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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    the serratus raaguus aud the external border of the latissimus were found absorbed by the neoplasm, and Vautrin abraded them. The wound was enormous, measuring 25 cm. in its transverse diameter, and extending vertically from a point situated 3 cm. from the clavicle to the eighth rib. In the midst was the pleural opening, through which could be seen the retracted lung. The toilet of the pleural cul-de-sac was made by wiping with sterile compresses, without irrigation. It was useless to try to close the pleural opening by approxi- mation, the loss of substance being too great. Passed a drain from the bottom of the pleural cavity toward the posterior costo-diaphragmatic angle across the thoracic wall, behind and internally to the angles of the ribs. The difficulty now was to close this immense wound. The flaps of skin and subcutaneous tissue, carefully husbanded during the opera- tion, served partly, but had to be supplemented by a flap taken from behind the wound and from the axilla, and with a pedicle large enough to insure its vitality. The wound was united with silkworm-gut, leaving an opening 5 cm. in diameter. The operation lasted one hour and a half. For two days she had attacks of vomiting and dyspnoea. The pulse remained regular at 100. The temperature rose the second day to 38.5°, and oscillated between 38° and 39° for about a week. About the third day the right lung com- menced to respire in its whole extent, and by the fifth its rhythm was normal. The drain discharged at first a suspi- cious serum, then frank pus. It is to be noted that the patient complained during eight or ten days of an intense pleuritic stitch, but at no time was the situation grave. About the fifteenth day she could sit up, and on the twenty-fifth the posterior drain was removed. The cicatrization was complete about the fortieth day, when the photographs were taken. It was observed that the lung was intimately adherent to the whole extent of the cicatrix, the sucking-in of which toward the cavity was easily seen during the respiratory movements. The patient left the hospital about the fiftieth day, thor-