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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![Among tlie |3ainful subcutaneous tu- mours that I have been able to examine microscopically, one was composed of dense fibrous tissue, with filaments laid insepa- rably close in their fasciculi, and compactly interwoven. These appeared to have been formed in or from a nucle;ited blastema; for thick-set, oval, and elongated nuclei were dis]3layed when acetic acid was added. Another was composed of well-foi-med fibro-ceUular tissue, with bundles of parallel undulating filamerits, matted or closely in- terwoven. With these were elongated fibro-cells,—the products, perliaps, of in- flammation, to which the tumour appeared to have been subject. The substance be- tween the filaments, and that from which they were probably developed, was here, also, a nucleated blastema. A tiiird speci- men presented obscure appearances of a filamentous structure, but no separable fila- ments : it seemed composed wholly of sucli nucleated blastema as was exposed by the action of acetic acid on the former speci- mens. In some parts, also, this presented appearances of filaments and nuclei ar- ranged in concentric circles around small cavities.* From these examples, we may believe that the painfid subcutaneous tumour mny be formed of either fibro-ceUular or fibrous tissue, in either a rudimental or a perfect state. They may also, I believe, be fibro- cartilaginous, as described by Professor Miller, t and by many other writers. But whatever such sUght diversity of tis- sue they may present, the characteristic of all these tumours is tlieir pain,—pam which may precede all notice of tlie tumour, or may not commence tiU much later, or may be contemporary with it, but which, when once it has set in, may rise to very agony, such as I suppose is not equalled by any other morbid growth. It is not often con- stant ; but, generally, without evideut cause, or with only a shght touch of the tumour, a paroxysm of pain begms, and, gradually increasing, soon reaches a terrible severity. Beginning at or near the tumour, it gra- dually extends mto all the adjacent parts, often flashing, like electric shocks, from one part of the limb to another, or to the whole trunk. Such a paroxysm may continue for a few minutes, or for several hours, and then it gradually subsides, leaving the parts sore and tender. Wilde it lasts, the * Like those drawn from a fibrous tumour of the uterus by Prof. Bennett (On Cancerous und Cancroid Growtlis, p. 189). t Principles of .Surffery, p. 630. An enirniv- in^, from the sketch by Prof. IJcnnett, makes this the only sure instance of fibro-curtilagiiious structure. In the other recorded cases the micro- scope was not used; and the naked eye cannot discern between fibrous cartilage and dense fibrous tissue. tumour, whatever may be its condition at other times, is always exquisitely sensi- tive ; the muscles of the hmb may aet with irregular spasms, or general convul- sions, like those of an epileptic seizure, may ensue. Sometimes, too, the tumour itself swells, the blood-vessels around it become larger and more tortuous, and the skin becomes oedematous or congested, imi- tating the change which sometimes ensues in a neuralgic part. There are many diver • sities in the characters and modes of the pain ; but this belongs to all the instances of it,—that its intensity is altogether dis- proportionate to its apparent cause, and that it cannot be explained by anytliing that can be seen m the structure or rela- tions of the tumour. This pain suggests interesting questions in relation to the pathology of all tumours ; but, before considering it, let me add some facts to complete the liistory of these. They appear usually to be of veiy slow growth. I removed one fi'om the leg of an elderly woman, who had noticed a gradual increase of it for ten years; yet, at last, it was less than half an inch in diameter. In other cases they may more quickly attain the same size; but this seems the limit of their size ; and, for any number of years, they may remain sources of intense pain, and yet undergo no apparent change of size or structure. They are usually single. I liave found only one ease in which more than one existed : in this case three lay close together over the great gluteal muscle.* When excised, they are not apt to recur. I removed one from the back of the leg of a lady twenty-eight years old, from whom, two years previously, a similar growtli was excised from the same part. After the first operation the pain was scarcely changed; after the secoud it ceased, and never re- turned. Sir Astley Cooperf removed two pamful tumours, at an interval of a year, from a young lady's leg ; but these are the only instances of apparent recmTcnee that I have found. I believe that they have no tendency to ulcerate, or to assume any of the peculiar characters of mahgnant disease.J In considering, now, the painfidness of these tumours, the first question is their relation to nerves : are nerves involved in them ? and do tlicy, as Velpeau§ seems to * W. Wood, I. c. t lllustr of Diseases of the Breast, p. 8*. i Dr. Wiirren (On Tumours, p. 00) speaks of a maliffii;int form of the disease in which the lym- phfitics are ult'ected, but relates no cose of it. The case reruiirini;: ami)utation which he relates appears to have owed its severity to the treat- ment. Dupuytren (Lemons (Irnles. i. 542) says they have or may acquire a scirrhous nature, and then end with Ciincerous softening; but he refers to only one case justifyina: such expres- sions, and this easels in'iperfcctly described. § M(5decine Opdratoire, torn. iii. p. 101.](https://iiif.wellcomecollection.org/image/b21475398_0044.jp2/full/800%2C/0/default.jpg)
