James Walker received a stroke upon the outside of the foot,
immediately below the ankle joint. A small tumor instantly formed,
which continued stationary for several weeks, and gave him little
uneasiness; but afterwards it began to increase, and was attended
with a shooting pain. The tumor was elastic, pretty tense, and rather
irregular in its appearance. I was anxious to operate, but the man
would not give his consent. I therefore advised frictions with anodyne
balsam, which at first gave him relief, but soon lost its effect. For
several weeks I heard nothing of him; but, at the end of this time,
he again applied to me. The irregularities of the tumor were much
greater, more prominent, of a red colour, and one of them had burst:
From this a soft half-organised fungus protruded, and a bloody fluid
run out constantly. An operation was again urged, but the timidity of
the patient made him again refuse. A month after this he came under the
management of another surgeon. There were now three openings in the
tumor, from each of which protruded a broad cauliflower-looking fungus,
covered with thick fœtid matter; there was likewise a thin red serum
discharged from the margins of the ulcers. The tumor was as large as
a child’s head, and one of the inguinal glands was a little swelled.
The man now consented to lose his limb, and amputation was accordingly
performed. Whenever the turniquet was applied, a very copious stream
of veinous blood issued from the tumor; but this ceased when the veins
had emptied themselves. Unluckily it was considered as unnecessary to
extirpate the diseased gland.
On examining the leg, all the bones of the ankle joint were found to
be quite soft and carious; the tumor consisted of a soft substance,
resembling the brain, with light membranous intersections. The cyst on
the upper part was hard and thick, but beneath it was entirely wanting,
having either never been formed betwixt the tumor and the tendons
of the muscle, or having been destroyed. The former opinion is the
most probable; for I have never in any stage found the cyst continued
over the under or back part of the tumor, but it always terminated
imperfectly in the part on which the tumor was seated.
The wound healed as well as could be desired, but the gland became
rather larger, notwithstanding which no operation was urged. Two
months after this I was requested to visit him. The gland was now as
large as the head of a newborn child; it was soft and spongy, and had
at one part an irregular prominence, but the skin was not coloured.
The pulse was about one hundred and thirty, and the patient completely
hectic. In this situation I proposed nothing excepting nourishment. He
died in the course of a week after I saw him.