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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![Now, the change wliich ensues in these eases is not ossiheat ion ; true bone, I be- lieve, is not formed in the fibrous tumours of the uterus. The clmnge is a calcareoiis degeneration, consisting in an amorplious deposit of Siilts of lime and other bases in the place of the fibrous tissue.* But the process is important, as being the manifes- tation of a loss ol formative power in the tumour. The calcified fibrous tmnom's probably never grow, and are as inactive as the calcified arteries of old age.f With these degenerations I may men- tion, (though it has probably more of the nature of a disease), a softening of fibrous tumours, in which, quickly, and ajDparently in connection with increased vascularity and congestion, they become cedematous, and tlien, as their tissxie loosens, become very soft, or even diffluent, or else break up, and appear shreddy and flocculent. In this state the outer and less softened part of the tumour may burst, or they may suppurate or slough. The most frequent seat of fibrous tumours is, beyond all comparison, in the uterus. Indeed, we may hold that the fibrous uterine tumom-s are the most frequent of all innocent tumours ; Bayle's estimate being probably true, that they are to be found in 20 per cent of the women who die after 35 years of age. But I shall not dwell on the fibious tumours in the uterus, fully described as they are by Dr. Robert Lee, and otlier writers on uterine patholo. y. I will only say, that such tumours may occur near, as well as in, the uterus ; but that, in respect of tliis nearness, they are probably limited to those parts in which fibrous and smooth muscu- lar tissue, like those of the uterus, extend ; namely, to such parts as the utero-rectal and utero-vesical folds, and the broad li-ya- ment8.§ Next to Ihe uterus, the nerves are the most frequent seats of fibrous tumours. But of these, while I can refer to the splendid monograph by Dr. Smith, I will say only that, among the neuromata the fibrous tumours reach their climax of mul- tipUcity, existing sometimes in every nerve * On tlie appearance of a crystalline form in tlie deposits, see DiifseHr ; Onderz. van liet Heetiweefsel en van VerlK-cningen in zaclite Ueelen. I'l. vii. . . . . t A remarkable exftnpl licaticn is ni .Mr. Ar- iiolt's Ciise. In 40 yciirs a calcified tiiiiniur did l ot ii:ore llinn double its size. t 'I'lie whole of tliis i)rocess is extremely veil descril)cd in Mr. Iliimplny's Lectures on Sur- gery, Lcc. xxvii. p. 13!) § It appears, ii deed, to be this mixed tis.'sne to which thefibrnns tumours parlicnlarly attach themselves ; loi they arc iu clusc relation witli it in other parts besides ihe ulei iis, —in llic skin, and tl.e sub nuicu','.!- tis^su-j of the digestive canal and other parts. of the body, and amounting tu 1 iiUU or more iu the same person. So, too, I will pass by tiie fibrous tu- mours of bones, referring for these to Mr. Stanley's IVeatise on the Diseases of the Boiies, and to Mr. Cajsar Hawkins's Lec- tures on their Tumours.* Instead of these instances of fibrous tumoiu's, the histories of which have been so fully written, I will select for illustration some that are less generally studied, es- pecially those that are found in tlie sub- cutaneous tissvie, and deeply seated near tlie periosteum, or other fibrous and tendinous stinicturcs. The fibrous tumours of the subcutaneous tissue, to which those of the submucous tissue closely correspoud, pass, as I have ah'cady said, with insensible gradations into the fibro-cellular. Many may be found that might deserve either name; but it is not very rare to find specuuens with all the distinctive features ascribed to the fibrous tumom-s of the uterus. These form firm, nearly hard, and tense, round or oval masses imbedded in the subcutaneous fat, raising and tldnning the cutis. They may here attain an immense size, as in a case from the Museum of Mr. Liston.f A tumour, weighhig up- wards of 12 pounds, is here shown, wliich was removed fi'om the front of a man's neck, together mth a ]:>ortion of the in- teguments and platysma tliat covered it. It was fifteen years in progress, and has now an aspect such as, I think, belongs only to a fibrous tumour. Specimens, however, of tliis size are very rare; they are commonly removed while less than an inch in diameter. In microscopic characters the subcuta- neous fibrous tumoiu's liave the genenil properties of tlie species, but they com- monly contain elastic tissue, aud they are apt, I think, to be lowly developed, having only a fibrous appearance, or even seeming composed of an uniform blastema, with imbedded elongated nuclei, like the ma- terial for the lormation of new tendons. A peculiar and important character in these fibrous tumours is, that though they may be completely isolated in every other part, they often adhere closely to the lower surface of the culis, and that, il' in any de- gree irritated, tliey soon protrude through it, and form vascular masses,—'fungous growtlis' as they are called. AYhen tliis hapjiens they may bleed profusely, and in a manner whicii, 1 behcve, is not imitated by any other innocent tumour. Nearly live years ago, a woman 52 years old was under Mr. Stanley's care, witli a tumom- * MnnicAi. f<Aziini i:. vols. xxi. ii.-v.](https://iiif.wellcomecollection.org/image/b21475398_0050.jp2/full/800%2C/0/default.jpg)
