged [blank]
Recommended by Wareham Union Outcome Own request
Source Dorset History Centre, Dorset County Hospital in-patient admissions register 1847-59, NG/HH/DO(C)/5/2/1

 

Hospital Dorset County Hospital Patient type In-patient
Number 4281 Date admitted 28 Jun 1858
Name Hibbs, James Renewed Aug by Dr. [name illegible]
Age 20 Under whose care Mr. Tapp
Occupation Labourer Disease Encepheloid dis[ease] of femur
Parish Winfrith Discharged 6 Oct 1858
Recommended by Mrs. Arnold Outcome Died [sic – see note]
Note The hospital’s management committee listed him as ‘cured’ at their meeting on 7 Oct 1858
Source Dorset History Centre, Dorset County Hospital in-patient admissions register 1847-59, NG/HH/DO(C)/5/2/1; management committee minutes 1856-62, meeting on 07/10/1858

 

OTHER SOURCES

  1. At their meeting on 4 May 1858, the Wareham Union Board of Guardians confirmed the order of the Guardians of the parish of Winfrith for James Hibbs to be admitted to Dorset County Hospital as an in-patient. [Dorset History Centre, Wareham Poor Law Union, board of guardians minutes 1857-59, BG/WA/A/1/12, p. 244]
  1. “J. H., aged 24, presented himself to the Hospital early in May, 1858, with a large uniform swelling of the left thigh, which had been growing about three months. It gave him no great pain ; but prevented him from walking, and following his occupation. The history which the man gave of it was as follows :–He had enjoyed good health until the preceding February, when during a heavy fall of snow, he had been engaged in very laborious work in clearing part of the line of railway. He was much exposed at this time to wet and cold, and noticed that his knee had become stiff, and somewhat swollen. The stiffness gradually increased so as to prevent his going to work. On first sight the tumour gave the impression of being malignant. The man was admitted into the Hospital, and impression as to malignancy was confirmed by further observation. A grooved needle was run into the substance of the tumour, and no fluid followed. A small portion of the tumour was extracted, and examined under the microscope, which, however, did not give any decided help in the diagnosis. The circumference of the thigh was eighteen inches. The man was advised to lose his limb at once, but would not consent, and left the Hospital, to go home and try poulticing. In the latter part of July he again applied for admission, the tumour having grown considerably both in circumference and longitudinally. The thigh now measured in circumference twenty-four inches. There was no history of cancer in any of his relatives, and his own general health was still tolerably good. Amputation was performed on July 29, 1858. On section the tumour was soft externally, bit as the knife approached the bone, a sense of hardness was experienced very much like cutting through soft carious bone ; in fact, the deeper part evidently contained irregular deposits of bone. The tumour grew from the periosteum, and not from the substance of the bone itself ; the latter was, however, greatly hypertrophied and hardened, almost to the consistence of ivory. A few days after the amputation a growth, similar in appearance to that amputated, appeared from the medulla, and grew rapidly. It was easily removed (being in shape a miniature cauliflower on a stem), and the medulla touched with the actual cautery. Four days after this it had grown again as large as a small nut ; this was removed, together with a small portion of the shaft of the bone ; considerable difficulty was experienced in sawing through the bone, owing to its intense hardness ; the circumference of the femur was nodulated. Three days afterwards the growth again appeared to a small extent. The man was now put on the following treatment :–[uncia]iii. of the expressed juice of the gallium aperium, and 10 minims of Donovan’s solution three times a-day, the growth touched from time to time with agent. nit. and the edges of the wound strapped together ; the growth disappeared, and the man was discharged cured October 7, 1858. Examination of the Tumour.–The growth was encapsuled, and did not infiltrate the adjacent muscles beneath which it lay. It was of irregular shape, and closely surrounded the shaft of the bone. The bone itself, although not involved in the tumour, was superficially eroded by its pressure. Under the microscope Mr. Bacot states that he could not discover any of the large poly-nucleated cells described as peculiar to cancer. It appeared to be made up of free nuclei and small mono-nucleated cells. Its section was firmer than that usually met with in specimens of medullary cancer. There can, howver, be little doubt as to its belonging to the malignant class of growths. Final Results.–Writing on May 24 of the present year, ten months after the amputation, Mr. Bacot informs us that he had a few days before seen the man driving his team near Dorchester, and, apparently, in excellent health.” [The Dorset County Hospital: Malignant growth from the femur. Amputation. Recovery. Under the care of Mr. Tapp. From notes by Mr. Bacot, late House-Surgeon. Medical Times & Gazette, 1859, new series, vol. 18, p. 579]
  1. “AMPUTATION. Of the Thigh. … Case 14.–The Dorset : Mr. Tapp.–A man, aged 24, presented himself with a large even swelling about the left thigh, which had been three months in development. There had been but little pain. It was believed to be malignant, and amputation was advised. To this he refused to consent, and left the Hospital. Two months later, however, he applied for re-admission, and amputation was performed on July 28. The tumour was found to be developed from the periosteum, and not from the substance of the bone itself. The latter, however, was greatly hypertrophied and as hard as ivory. In the subsequent treatment, a spouting fungus repeatedly grew from the medulla of the bone, and required removal. Finally another portion of the bone was sawn away. The stump healed, and the man left the Hospital on October 7. [Statistical report of the principle operations performed during 1858. Medical Times & Gazette, 1859, new series, vol. 18, p. 497]

Comment: This patient initially refused amputation but was re-admitted when he finally agreed to surgery – and for his pains he had to undergo two operations. Hibbs’ discharge was incorrectly recorded in the ‘died’ column of the admissions register, but the management committee minutes reveal that he was in fact discharged ‘cured’. There is also a discrepancy in the age – house surgeon William Bacot resigned in November 1858, and therefore he would not have had access to the admissions register when he submitted his report to the medical press.

 

 

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