Anomalies And Curiosities Of Medicine Part 59

Schaeffer speaks of hypertrophied mammae in a girl of fourteen, the right breast weighing 3900 grams (136 1/2 oz.) and the right 3500 grams (122 1/2 oz.). Hamilton reports a case of hypertrophied glands in a woman of thirty-two, which, within the short s.p.a.ce of a year, reached the combined weight of 52 pounds. They were successfully excised.

Velpeau, Billroth, and Labarracque have reported instances of the removal of enormously hypertrophied mammae. In 1886 Speth of Munich described a hypertrophy of the right breast which increased after every pregnancy. At the age of twenty-six the woman had been five times pregnant in the s.p.a.ce of a little over five years, and at this time the right breast hung down to the anterior superior spine of the ilium. It weighed 20 pounds, and its greatest circ.u.mference was 25 inches. There was no milk in this breast, although the left was in perfect lactation.

This case was one of pure hypertrophy and not an example of fibro-adenoma, as ill.u.s.trated by Billroth. Warren figures a case of diffused hypertrophy of the breast which was operated on by Porter. The right breast in its largest circ.u.mference measured 38 inches and from the chest-wall to the nipple was 17 inches long, the circ.u.mference at the base being 23 inches; the largest circ.u.mference of the left breast was 28 inches; its length from the chest-wall to the nipple was 14 inches, and its circ.u.mference at the base 23 inches. The skin was edematous and thickened. Throughout both b.r.e.a.s.t.s were to be felt hardened movable ma.s.ses, the size of oranges. Microscopic examination showed the growth to be a diffused intraca.n.a.licular fibroma. A peculiar case was presented before the Faculty at Montpellier. The patient was a young girl of fifteen and a half years. After a cold bath, just as the menses were appearing, it was found that the b.r.e.a.s.t.s were rapidly increasing in size; she was subsequently obliged to leave service on account of their increased size, and finally the deformity was so great as to compel her to keep from the public view. The circ.u.mference of the right breast was 94 cm. and of the left 105 cm.; the pedicle of the former measured 67 cm. and of the latter 69 cm.; only the slightest vestige of a nipple remained. Removal was advocated, as applications of iodin had failed; but she would not consent to operation. For eight years the hypertrophy remained constant, but, despite this fact, she found a husband. After marriage the b.r.e.a.s.t.s diminished, but she was unable to suckle either of her three children, the b.r.e.a.s.t.s becoming turgid but never lactescent. The hypertrophy diminished to such a degree that, at the age of thirty-two, when again pregnant, the circ.u.mference of the right breast was only 27 cm. and of the left 33 cm. Even thus reduced the b.r.e.a.s.t.s descended almost to the navel. When the woman was not pregnant they were still less voluminous and seemed to consist of an immense ma.s.s of wrinkled, flaccid skin, traversed by enormous dilated and varicose blood-vessels, the mammary glands themselves being almost entirely absent.

Diffuse hypertrophy of the breast is occasionally seen in the male subject. In one case reported from the Westminster Hospital in London, a man of sixty, after a violent fall on the chest, suffered enormous enlargement of the mammae, and afterward atrophy of the t.e.s.t.i.c.l.e and loss of s.e.xual desire.

The names goiter, struma, and bronchocele are applied indiscriminately to all tumors of the thyroid gland; there are, however, several distinct varieties among them that are true adenoma, which, therefore, deserves a place here. According to Warren, Wolfler gives the following cla.s.sification of thyroid tumors: 1. Hypertrophy of the thyroid gland, which is a comparatively rare disease; 2. Fetal adenoma, which is a formation of gland tissue from the remains of fetal structures in the gland; 3. Gelatinous or interacinous adenoma, which consists in an enlargement of the acini by an acc.u.mulation of colloid material, and an increase in the interacinous tissue by a growth of round cells. It is this latter form in which cysts are frequently found. The accompanying ill.u.s.tration pictures an extreme ease of cystic goiter shown by Warren.

