Seated man with large tumor of upper arm. Fourth Report, Chinese Repository, vol. 5, 1836-1837, p. 329-331: No 2152: Amputation of the Shoulder-Joint. Absorption of the os humeri and enlargement of the arm. Po Ashing, aged 23, entered the hospital on the 3rd of November. Six years since, he fell from a house and broke the humerus of the left arm, half way from the elbow to the shoulder, the lower portion passing upwards and backwards. Union so far took place as to render the arm serviceable, till six months since, in a crowd, at a “sing song” it was again broken. From that time, according to the statement, the arm gradually became larger, till it had attained its present enormous size. Beside of being painful, the weight of it drew him quite one side; at several places it seemed ready to burst; the skin was bright and glistering, and the veins passing over it were numerous and much enlarged. There was no doubt of it containing fluid, and though no pulsation could be felt, apprehensions were entertained that the tumor might be of an aneurismal nature. November 14th, assisted by Messrs. Cox, Cullen, Jardine and Bonsall, I punctured the arm, supposing that it might possibly contain pus, and that the necessity of amputation might be avoided; yet prepared if disappointed in this, to remove the arm. On opening the abscess, a dark greenish fluid escaped, with considerable force but soon became darker and more bloody. Sixteen ounces were first discharged, but the character of the fluid was not decisive. In the hope that the fluid was from some small vein, divided by the incision, and that there was deep-seated pus, the lancet was reentered nearly its whole length, but the same discharge continued with a similar proportion of venous blood: thirty-two ounces in all were discharged, and the aperture closed. All were agreed that the only chance of life was in the removal of the arm; but the exhaustion of the patient and the absence of his father induced us to postpone the operation until the next day, unless subsequent symptoms forbade. At 3 o’clock PM it appeared that the tumor, which had been diminished by opening it, had attained more than its former size, and supposing that the vein, which had been opened was emptying itself into the tumor, and that there could be no safe delay, the operation would have been performed immediately but for the absence of the patient’s friends. The next morning (Nov. 15th) the circumference was still but thirty inches, the integument having reached its maximum of distension, it appeared that the fluid was insinuating itself beneath the integument about the shoulder joint, increasing the difficulty and hazard of the amputation. It proved, however, to be mere tumefaction. The father and friends of the patient had come, and given the agreement liable to fatal terminations; and the patient had recovered very much from his previous exhaustion. At 11 A.M. the gentlemen present the preceding day were ready and everything was prepared for the amputation. The patient was seated supported around the waist by a sheet; the tourniquet was applied, also the subclavian artery secured by an assistant; a single flap was formed as recommended by Liston, the extent of the disease not admitting the use of the catlin as practiced by Cooper. With a large scalpel two incisions were made, commencing on either side of the acromion process and meeting of the origin of the deltoid muscle, which was immediately dissected up: the capsular ligament divided, the head of the humerus turned out of the socket, and another stroke of the knife upwards, dissevered the arm from the body. The time did not exceed a minute, from the application of the scalpel till the arm was laid upon the floor; the patient was then upon a bed, and the pressure upon the artery removed. An excellent flap was formed, and dressings were applied as usual. Afterwards the patient threw up the brandy and water and pother medicines.
The best representation of the arm after the amputation, so far as shape is concerned, is that of a large ham of bacon. It weighed about 16 catties, equal to 21 . pounds. Opening the arm at the place where it was punctured the preceding day, a dark coffee-colored fluid gushed put. (….) Opening other cavities, there was a similar discharge and a quantity of matter resembling putrid crassamentum, of a light purplish color, or like the disorganized lungs of persons who have died of pulmonary consumption. (…)The bone was entirely absorbed, except an inch of each extremity. (…) At the head of the humerus it appeared, till we discovered the absorption of the whole bone, as if nature had formed a new joint. (…) The muscles were much diseased (…) From the elbow downward, the muscles were perfect. The forearm was oedematous, and considerable adipose substance, was found under the integument. All who were present pronounced the case the most remarkable they had ever seen. The patient is the first Chinese, so far as I know, who has ever voluntarily submitted to the amputation of a limb. At 5 o’clock the patient, having awoke from sleep, asked what he might eat. Congee was given. The expression of his countenance was good; he spoke with a natural voice, complained of cold, though his body was of good temperature, the skin feeling natural, with a gentle perspiration upon the forehead. (…) He occasionally started in his sleep, and when awake spoke of his arm as it were still on. (…) On the 21st, the dressings were changed again, and the remaining sutures slipped, and the wound had the most healthy appearance. Patient walks his room, his general health is good, and his strength is fast restoring. His gratitude and that of his father seem deep and sincere. Donated by Peter Parker to the Yale School of Medicine and transferred to the Historical Library.
Medicine, Chinese Missions and Missionaries Missions, Medical Neoplasms Tumors
Case No. 2152 Parker, Peter, 1804-1888 Po Ashing
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