Clinical Paper: Popliteal aneurysm; osteo-sarcoma of tibia, etc.

British Medical Journal, 6 June 1885, page 1154


(Cases under the care of Mr. F. BAZLEY FISHER.)  

[Reported by Mr. MACARTNEY, House-Surgeon.]  

  1.  Popliteal Aneurysm ; Ligature of Femoral Artery ; Recovery. — J. L., a discharged soldier, was admitted on September 2nd, 1884. He had a popliteal aneurysm, with apparently very thin walls. The heart’s action was very rapid, with a systolic murmur at the apex. He was placed on reduced diet, and five grains of iodide of potassium, increased to ten grains, were given three times daily, and an elastic bandage was applied from the toes to the middle of the thigh three or four times daily, for about an hour at a time. After three weeks of treatment, the pulsation was very slight, but the patient becoming agitated the pulsation increased, but yielded to continued treatment.  This occurred more than once, and, as the tumour appeared to be increasing in size, the femoral artery was ligatured, on December 9th, at the apex of Scarpa’s triangle, under carbolic spray, stout carbolised silk being used as a ligature, and both ends cut off short. The wound was closed by carbolised silk suture, and antiseptic dressings applied. Only two other dressings were required, and the patient recovered without a single bad symptom, and was discharged cured January 8th, 1885.  The night after the operation the temperature rose to 99˚, but never went above normal afterwards. No pulsation could be detected in the tibial arteries at any time after operation.  
  2. Osteo-sarcoma of Tibia; Amputation of Thigh. — M. H., aged 42, was admitted August 25th, 1883, with a large swelling on the left tibia just below the knee. She first noticed it about nine months before admission, but had complained of aching pain in the leg for two years. The tumour had been growing rapidly, and was acutely painful ; several loose pieces of bone could be detected in it. On September 11th, 1883, it was laid open under carbolic spray. The bone was found to be hollowed out and greatly expanded. The thigh was amputated in the lower third. A very great quantity of oozing took place from the stump, which required daily dressing, so that antiseptics were abandoned after some time. The stump was not quite healed until December 15th. She went home in January, 1884; and, a year afterwards, was enjoying good health, wearing an artificial leg, and able to work well.