A strange feature of tumors of the thyroid is that pressure-atrophy and flattening of the trachea do not take place in proportion to the size of the tumor. A small tumor of the middle lobe of the gland, not larger that a hen's egg, will do more damage to the trachea than will a large tumor, such as that shown by Senn, after Bruns. When a tumor has attained this size, pressure-symptoms are often relieved by the weight of the tumor making traction away from the trachea. Goiter is endemic in some countries, particularly in Switzerland and Austria, and appears particularly at the age of childhood or of p.u.b.erty. Some communities in this country using water containing an excess of calcium salt show distinct evidences of endemic goiter. Extirpation of the thyroid gland has in recent years been successfully practiced. Warren has extirpated one lobe of the thyroid after preliminary ligation of the common carotid on the same side. Green practiced rapid removal of the tumor and ligated the bleeding vessels later. Rose tied each vessel before cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one of Rose's operations which lasted for four hours. Although the operatic technic of removal of the thyroid gland for tumor has been greatly perfected by Billroth, Lucke, Julliard, Reverdin, Socin, Kocher, and others, the current opinion at the present day seems to be that complete extirpation of the thyroid gland, except for malignant disease, is unjustifiable. Partial extirpation of the thyroid gland is still practiced; and Wolfler has revived the operation of ligating the thyroid arteries in the treatment of tumors of the thyroid gland.

Fibromata.--One of the commonest seats of fibroma is the skin.

Multiple fibromata of the skin sometimes occur in enormous numbers and cover the whole surface of the body; they are often accompanied by pendulous tumors of enormous size. Virchow called such tumors fibroma mollusc.u.m. Figure 237 represents a case of multiple fibromata of the skin shown by Octerlony. Pode mentions a somewhat similar case in a man of fifty-six, under the care of Thom. The man was pale and emaciated, with anxious expression, complaining of a tumor which he described as a "wishing-mark." On examination he was found to be covered with a number of small tumors, ranging in size from that of a small orange to that of a pin's head; from the thoracic wall over the lower true ribs of the right side was situated a large pendulous tumor, which hung down as far as the upper third of the thigh. He said that it had always been as long as this, but had lately become thicker, and two months previously the skin over the lower part of the tumor had ulcerated. This large tumor was successfully removed; it consisted of fibrous tissue, with large veins running in its substance. The excised ma.s.s weighed 51 pounds. The patient made an early recovery.

Keloids are fibromata of the true skin, which may develop spontaneously or in a scar. Although the distinction of true and false keloid has been made, it is generally discarded. According to Hebra a true typical keloid is found once in every 2000 cases of skin-disease. It is, however, particularly the false keloid, or keloid arising from cicatrices, with which we have mostly to deal. This tumor may arise from a scar in any portion of the body, and at any age. There seems to be a disposition in certain families and individuals to keloid-formations, and among negroes keloids are quite common, and often of remarkable size and conformation. The form of injury causing the cicatrix is no factor in the production of keloid, the sting of an insect, the p.r.i.c.k of a needle, and even the wearing of ear-rings having been frequent causes of keloid-formations among the negro race.

Collins describes a negress of ninety, born of African parents, who exhibited multiple keloids produced by diverse injuries. At fourteen she was burned over her b.r.e.a.s.t.s by running against a shovelful of hot coals, and several months later small tumors appeared, which never suppurated. When a young girl a tumor was removed from the front of her neck by operation, and cicatricial tumors then spread like a band encircling one-half her neck. There were keloids over her scapulae, which followed the application of blisters. On her back, over, and following the direction of the ribs, were growths attributed to the wounds caused by a flogging. This case was quite remarkable for the predisposition shown to keloid at an early age, and the variety of factors in causation.

About 1867 Duhring had under his observation at the Philadelphia Hospital a negro whose neck was encircled by enormous keloids, which, although black, otherwise resembled tomatoes. A photograph of this remarkable case was published in Philadelphia in 1870.

A lipoma is a tumor consisting of adipose tissue. When there is much fibrous tissue in the tumor it is much firmer, and is known as a fibro-lipoma. Brander describes a young native of Manchuria, North China, from whom he removed a fibro-lipoma weighing 50 pounds. The growth had progressively enlarged for eleven years, and at the time of extirpation hung as an enormous ma.s.s from beneath the left scapula. In operating the tumor had to be swung on a beam. The hemorrhage was slight and the patient was discharged in five days.

