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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    lind successive productions of epidermis, formed in layers on the inner walls of the cyst, and thence successively shed, and pushed inwards towards its centre. A section of such cysts (which were particu- larly described by Su- Everard Home from the Hunterian specimens) presents layers of white soft epidermis, like macerated epidermis of the heel or palm. The exter- nal layers are commonly quite regular; but the internal are more disorderly, as if broken up and mingled with less organised productions. 2dly. A peculiar appearance IS given to contents like these, where, among the layers of epidermal scales, abvmdant crystals of cholestearine are mingled. They hence derive an appear- ance like that of the masses to which Miiller* has given the name of cholestea- toma, or laminated fatty tumour; and, indeed, the few instances of well-marked examples of this disease wliich I have been able to examine, as well as Miiller's own account, make me think that what he named cholesteatoma is only a combination of layers of epidermal scales with crystals of cholestearine.t The a]opearance produced by such a com- bination is quite pecuUar. It forms nodu- lar masses of soft and brittle substance, like wax or spermaceti, the surfaces of which present a bright glistening, hke that of mother-of pearl, while their sections are finely iMmiuated. It is a rare disease ; the most fi'equent seats of well-marked speci- mens appeai'ing to be in ovarian cysts, and in connection with the membranes of the brain. The characters are well shown in the contents of a small ovarian cyst in St. Bartholomew's Hospital; and in the tu- mour within the occipital part of the cranium, in Mr. Hawkins's Collection, to ■whicli I have already refeiTcd. Striking •examples are figured by CruveUhier ;J but the want of microscopic examination leaves their constitution uncertain. 3dly. In the opposite extreme to these cysts, in which the cuticular product is most perfect, we find an innimierable variety of contents, of buff- and ochre-yellow, and brownish materials, that seem to consist mainly of degenerate cuticle mingled with sebaceous secretions. The microscope finds in tliem a confused mass of withered scales, of granular fatty matter, clustered and float- ing free, of cholestearine-crystals, and of earthy matter in free molecules, or enclosed within the cells or scales. And all these may be floating in liquid, or retained in some soft tenacious mass, or clustered in * On Cancer, p. 163: West's translation. + Other writers Iiave applied tlie name of clio- lestcatoma more vairnely. t Anatomie Pathol, li'v. ii. p. C>. hard nodular and ]Kjintcd masses, project- ing like stalactites from the old cyst-walls.* One more phase of this disea.se deserves especial notice—that in which the cyst ulcerates, and its contents protrude. An inflammation in or about the sac often appears the inducement to this change ; and sometimes the inflammation itself can be traced to nothing but disturbance of the general health. The probabihty that it may thus arise makes the caution \ery valuable which Mr. Humphryf gives con- cerning the removal of all tumors. It is always well (he says) to bear in mind that persons are most likely to consult us respecting these, or other gi'owths of the like kind, when they are out of health, and consequently unfit to bear an operation : they do so because the tumour is then most productive of pain and annoyance. A distressing instance of the truth of tliis occuiTcd to myself thi-ee years ago. A strong, but very intemperate man, came to me as an out-patient, with an ulcerated sebaceous cyst, about three-quarters of an inch in diameter, just below and to the right of the umbilicus. He had obseiwed a tumour here for 16 years; but he had scarcely thought of it till, during the last five weeks, it had grown quickly, and in the last fortnight had ulcerated. I saw no reason to be very cautious in such a case ; so sht the tumour and removed it, as well as the thickening and adhesion of the parts ar mnd woidd allow. In the evening, having returned to his work and some intemperance, hfemorrhage ensued from a small cutaneous vessel, and before he reached the hospital he lost more than a pint of blood. I tied the artery, and applied solution of alum to the rest of the wound, for its whole surface was oozing blood, and he was admitted into the hospital. The next day he became very feverish, and he appeared as if he were going to have typhus, which was then prevalent. But from this state he partially recovered; and then abscesses formed in liis groins, and discharged profusely. Nothing improved his health, and three months after the ope- ration he died, apparently exhausted by the continual discharge from the abscesses, and with both external epigastric veins and parts of the femoral veins full of old clotted blood—the consequence of slow phlebitis. Cases like this, or ending fatally much sooner than this did, with erysipelas or more acute phlebitis, have occuiTed to * See Museum, CoUepe of Surgeons, 157 and 2297; and a most remarknbie specimen in the Mnseuni of Guy's Hospital, which was removed from iin old man's thiijli. t Lectures on Surs-ery, p. 13.5, from the Pro- vincial Medical and SurgicalJournal.
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