Thoracic resection for tumors growing from the bony wall of the chest / F.W. Parham.

  • Parham, Frederick W.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Thoracic resection for tumors growing from the bony wall of the chest / F.W. Parham. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    tumor. It adhered to tlie seventh, eighth, aud ninth ribs and the adjacent intercostal spaces. The ei<:;litli rib, completely involved in sarcomatous tissue, was fractured during the manipulation. The three ribs were dissected clear and then resected to the extent of 9 cm. each. He then made an inci- sion along the sixth intercostal space and carried the knife down througli the points of section of the ribs in front and behind. There was some escape of sero-purulent fluid. He was now able to pull down a sort of trap-door, which was adherent only below. On its internal surface the deep part of the tumor showed in relief, well circumscribed in appear- ance. This opening disclosed a large cavity lined with false membranes. The lung, pressed backward, occupied the depth of this cavity. This thoracic flap was now grasped with the fingers of the left hand and the scissors carried cautiously along the ninth intercostal space, so as to be certain of passing beyond the limits of the tumor. He had still to resect a small frairmeut of the ninth rib, which seemed suspicious of malignancy. In clearing the pleura he perceived on the floor of the pleural cul-de-sac, near the inferior border of the thoracic opening, a hole 2 cm. by 7 cm. in extent. Taking this to l)e an accessory cavity, he introduced his fingers, but was not a little surprised to come upon a smooth surface, limited below by a sharp edge. This proved to be the liver, and he was in the peritoneal cavity. With the aid of a mirror he was able to see clearly this viscus, the upper part of the ascending colon, and some intes- tinal coils. It was evident that he had accidentally cut a part of the diaphragm which adhered to the tumor. Examination of the tumor showed small bundles of muscle-fibre, broken down by the disease, but the peritoneal lining had as yet suf- fered no alteration. Some olots discovered on the surface of the liver were i-emoved by means of a mounted sponge. Having made as well as ]>ossible the toilet of the peritoneal cavity, he closed the diapiiragmatic wound witii five points of strong catgut suture. The pleura having l>een cleared by
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