The true lipoma must be distinguished from diffuse acc.u.mulations of fat in different parts of the body in the same way that fibroma is distinguished from elephantiasis. Circ.u.mscribed lipoma appears as a lobulated soft tumor, more or less movable, lying beneath the skin. It sometimes reaches enormous size and a.s.sumes the shape of a pendulous tumor.

Diffuse lipoma, occurring in the neck, often gives the patient a grotesque and peculiar appearance. It is generally found in men addicted to the use of alcohol, and occurs between thirty-five and forty-five years of age; in no case has general obesity been described.

In one of Madelung's cases a large lobe extended downward over the clavicle. The growth has been found between the larynx and the pharynx.

Black reports a remarkable case of fatty tumor in a child one year and five months old which filled the whole abdominal cavity, weighing nine pounds and two ounces. Chipault mentions a case of lipoma of the parietal region, observed by Rotter. This monstrous growth was three feet three inches long, descending to the knees. It had its origin in the left parietal region, and was covered by the skin of the whole left side of the face and forehead. The left ear was plainly visible in the upper third of the growth.

Chondroma, or enchondroma, is a cartilaginous tumor occurring princ.i.p.ally where cartilage is normally found, but sometimes in regions containing no cartilage. Enchondroma may be composed of osteoid tissue, such as is found in the ossifying callous between the bone and the periosteum, and, according to Virchow, then takes the name of osteochondroma. Virchow has divided chondromata into two forms--those which he calls ecchondromata, which grow from cartilage, and those that grow independently from cartilage, or the enchondromata, which latter are in the great majority. Enchondroma is often found on the long bones, and very frequently upon the bones of the hands or on the metatarsal bones.

Figure 244 represents an enchondroma of the thumb. Multiple enchondromata are most peculiar, and may attain enormous sizes.

Whittaker describes a farmer of forty who exhibited peculiar tumors of the fingers, which he calls multiple osteoecchondromata. His family history was negative. He stated that at an early age he received a stroke of lightning, which rendered him unconscious for some time. He knows of nothing else that could be in possible relation with his present condition. Nine months after this accident there was noticed an enlargement of the middle joint of the little finger, and about the same time an enlargement on the middle finger. Gradually all the joints of the right hand became involved. The enlargement increased so that at the age of twelve they were of the size of walnuts, and at this time the patient began to notice the same process developing in the left hand. The growths continued to develop, new nodules appearing, until the fingers presented the appearance of nodulated potatoes.

One of the most frequent of the fibro-cartilaginous tumors is the "mixed cartilaginous" tumor of Paget, which grows in the interst.i.tial tissues of the parotid gland, and sometimes attains enormous size.

Matas presented the photograph of a negress having an enormous fibroma growing from the left parotid region; and there is a photograph of a similar case in the Mutter Museum of the College of Physicians, Philadelphia.

The hyaline enchondroma is of slow growth, but may at times a.s.sume immense proportions, as is shown in the accompanying ill.u.s.tration, given by Warren, of a patient in whom the growth was in the scapula.

In 1824 there is quoted the description of a peculiar growth which, though not definitely described, may be spoken of here. It was an enormous encysted tumor, springing from the clavicle of a Veronese n.o.bleman. Contrary to general expectations it was successfully removed by Portalupi, a surgeon of Venice. It weighed 57 pounds, being 20 1/2 inches long and 30 inches in circ.u.mference. It is said this tumor followed the reception of a wound.

Among the benign bone tumors are exostoses--h.o.m.ologous outgrowths differing from hypertrophies, as they only involve a limited part of the circ.u.mference. When developmental, originating in childhood, the outgrowths may be found on any part of the skeleton, and upon many and generally symmetric parts at the same time, as is shown in Figure 248.

Barwell had a case of a girl with 38 exostoses. Erichsen mentions a young man of twenty-one with 15 groups of symmetric exostoses in various portions of the body; they were spongy or cancellous in nature.

Hartmann shows two cases of multiple exostoses, both in males, and universally distributed over the body.

Macland of the French navy describes an affection of the bones of the face known as anakhre or goundron (gros-nez). It is so common that about one per cent of the natives of certain villages on the Ivory Coast, West Africa, are subject to it. As a rule the earliest symptoms in childhood are: more or less persistent headache, particularly frontal, sanguineous and purulent discharge from the nostrils, and the formation of symmetric swellings the size of an almond in the region of the nasal processes of the superior maxilla. The cartilage does not seem to be involved, and, although it is not so stated, the nasal duct appears to remain intact.

