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
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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![grow, and t]ien,a2)parently,proclnce on their inner surface a growth of skin, with its layer of cutis, subcutaneous fat, epidermis, and all the minute appended organs of the ])roper integument of the body; or (o) such cysts may form in the subcutaneous tissue. Tliey are, indeed, rare in this tissue in man, except in cases of congenital growth ; but in the little cysts that are found at or soon after bu-th, about the brow, or in or near the orbit, the inner surface is often ])er- fectly cutaneous ; and Lebert* has detected in such cysts all the minute structures and organs of the skin. Some similar speci- mens of cysts lined with skin are in the Museum of the College.f These were taken from the subcutaneous tissue of a cow and of an ox; and in some of them the inner sui'face of the cyst could hardly be distinguished from the outer hairy inte- gument of the animal. Besides these, the common seats of cu- taneous cysts, perhaps any part or organ may in rare instances present them; for the records of surgery and pathology woidd furnish abundant instances of aberrant cysts containing hair and fatty matter, such as we must class with these m which the cutaneous structure and products are more perfect. The most singidar and fre- quent of these rarer examples are in the testicle,! the lung,§ the kidney, || or the bladder,*!! and the skull or brain. Those in tlie brain are of chief interest. I found this specimen** many yearsago in an elderly man. While he was in St. iBartholomew's Hospital with an ulcerated leg he suddenly died; and the only probable cause of death appeared to be a mass of graniUar fatty matter mixed with short stiff hairs, which lay in the tissue of the pia mater under the cerebellum. A yet more remarkable ease is in the Museum of St. George's Hospital, in Mr. Ctesar Hawkins's collection. It exhibits a mass of fatty matter, and a lock of dark hair 1 j or 2 mches long, attached to the inner surface of the dui-a mater at the torcular Herophili. This was found in a child two and a half years old, in whom it appeared to have been congenital. ]S ow it is perhaps only during the vigour of the fonnative forces in the foetal or ear- liest extra-uterine periods of life, that cysts thus highly organized and productive are (!ver formed. The sebaceous, epidermal, or Aliliandliineroii, p. 99, e. s. The structure is well shown in Xo. 158 in the College-Museum, t Nos. 161, 16.3, &c. i Sofi Goodsir, in Edinb. Monthly Journal, Jnno 1845. § Kolliker, in the Zcitschrift fiir wissensch. Zoolo^ie, H. ii. p. 281. II Mus.Coll. Siirp:., 1904. II Mi'd. Coll Surfr. 2626. ** .Mns. .St. Uiirlholoinew's, Ser. vi. 56. cuticvdar cysts that grow in later life are imperfect, impotent, imitations of these ; yet clearly arc the same disease, and are, therefore, most naturally classed with the prolifei'ous cysts, needing only to be named according to thcii' contents. We cannot tell, in any advanced case of such a cyst, whe- tlier the more complicate structures of tlie skin ever existed ; if they did, they have de- generated before the cyst became of distinct size; yet the retained likeness is sometimes shown in the fact that, when such cysts are laid open to the air, they do not granu- late, but assume for their internal snrfaces the characters of the adjacent and now continuous skin.* Of these sebaceous or epidermal cysts it is interesting to notice the frequent here- ditary origin. Perhaps, in the majority of cases, the beai'ers of these have known one or more members of their family similarly endowed. They are certainly more com- monly hereditaiy than are any forms of cancer. I have already refeiTcd to the double mode of origin of the epidermal cysts. Su- Astley Cooper first obsei-ved that some among them coidd be emptied, by pressing their contents through a small aperture in the cutis over them, and hence concluded that they are all examples of hair-foBicles distended with their secretions and over- grown : but probably this conclusion is true for only a minority of these cysts. They are, I think, comparatively few in which an apertm-e can be found ;t the greater part are closed on all sides alike, and must be regarded as cysts new formed, resembling, except in situation, those which are found where, naturally, no hair-follicles exist. The characters of these epidermal cysts may be extremely various, in regai'd not- only to their walls, but to their contents. Then* walls may be thin, delicate, and pliant; or laminated, thick, and hard, with tough fibrous tissue ; or they may be calcified ; and I believe a general rule may be connected with the differences in these, as in other cysts, namely, that the thin- walled are the most jDroductive, grow most rapidly, and are the seats of most active change. It would seem as if all thicken- ings of cyst-walls, all deposits of calcareous and fatty matters, were indications of de- generation and loss of productive power. Among the contents of these cysts wo may observe extreme varieties. The chief alone need bo referred to. And, 1st, we * See Home, Hunter's Works, vol. iii. p. 635: nml a remarkable case by Mr. Green, in the Mkdical Gazette, vol. ii. p. 346. t Mr. South espcc'ally notices this in his edi- tion of Chelius's Surgery, vol. ii. p. 69.S.](https://iiif.wellcomecollection.org/image/b21475398_0033.jp2/full/800%2C/0/default.jpg)
