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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    inches in its loni^ diameter, is irregularly oval in shape, hard, slightly looiilated, })ainless, situated over the sternal ends of the third and fourth ribs and firmly attached to one of them, the skin over it being normal and movable. Under an anjes- thetic, growth was exposed by oblique incision ; soft tissues easily separated from it, and the projecting part cut off with chisel and mallet. Proved to be an enchoudroma; hard ex- ternally, but of a crumbly consistence underneath, attached to the third rib, a portion still being left wedged tightly in the third interspace, pressing the fourth rib downward. On removing this with a gouge it was seen that the growth expanded beneath the ribs into a mass of the size of one's fist. Owing to crumbling consistence and want of support, could only be removed piecemeal. The ])ortion of the rib from which the growth originated was cut away, and so, then, was the capsule, which was so blended with the stretched pleura that it was necessary to excise the implicated piece, measuring three inches by three inches. There was now an opening of irregular shape in the chest-wall. Each bleeding point had been at once secured. The pale, salmon-colored lung, covered only by visceral pleura, could be distinctly seen. The exposed lung moved synchronously with each movement of inspiration and expiration, forward and back- ward, to and from the anterior chest-wall, rather than ujnvard and downward, through a sj)ace of fully three inches. The amount of the movement varied with the length and the depth of the respiration, from one inch to contact wilii the chest-wall—in fact, great care had to be exercised to avoid including; the luno; in the sutures closino; the wound. These physiological facts I leave to physiologists to explaiu. It was impossible to bring the edges of the })arietal }>leura together, so I sutured the s^ft parts together over the open- ings, placing a short, good-sized rubber drainage-tube in the lower angle, antii^ii>itini: there woidd be some pleuritic effu- sion. Patient fairly coinfi)rtal)le, tliough temperature kept at 100° F. for forty-eight hours. Dressings were now changed, and ;is they were dry an.) the percussion-note over the base
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