The headache and discharge continue for a year, and the swelling continually increases through life, although the symptoms gradually disappear, the skin not becoming involved, and no pain being present.

It has been noticed in young chimpanzees. The ill.u.s.tration represents a man of forty who suffered from the disease since p.u.b.erty. Pressure on the eyeball had started and the native said he expected that in two years he would lose his sight. Figure 251 shows an a.n.a.logous condition, called by Hutchinson symmetric osteomata of the nasal processes of the maxilla. His patient was a native of Great Britain.

Among neuromata, multiple neurofibroma is of considerable interest, chiefly for the extent of general involvement. According to Senn, Heusinger records the case of a sailor of twenty-three in whom all the nerves were affected by numerous nodular enlargements. Not a nerve in the entire body was found normal. The enlargement was caused by increase in the connective tissue, the axis-cylinders being normal. In this case there was neither pain nor tenderness.

Prudden reports the case of a girl of twenty-five who, during convalescence from variola, became paraplegic, and during this time multiple neuromata appeared. At the postmortem more than a thousand tumors were found affecting not only the peripheral branches and the sympathetic, but also the cranial nerves and the pneumogastric. Under the microscope these tumors showed an increase in the interfascicular as well as perivascular fibers, but the nerve-fibers were not increased in size or number. Virchow collected 30 cases of multiple neurofibromata. In one case he found 500, in another from 800 to 1000 tumors.

Plexiform neuroma is always congenital, and is found most frequently in the temporal region, the neck, and the sides of the face, but almost any part of the body may be affected. Christot reports two cases in which the tumors were located upon the cheek and the neck. Czerny observed a case in which the tumor involved the lumbar plexus. Quoted by Senn, Campbell de Morgan met with a plexiform neuroma of the musculo-spiral nerve and its branches. The patient was a young lady, and the tumor, which was not painful, had undergone myxomatous degeneration.

Neuroma of the v.u.l.v.a is a pathologic curiosity. Simpson reports a case in which the tumor was a painful nodule situated near the urinary meatus. Kennedy mentions an instance in which the tumor appeared as extremely tender tubercles.

Tietze describes a woman of twenty-seven who exhibited a marked type of plexiform neurofibroma. The growth was simply excised and recovery was promptly effected.

Carcinomatous growths, if left to themselves, make formidable devastations of the parts which they affect. Warren pictures a case of noli-me-tangere, a destructive type of epithelial carcinoma. The patient suffered no enlargement of the lymphatic glands. The same absence of glandular involvement was observed in another individual, in whom there was extensive ulceration. The disease had in this case originated in the scar of a gunshot wound received during the Civil War, and had destroyed the side of the nose, the eye, the ear, the cheek, including the corresponding half of the upper and lower lips.

Harlan reports a most extraordinary epithelioma of the orbit in a boy of about five years. It followed enucleation, and attained the size depicted in a few months.

Sarcomata, if allowed full progress, may attain great size. Plate 10 shows an enormous sarcoma of the b.u.t.tocks in an adult negro. Fascial sarcomata are often seen of immense size. Senn shows a tumor of this variety which was situated between the scapulae.

Schwimmer records a curious case of universal small sarcomata over the whole body of a teacher of the age of twenty-one, in the Hungarian lowlands. The author called the disease sarcomata pigmentosum diffusum multiplex.

The bones are a common seat of sarcomatous growths, the tumor in this instance being called osteosarcoma. It may affect any bone, but rarely involves an articulation; at times it skips the joint and goes to the neighboring bone.

A case of nasal sarcoma is shown by Moore. The tumor was located in the nasal septum, and caused a frightful deformity. In this case pain was absent, the sense of smell was lost, and the sight of the right eye impaired. Moore attempted to remove the tumor, but in consequence of some interference of respiration the patient died on the table.

Tiffany reports several interesting instances of sarcoma, one in a white female of nineteen following a contusion of tibia. The growth had all the clinical history of an osteosarcoma of the tibia, and was amputated and photographed after removal. In another case, in 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 ma.s.s 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 ma.s.s. 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 pa.s.sed 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 circ.u.mference.

