An Account of Tumours, Which Rendered the Bones Soft. Communicated to the Royal Society by Mr. Pott, Surgeon

I have the Honour to be with all possible Esteem and Respect, SIR, Your most humble and most obedient Servant, De Bremond, of the Royal Academy of Sciences. XII. An Account of Tumours, which rendered the Bones soft. Communicated to the Royal Society by Mr. Pott, Surgeon. In November 1737, a Gentleman, aged 27, complained to me of a Swelling in the Inside of his Right Thigh (being in every other respect in perfect Health). Upon Examination it appeared to be an encysted Tumour of the Steatomatous kind, lying loose between the Sartorius and Vastus internus Muscles. I told him, I could propose no way of curing it, but by taking it out; which was accordingly done, and he very well in Six Weeks. After this he continued well for near a Year (except that he now-and-then complained of a slight Pain in the Joint of that Hip, which went off and returned at different times); and then fell into such a Disposition to sleep, that no Company or Diversion, nor his own Endeavours to the contrary, could keep keep him awake after Eight or Nine o’Clock in the Evening, if he sat down. This continued on him for Three or Four Months, and then the Pain in his Hip grew worse; for which he used the Cold bath, Flesh-brush, and riding on Horseback, but without any Effect. Hercupon he asked the Advice of Dr. Beaufort, who put him into a Course of the Æthiops Mineral, Cinnabar of Antimony, and Gum Guaiacum, with the Spa-water, and purging with Calomel, by Intervals: This Method he pursued for a considerable time, but without any Benefit. After this, by the Advice of some Acquaintance, he took half a Drachm of Salt of Hartshorn Night and Morning, in a Draught of warm Whey, for some time; but without any sensible Effect, even by Perspiration. Some little time after this, he began to complain of a slight periodical Heat and Thirst, which returned every Night, with a quick hard Pulse, but which was not so great as to make him uneasy. It was now September 1739. when, having an Opportunity of going with some Friends, he determined to try what the Bath would do for him: In his Journey thither, the nocturnal Heat and Thirst increased too much, as to prevent his sleeping; but in the few Days that he spent in recovering from the Fatigue of the Journey, they seemed to go off again. He then began to use the Waters both internally and externally; upon which the last-mentioned Symptoms again appeared, and he was obliged to desist, and use cooling Medicines. His Physicians then advised him to bathe the affected Limb only; upon which they returned again, and with such Violence, that the farther Use of the Waters was thought highly improper, and he left them off. During this time the Sight of his Left Eye grew dim, which Dimness increased gradually for some little time, till he became quite blind of that Eye; the Bulb of it being considerably enlarged, and thrust forward out of the Orbit. For the most part of the Time he had been at Bath, he had generally been very costive; and, upon leaving off the Water, had no Stool for some Days; for which Reason a common Clyster was given, and produced so profuse a Discharge of serous Matter, and continued for so many Hours, (almost incessantly) that he was reduced as low as possible. For some time past, several small Tumours had appeared in different Parts of him, viz. Five or Six on his Head, Two or Three in his Back, and one in the Neck, all lying just under the Skin, and sensibly increasing every Day, till they came to a considerable Size. December the 2d 1739. he returned to London. His chief Complaints now were an excessive Languor, an Inability to move his Right Hip (and when moved by another Person, a very acute Pain in it); an Incapacity of sleeping when in Bed, and an intense Thirst in the Night, with a quick hard Pulse. He now took the Advice of Dr. Hartley and Dr. Shaw, who prescribed him the Cinnabar of Antimony Three times a Day, to drink the Selters Water, and keep to a cooling Regimen; and allowed him him a moderate Dose of the Pill Matthæi every Night; by means of which he got some Sleep, of which he had for some time been absolutely deprived. When he had taken the Cinnabar Five or Six Days, and during that time had no Stool, it was thought proper to give him a Clyster; which brought away all the Medicine, without the least Alteration; nor was there ever after this Time any Appearance of any Mucus being secreted by the Intestinal Glands, he never going to Stool above once in a Week (and then there came away a few Lumps of Excrement as hard as Pieces of Wood); which were expelled with such Labour and Fatigue as can hardly be imagined; though he generally took an oily Clyster to render it more easy, and washed down his Medicines with