A Case of Melanotic Tumor of Hand, Removed by Amputation at Wrist-Joint

13amaii, a spare woman, aged 26, admitted 13th January, 3864, with a melanotic tumor upon the palmar surface of the right hand. She stated that the disease commenced as a small vascular swelling upon the middle portion of the palmar surface of the third metacarpal bone. It increased rapidly, and has now attained the size of a split apple, occupying nearly the whole of the palm of the hand. The surface has a large ulcer upon it; is convex and uneven ; base broader and firm ; all the metacarpal bones are implicated, excepting the first; motion of fingers impeded; discharge foetid ; pain constant, and increasing at night; no fever ; pulse 102 ; bowels open ; appetite good. Flap amputation was performed at the wrist-joint, under chloroform. Three metallic sutures applied with adhesive straps, lint, splint, bandage, and cold water. Ilab. liq. op. sedativ. xxv., ex aqua camph., 6 tis hor. Microscopical examination was made by Dr. Ewart, of the Medical College, who writes of it as follows :? " The tumor is a pure and unalloyed example of melanosis. Its section is as black as pitch. Its stroma under the microscope presented nothing but an enormous aggregation of caudate and fusiform cells, and no sign of any fibre tissue. There were also fatty matter cells and granules, and much pigmentary material. Microscopically, it is a most malignant growth and likely to return.;'