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 a.s.sociation 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, coa.r.s.e, 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 ill.u.s.tration is from a photograph which was taken at the time of the first interview. The measurements made at the time were as follows: circ.u.mference at the largest part, just below the umbilicus, 50 inches; circ.u.mference 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 pa.s.s 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 an elephant. The abdomen in its largest circ.u.mference measured 68 inches, and 27 inches from the ensiform cartilage to the umbilicus. The umbilicus was five inches in diameter and three inches in length. Eight gallons and seven pints of fluid were removed by tapping, much remaining. The whole tumor weighed 135 pounds. Death from exhaustion followed on the sixth day after the tapping.

Ovarian cysts, of which by far the greater number are of the glandular variety, form extremely large tumors; ovarian dropsies of enormous dimensions are recorded repeatedly throughout medical literature. Among the older writers Ford mentions an instance of ovarian dropsy from which, by repeated operations, 2786 pints of water were drawn.

Martineau describes a remarkable case of twenty-five years' duration, in which 80 paracenteses were performed and 6630 pints of fluid were withdrawn. In one year alone 495 pints were withdrawn. Tozzetti mentions an ovarian tumor weighing 150 pounds. Morand speaks of an ovarian cyst from which, in ten months, 427 pounds of fluid were withdrawn. There are old records of tubal cysts weighing over 100 pounds. Normand speaks of an ovary degenerating into a scirrhous ma.s.s weighing 55 pounds. Among recent operations Briddon describes the removal of an ovarian cyst which weighed 152 pounds, death resulting.

Helmuth mentions an ovarian cyst from which, in 12 tappings, 559 pounds of fluid were withdrawn. Delivery was effected by instrumental aid. The tumor of 70 pounds was removed and death followed. McGillicuddy mentions a case of ovarian cyst containing 132 pounds of fluid. The patient was a woman of twenty-eight whose abdomen at the umbilicus measured 69 inches in circ.u.mference and 47 inches from the sternum to the p.u.b.es. Before the operation the great tumor hung down as far as the knees, the abdominal wall chafing the thighs. Figure 263 shows the appearance of a large ovarian cyst weighing 149 pounds. The emaciation of the subject is particularly noticeable. Reifsnyder describes a native Chinese woman affected with an ovarian tumor seen at the Margaret Williamson Hospital at Shanghai. She was four feet eight inches in height, and twenty-five years of age. The tumor had been growing for six years until the circ.u.mference at the umbilicus measured five feet 7 3/4 inches; 88 quarts of fluid were drawn off and the woman recovered. In the College of Physicians, Philadelphia, there are photographs of this case, with an inscription saying that the patient was a young Chinese woman who measured but four feet eight inches in height, while her girth was increased by an ovarian cyst to five feet 9 1/8 inches. The tumor was removed and weighed 182 1/2 pounds; it contained 22 gallons of fluid. Figure 265 shows the appearance of the woman two months after the operation, when the girth was reduced to normal. Stone performed ovariotomy on a girl of fifteen, removing a tumor weighing 81 1/2 pounds. Ranney speaks of the successful removal of a unilocular tumor weighing 95 pounds; and Wall tells of a death after removal of an ovarian tumor of the same weight. Rodenstein portrays the appearance of a patient of forty-five after death from an enormous glandular ovarian cystoma. The tumor was three feet high, covered the b.r.e.a.s.t.s, extended to the knees, and weighed 146 pounds.

Kelly speaks of a cyst weighing 116 pounds; Keith one of 89 1/2 pounds; Gregory, 80 pounds; Boerstler, 65 pounds; Bixby, 70 pounds; and Alston a tumor of 70 pounds removed in the second operation of ovariotomy.

Dayot reports the removal of an enormous ovarian cyst from a girl of seventeen. The tumor had been present three years, but the patient and her family refused an operation until the size of the tumor alarmed them. Its largest circ.u.mference was five feet 11 inches. The distance from the xiphoid to the symphysis pubis was three feet. The tumor was covered with veins the size of the little finger. The apex of the heart was pushed to the 3d inters.p.a.ce and the umbilicus had disappeared.

There were 65 quarts of a thick, brown fluid in the tumor. The patient recovered in twenty-five days.