The danger of allowing warts and moles to remain lest they become malignant : with twenty-five illustrative cases : read at the Fifty-fifth Annual Session of the American Medical Association, in the Section on Surgery and Anatomy, and approved for publication by the Executive Committee, Drs. DeForest Willard, Charles A. Powers and J.E. Moore / W.W. Keen.

William Williams Keen

Date:: 1904

Credit: The danger of allowing warts and moles to remain lest they become malignant : with twenty-five illustrative cases : read at the Fifty-fifth Annual Session of the American Medical Association, in the Section on Surgery and Anatomy, and approved for publication by the Executive Committee, Drs. DeForest Willard, Charles A. Powers and J.E. Moore / W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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scapulo-thoracic Amputation; Death from Anuria 31 Hours After Operation. History.—Joseph W., aged 49, Lansdowne, Pa., first con- sulted me Feb. 12, 1896, at the request of the late Dr. J. M. Da- Costa. His father and paternal grandfather died of old age; his mother is still living and healthy. Over the middle of the posterior border of the left scapula he has always had a birth- mark. Eighteen months ago it began to groAV. Plasters of some kind were applied to it, and it finally “fell out.” Soon after that a large tumor began to form over the left scapula. Examination.—I found a stout, healthy-looking man, weigh- ing 165 pounds. The Avhole of the spinous portion of the scapula, especially toward the axillary border, was involved in a tumor the size of a large fist. The tissues in the axilla also were involved up to the level of the scapula. I was unable to determine whether the supraclavicular glands were involved. The skin itself did not appear to be involved over any portion of the tumor except at its middle, where it was adherent to the tumor. The skin on his back Avas studded AA’ith 20 or 30 other congenital nevi. I advised amputation of the entire upper extremity' as the only possible chance of life. Operation.—March 19, 1896. After four days of preparation in bed, during which his secretions were regulated, I first re- moA'ed the middle half of the clavicle, and then, Avithout diffi- culty ligated the subclavian artery and vein. To facilitate ac- cess to the vessels from the first clavicular incision, 1 made an incision 5 cm. long in the groove betAveen the deltoid and the pectoralis major toward the axilla. Having secured the vessels, I then prolonged the second incision to the anterior border of the axilla and separated the muscles. I then opened the axilla, securing the smaller vessels as they were divided. A number of axillary glands at this point were attached to the vessels, but Avere all removed later in one mass with the arm. As soon as the scapula Avas Avell separated from the trunk, I divided the nerA^es. This allowed the scapula to fall away from the trunk very widely. My incision was then prolonged doAvn on the arm Avell toward the elboAV, where I made a circular incision around the arm and dissected off the flap from the arm. This gave me a long flap with which to cover the gap caused by re- moA'al of the scapula. Dissecting the healthy skin over the scapula backward, I then separated the attachments of the scapula along both its superior and posterior borders, thus severing the entire limb from the trunk. On approximating the flap, I found that I had more than Avas necessary to close the Avound, and cut aAvay some 6 or 7 cm. of theloAver portion. Results.—Until toAvard the end of the operation he did very Avell. Then his pulse began to fail and his color became very bad. Drs. T. S. K. Morton and G. G. Davis, who were assisting me, then infused 14 oz. of normal salt solution through the

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