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a white male of thirty； the same author successfully performed a hip…amputation for a large sarcoma of the left femur。 The removed member was sent entire to the Army Medical Museum at Washington。
The fatality and incurability of malignant growths has done much to stimulate daring and marvelous operations in surgery。 The utter hopelessness of the case justifies almost any means of relief； and many of the visceral operations； resections of functional organs； and extraordinary amputations that were never dreamed of in the early history of medicine are to…day not only feasible and justifiable； but even peremptorily demanded。
Varicose veins sometimes become so enlarged and distorted as to simulate the appearance of one varicose tumor。 Adams describes a curious case of congenital dilatation of the arteries and veins in the right lower limb； accompanied by an anastomosis with the interior of the os calcis。 The affected thigh exceeded the other in size by one…third； all the veins being immensely swelled and distorted。 The arteries were also distorted and could be felt pulsating all over the limb。 The patient died at thirty from rupture of the aneurysm。
Abbe shows a peculiar aneurysmal varix of the finger in a boy of nine。 When a babe the patient had； on the dorsum of the little finger； a small nevus； which was quiescent for many years。 He received a deep cut at the base of the thumb； and immediately after this accident the nevus began to enlarge rapidly。 But for the local aneurysmal thrill at the point of the scar the condition would have been diagnosed as angioma； but as a bruit could be heard over the entire mass it was called an aneurysmal varix； because it was believed there was a connection between a rather large artery and a vein close to the mass。 There is a curious case reported of cirsoid tumor of the ear of a boy of thirteen。 Figure 259 shows the appearance before and after operation。
Jessop records a remarkable case of multiple aneurysm。 This case was particularly interesting as it was accompanied by a postmortem examination。 Pye…Smith reports an extremely interesting case in which death occurred from traumatic aneurysm of an aberrant subclavian artery。 The patient fell from a height of 28 feet； lost consciousness for a few minutes； but soon recovered it。 There was no evidence of any fracture； but the man suffered greatly from dyspnea； pain between the shoulders； and collapse。 The breath…sounds on auscultation and the difficulty in swallowing led to the belief that one of the bronchi was blocked by the pressure of a hematoma。 Dyspnea continued to increase； and eighteen days after admission the man was in great distress； very little air entering the chest。 He had no pulse at the right wrist； and Pye…Smith was unable to feel either the temporal or carotid beats on the right side； although these vessels were felt pulsating on the left side。 Laryngotomy was done with the hope of removing a foreign body； but the man died on the tenth day。 A postmortem examination disclosed the existence of an aberrant right subclavian artery in the posterior mediastinum； and this was the seat of a traumatic aneurysm that had ruptured into the esophagus。
Relative to the size of an aneurysm； Warren reported a case of the abdominal aorta which commenced at the origin of the celiac axis and passed on to the surfaces of the psoas and iliac muscles； descending to the middle of the thigh The total length of the aneurysm was 19 inches； and it measured 18 inches in circumference。
A peculiar sequence of an aortic aneurysm is perforation of the sternum or rib。 Webb mentions an Irish woman who died of aneurysm of the aorta； which had perforated the sternum； the orifice being plugged by a large clot。 He quotes 17 similar cases which he has collected as occurring from 1749 to 1874； and notes that one of the patients lived seven weeks after the rupture of the aneurysmal sac。
Large Uterine Tumors。Before the meeting of the American Medical Association held in Washington； D。C。； 1891； McIntyre a reported a case of great interest。 The patient； a woman of thirty…eight； five feet 5 1/2 inches in height； coarse； with masculine features； having hair on her upper lip and chin； and weighing 199 1/2 pounds； was found in a poor…house in Trenton； Missouri； on November 26； 1890； suffering from a colossal growth of the abdomen。 The accompanying illustration is from a photograph which was taken at the time of the first interview。 The measurements made at the time were as follows： circumference at the largest part； just below the umbilicus； 50 inches； circumference just below the mammae； 35 inches； from the xiphoid cartilage to the symphysis pubis； 32 inches； not including the appendum； which is shown in the picture。 Percussion suggested a fluid within a sac。 The uterus was drawn up to the extent of from 12 to 14 inches。 The woman walked with great difficulty and with a waddling gait； bending far backward the better to keep 〃the center of gravity within the base；〃 and to enable her to sustain the enormous weight of the abdomen。 She was compelled to pass her urine while standing。 Attempts had been made six and two years before to tap this woman； but only a few drops of blood followed several thrusts of a large trocar。 A diagnosis was made of multilocular ovarian cyst or edematous myoma of the uterus； and on the morning of December 7； 1890； an operation was performed。 An incision 14 inches in length was first made in the linea alba； below the umbilicus； and afterward extended up to the xiphoid cartilage。 The hemorrhage from the abdominal wall was very free； and the enormously distended vessels required the application of a large number of pressure…forceps。 Adhesions were found almost everywhere the most difficult to manage being those of the liver and diaphragm。 The broad ligaments and Fallopian tubes were ligated on either side； the tumor turned out； the thick； heavy pedicle transfixed and ligated； and the enormous growth cut away。 After operation the woman was immediately placed on platform scales； and it was found that she had lost 93 1/2 pounds。 Unfortunately the patient developed symptoms of septicemia and died on the fifth day。 In looking over the literature on this subject McIntyre found no mention of any solid tumor of this size having been removed。 On April 18； 1881； Keith； late of Edinburgh； now of London； successfully removed an edematous myoma； together with the uterus； which was 42 pounds in weight。 In a recent work Tait remarks that the largest uterine myoma which he ever removed weighed 68 pounds； and adds that it grew after the menopause。 McIntyre believes that his tumor； weighing 93 1/2 pounds； is the largest yet reported。 Eastman reports the removal of a fibroid tumor of the uterus weighing 60 pounds。 The patient recovered from the operation。
It is quite possible for a fibrocyst of the uterus to attain an enormous size； equaling the ovarian cysts。 Stockard describes an instance of this nature in a negress of fifty； the mother of several children。 About twelve years before a cyst in the right iliac region was tapped。 The woman presented the following appearance： The navel hung below her knees； and the skin near the umbilicus resembled that of