Lectures on tumours, delivered in the theatre of the Royal College of Surgeons of England / by James Paget, F.R.S.

  • James Paget
Date:
1851
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Credit: Lectures on tumours, delivered in the theatre of the Royal College of Surgeons of England / by James Paget, F.R.S. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    tain cysts and the secretions or structures of the glands in or near whicli tliey occur; nor yet the likeness which commonly exists between the solid tumour and the tissue in which it is imbedded. These tilings are as if the first beginning of the abnormal growth were in some detached element of the natural tissue, which ele- ment, being perverted from its normal course, thenceforward multiplies and grows, conibrming, in nearly all cases, with the type, in minute structure and composition, but more and more widely deviating from it in shape and size. Such are the facts, and such the specula- tions that we may entertain respecting the origin, or, at least, the smallest visible beginning, of a cyst or an innocent solid tumom*. Need I add that if even this be true, we are yet far from the explanation of Hie cardinal point in the pathology of tu- inom-s — then- continual growing. . Why should these detached tissue-germs, or any less mmute and less isolated portion of an organ, grow while all other germs and parts that are most like them remain unchanged ? 1 have ah'eady confessed my ignorance. I will endeavour now to illustrate the histories of particular foi*ms of the simple or barren cysts. 1. The first that may be enumerated are GrASEOUs Cysts. I know, indeed, concerning them only the specimens placed by Hunter in his museum ;* but these should be ad- mired, or almost venerated; for theh' his- tories include the honourable names of Hunter, of Jenner, and of Cavendish. Mr. Hunter says of them,—I have a piece of the intestine of a hog, which has a number of air-bladders in it. It was sent to me by my friend Mr. Jenner, surgeon, at Berkley, who informed me that this ap- pearance is found very frequently upon the intestines of hogs that are killed in the summer months. Mr. Cavendish was so kind as to examine a little of this air; and he found ' it contained a little fixed air, and the remainder not at all inflam- mable, and almost completely phloijisti- cated.'t y I h What a relic have we here! Surely, never, on an object so mean to common apprehensions, did such rays of intellectual light converge, as on these to which were addressed the frequent and inquiring ob- servation of Jenner—the keen analysis by Cavendish — and the vast comparison and deep reflection of John Hunter! Surely, never were the elements of an inductive process combined in such perfection ! Jen- « -Museum of ilie Coll. of Surg., No. 133-4. t See Hunter's Works, vol. tv. p. 9S, and De- scription of PI. xxxvii. ner to observe; Cavendish to analyse; Hunter to compare and to reflect! 2. The Sjerotjs Cysts are, of all the order, the most abundant. Then* most frequent seats are, by a hundred-fold majority, in or near the secreting glands or membranes, or the so-called vascular glands ; but there is scarcely a part in which they may not be found. Their frequency in connection with secreting structures has led some to hold that they are all examples of jierverted epithehal or gland-cells ; but their occur- rence in such parts as bones and nerves, among deep-seated muscles, and in fibrous tumours, makes it sure that they may originate independently of gland-cells ; * though why any element of a solid tissue should retain the vesicidar form which it has in its germ-state, and in tliat form grow, we cannot tell. Of this numerous group of serous cysts, however, I will speak at present of only such as may best illustrate their general pathology, and are of most importance in surgical practice ; and I wiU, to these ends, refer chiefly to the cysts in the neck and in the mammai-y gland. Single serous cysts in the neck form what have been called hydroceles of the neck, and are well exemplified by a specimen in the museuni.f This is a single oval cyst, with thin, flaccid, membranous walls, and even now, after shrinking, measures more than six inches in its chief diameter. It ■was successfully removed by Mr. Thomas Blizard from between the platysma and sterno-mastoid muscles ; and a ])art of it is said to have passed behind the clavicle. It was filled with a clear brownish fluid. Such cysts, but various in size and other characters, are more apt to occm* in the neck than in any other part of the body. Many are single cysts like this ; but others are complex, having many cavities, whe- ther separate or communicating ; and some consist of very numerous cysts,—even of * Some very interesting specimens of serous cysts i c bones are in the museum of St. George's Hospital. 'Ihey are described by Mr. Ca;sar Hawkins, in his lectures on Tumours in the Medical Gazette, vols. xxi. xxli.; and in a Clinical Lecture in the same, vol. xxv. j). 472. '1 here are also some remarkable specimens of cysts in the antrum, in the museum at St. Tho- mas's Hospital, prepared by Mr. Wm. Adams, who showed them to me. t Mus. Coll. Surj;;. 146. Many well-marked examples of the disease in all its forms are re- corded by Dr. O'Beiriiu (Dublin Jour, of Med. and Chem. Sc. vol. vi. p. 834); Mr. Lawrence (Med.-Cliir. Trans, vol. xvii. p. 44); Mr. CiEsar Hawkins (IVIed. Chir. Trans, vol. xxii. p. 231); Mr. Liston (Practical Surgery, p. 330, ed. 1846); and others. A monopriiph by Wernher (Die aiiseborenenCysten-Hygrome ;Giessen, 184;t) is reterreil to by Bruch, 1. c, but I have not been able lu see it.