a soapy Draught. The Joint of the Hip was now become quite stiff, all the Inguinal Glands being loaded with the same kind of Matter of which the other Tumours seemed to be composed; and a large Cluster more of them might be felt under the Glutei Muscles, and behind the Trochanter. The Cinnabar was now left off, and mercurial Unction proposed and consented to; and accordingly a proper Quantity was rubbed in every Night, stopping now-and-then to see what Turn it would take; and in this Course he continued for more than a Month, but without any Benefit, nor did the Mercury produce any visible Effect on him. Sir Edward Hulfe, being called in, directed the burnt Sponge, which he took for some time, till, growing worse and weaker, he determined to try Mr. Ward. He took his sweating and purging Medicines Two or Three times, but found no sort of Effect from them; and being now quite tired of Physic, and reduced extremely low, he determined to pass the rest of his Time as easily as he could, by gradually increasing his Opiate; and in this manner languished, incapable of stirring or helping himself, till the 2d of May 1740. and then died. For a considerable Time before he died, he was nourished by Fluids only: Yet, as soon as ever they were received into the Stomach, in however small Quantity, they gave him an acute Pain at the Bottom of his Belly, just above the Pubis. For Two Months, or more, before his Death, he could never make any Water while he was up, but always made a good deal at different times when in Bed. Soon after his Return to London, I opened the Tumour I had taken out of his Thigh Two Years before, and found the Inside of it ossified. Upon Dissection, the first thing that offered itself was a large Tumour on the Sternum, which had been perceived about Three Months before he died: It was as large as a Turkey's Egg, and so hard and immoveable, that I was in doubt whether it was upon or under the Bone. Upon removing the Skin, it appeared covered by the Expansion of the Tendons of the intercostal Muscles, and the Periosteum: This Coat being taken off, it was of a suetty kind of Substance for about half an Inch deep; and below this was a kind of Cartilage intermixed with a great many bony Particles. I then shaved off all this diseased Body even with the Surface of the rest of the Sternum, but found no Bone, it being quite dissolved and confounded with the Mass of Matter that composed the Tumour, which was equally protuberant within the Thorax, and composed of the same Materials. Part of the Fifth and Seventh Ribs were dissolved in the same Manner, into a kind of Substance between Bone and Cartilage, with a thick Coat of fleatomatous Matter. Within the Cavity of the Thorax were Thirty-seven of these diseased Bodies, most of them attached either to the Vertebrae or the Ribs; and wherever they were attached, the Cortex of the Bone was destroyed, and its internal cellular Part filled with the diseased Matter. Immediately above the Diaphragm was a large scirrhous Body, lying across the Spine and the Aorta, the latter of which lay in a Sinus formed in its lower Part; it had no Attachment to any other Part, and weighed 13 Ounces and a half; and from its Situation, I think, must have taken its Rise from some of the Lymphatic Glands lying about the Thoracic Duct. From the Origin of the Aorta, from the Heart, quite up to the Basis of the Cranium, all the Blood-vessels were surrounded with these scirrhous Bodies, and the Thyroid Gland was diseased in like Manner, and bony within. On the Left Side was another of these Bodies, made out of the Glandula Renalis, weighing Nine Ounces Three-quarters. On the Right, the *Glandula Renalis* was in a natural State; but the *Cellular Membrane*, which surrounds the Kidney, was filled with a large Cluster of these Bodies of different Sizes, some of them intirely suetty, others intermixed with bony Particles: Three or Four of them were attached to the Body of the Kidney, and these were a sort of *Cartilage*, beginning to ossify. The *Pancreas* was quite scirrhous, and very large. One very large *Tumour* sprung from the spongy Body of the Third *Vertebra* of the Loins, the bony Texture of which was so dissolved, and mixed with the Matter of the *Tumour*, that the Knife passed through it with great Ease. The inner Side of the *Os Ilium*, all the *Ischium* and *Pubis*, were covered with these Appearances; and, upon removing them, the Bone was found in the same State as the *Sternum* and Ribs. The Middle of the Right *Os Femoris* was surrounded with a Mass of the same Matter, and the Bone underneath in the same State. In the Bottom of the Orbit, surrounded by the *Recti Muscles*, was a pretty large *Steatoma* which occasioned the Protrusion of the Eye; and, by pressing on the Optic Nerve, (in all Probability) the Blindness.