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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    scapula was removed the tumor would come away witli it, leaving the thoracic parietes intact. Accordingly two very free incisions were made posteriorly—one from the superior to the inferior angle of the scapula, the other almost at right angles to this. The muscles at the vertel)ral border were divided ; next those at the su[)erior border and angle; the acromion was divided and the shoulder-joint freely opened. Tlie amount of ijlood lost was quite inconsiderable. The axil- lary l)order was next attacked, and, as the bone could now be separated from the chest, it became evident that the subscapu- laris and teres muscles no longer existed as such, but were incorporated in the tumor mass, the growth, firm and fii)rous, entirely infiltrating their substance. It was also ascertained that the tumor projected markedly toward the thorax on the upper aspect of the inner axillary wall, and the intercostals and serratus magnus were implicated in the growth. Seeing the hopeless nature of the case if abandoned, an attempt was made to peel away the intercostals and pleura from tlie tumor, but this was quite impossible, and in attcmj)ting it tlie thoracic cavity was opened, and the finger could plainly feel the growth projecting upward against the ribs and lung, though, of course, covered by the firmly adherent pleura. Under such desperate circumstances the ])art3 were readjusted and the wound dressed antiseptically. Obvious pneumothorax existed, and the heart became displaced, but there were no signs of shock. The boy died on the following day. The autopsy showed the lung collapsed, witli pleura non- adherent. The first and second ribs were firmly ini'orj>i)rate<l with the tumor. The growth appeared to have originatc<l in the subscapularis, and, though it apparently sprang from the scapula, this was really not the case. The whole sub- scapularis was practically a sarcoma, and the growth had in like manner invaded the teres and serratus magnus and the intercostals. At the upper limit the main vessels and nerves passed tlirough its substance and were incorporated witli it. Mr. Targett, of the Royal ColicLre of Surgeons, of Knghunl, further examined the tumor and found the bone full of it
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