William Stirling, without any very evident cause, perceived a small
tumor on the top of the shoulder, about midway betwixt the termination
of the neck and the articulation of the humerus. This gradually
increased for some months, and by the time when I saw him was
larger than a goose’s egg: It was spongy and elastic, and attended
occasionally with pain.
Although the duration of the tumor was an unfavourable circumstance,
yet I undertook the operation. I made an incision through the whole
length of the skin, and dissected it off the tumor, (the upper part of
which was covered with a coat, or cyst), down to its base; but, when
I now began to separate it from the parts below, I found that it had
no defined bottom, but penetrated down betwixt the muscles, which were
soft, pale, and had lost their fibrous structure. I therefore cut off
the tumor close by the muscles, and then separating them with the back
of the scalpel, I removed with the finger as much of the tumor as I
could observe. Several arteries sprung; but these were pretty readily
tied, although the vessels were very tender. A troublesome oozing,
however, took place from many points of the diseased muscles. This was
moderated by applying the sponge dipped in cold water, after which the
skin was laid down, and its lips brought close together.
On dressing the patient on the third day after the operation, the skin
was found not to have united; but its lips were red and inflamed. In
this state it continued for several days, when the part began to grow
tumid, and discharge a thin fœtid matter. The skin then retracted still
more, and a fungus protruded, which gradually increased; but it was
smooth and regular, and of a pale colour, so that it rather had the
appearance of a superficial ulcer, raised up by a tumor from below,
than the ulcerated surface of a diseased substance itself. In this
state it continued for two or three months, when irregular projections
appeared on the ulcerated surface of the new tumor. These soon burst,
and a fungus protruded, of a carcinomatous appearance, and bleeding
very frequently and profusely. Swellings of the axillary glands
succeeded this, and the patient became much enfeebled, and evidently
hectic. As I have not heard of him for several weeks, I suppose that he
has died.
In this case a second tumor succeeded to the first, owing to the
impossibility of extirpating the whole, and this exactly resembled
the original one, except in having its surface covered from its
commencement with an ulcer; but this ulcer was not the specific one of
the spongoid inflammation.