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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Licence: Public Domain Mark

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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    tliyro-liyoid iiienibrane, was a smooth oval timiour, about an incli in length, lie had obsen-ed a regular increase of this tumour for five or six years ; but its bulk and de- formity alone were inconvenient. Mr. Lawrence freely eut into it, and let o\it a thick honey-like fluid, m which large groups of crystals of cholestcarine were visible even with the naked eye. The cyst, after the incision, suppurated, and then the wound healed, and the patient left the hos- pital quite well. I may add that such cysts as these are not nucommon near the gums, lying usually beneath the reflection of the mucous mem- brane from the gum to tlie clieek. Their occasional large size, and their thick walls obscm-ing the sense of fluctuation, may make them at Tu'st look formidable. A woman, thirty-eight years old, was under my care last September, in whom, at first sight, I could not but suppose something was dis- tending the antrum, so closely was the deformity of the face due to such diseases imitated. But the swelling was soft .and elastic, and projected the tliin mucous membrane of the gum of the upper jaw, like a half-empty sac. I cut into the sac, and let out nearly an ounce of tm-bid brownish fluid, sparkKng with crystals of cholestcarine. The posterior wall of the cyst rested in a deep excavation on the surface of the alveolar border of the upper jaw,—an adaptation of shape attained, I suppose, as the result of the long-continued pressure of the cyst, which had existed six years. At nearly the same time a young man was under my care with a similar swelling of larger size, wliich he ascribed to an in- jury of the gum or alveolar border of the upper jaw only six months previously. In neither of the cases could I find any disease of the maxillary bone; but I believe it sometimes exists in intimate connection with these cysts. In no organ is the formation of cysts more important than in the inammai*y gland. Every variety of them may be found here : but I will speak at present of only- the serous cysts. Some of tlicso cysts are dilated ducts, or portions of ducts grown into the cyst-form. During lactation, cysts thus derived may be filled with milk, and may attain an enor- mous size, so as to hold, for exam])le, a pint or more of milk.* In other cases tlicy may contain the remains of milk, as fatty matter, epithelial scales, &c.; or they may * See ft case by M. Jobert do Liiniballe, in the Mcilical Times, Jnn. 4, II, 1845, and a colleciion of cases by .Mr. Hirkett, in one of wtiicli ten pints of milk were evacuated (Diseases of tiie Hicnst, p. 200). be filled with transparent watery fluid, with- out coagidable matter;* but much more commonly tliey contain serous fluid, pure, or variously tinged with blood or its altered coloui-in'g matter, or with various green, or brown, or nearly black fluid.f The complete' pi-oof of the origin of some of these cysts as dilated portions of ducts, is, that by prcssm'e they may be emptied through the nipple, or that bristles may be passed into them from the orifices of tubes. But altliough these facts may be often ob- served, yet I agree with Mr. Birkett in thinking' that the majority of cysts in the mammary gland are formed in the manner of the renal cysts, to wliich, indeed, they present many points of resemblance. The most notable instances of mammary cysts are those in which the whole of the gland is found beset with them. This may occur while the proper substance of the gland appears quite healthy ;J but I think it is more commoiily concurrent with a contracted and partially indurated state of the gland,—a state which, independent of the cysts, appears similar to cirrhosis of the liver, and has, I think, been named cii'rhosis of the mammary gland. Its coin- cidence with cysts proves its nearer relation to that shrivelled and eonti*acted state of the granular kidney with which tlie renal cysts are so commonly connected; or, per- haps, more nearly to the shrivelled, indu- rated state of the lung th it may coincide with dilatation of the bronchi. The cysts in these cases are usiially of small size, thin-walled, fidl of yellow, bro\vn, green, and variously deep-coloured fluids,— fluids that are usually turbid, various in tinge and density, but not usually much denser than serum. They do not lie in groups, but are scattered through, it may be, the whole extent of the gland. Similar small cysts are sometimes found in connec- tion with hard cancer of the breast; and in this case they have been called by Mr. Hunter and others cancerous hydatids : but their proper relation in such cases ap- pears to be, not with the cancer, but with tlie coineidently slu'ivelled gland. In this disease of the mammary ghmd there is no reason to believe a malignant nature, though the coincidence with cancer appears not rare. Yet the diagnosis be- tween it and cancer is not always clear, and many breasts have been removed in this * I3rodie, Lectures on Pathology and Surj;ery, p. 155. t Thcif various contents are well shown in Cooper's Illustrations of Diseases of the Breast, pi. i.; and a full account of all the discuses of thm class is given by Mr. Birkett in his work already cited. Two such cases are described by Sir B. C. n ri id ie—Lectures on Pathology and Surgery, p.