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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![dtvitlccl on this poiut; and it is eouliriued by some of the cases I have watched.* Tlius, a lad, eighteen years old, was under Mr. Stanley's care, lour years ago, with a tiim:)iu' occupying the interior of the sym- physis, and immediately adjacent parts, of his lower jaw-bone. It had been obsei-ved gradually increasmg for eight montlis with- out paiu, and in its growth had disparted tlie walls of the jaw, hollowing out a cavity for itself, and projecting into the mouth through one of the alveoli. Mr. Stanley removed the portion of the jaw, from the first left molar to the first right bicuspid tooth, and the tumour presented tlie greenish and greyish basis, blotched with crimson and various brownish tints, and the characters of firmness, suceulency, and inieroseopic texture, which I liave described, as most distinctive of the fibro plastic tu- mours. It was the specimen from which some of the microscopic sketches were made, and might be considered typical. This patient is still in good health, with no ap- pearance of return of the disease. Mr. Lawrence lately had under care a woman, twenty-one years old, with a tu- mour in the alveolar part of the front of the upper jaw. This was of about twelve months diu-ation. It was seated between ■the walls of the alveolar and adjacent por- tion of the upper jaw, projecting slightly into both the mouth and the cavity of the nose. After cutting away the front wall of the jaw, the tiimom* was cleared out from all the cavity in which it lay imbedded. It was in all microscopic characters hke that last mentioned, and resembled it in general features, except in that it had in evei-y part the dark ruddy colour of a strong heart. The operation was performed seven months ago, and there has been no reappearance of the disease, such as would probably have occm-red even before this in the case of a mahgnant tumom*, if an at- tempt had been made to remove it, without the bone in which it was growing.f But I believe we must not yet accept the rule, exemplified by these and similar cases, as free from exceptions ; for I have seen * Some of the srowths included under the iiaiiiearedifficulttu remove eiitire,and someare so pliiced that the surgeon is often tempted to leave I ortions of them. So n fibro-plnstic e]nilis or aural polypus may prow apain after an operaMon, but this may be only because the removal was incomplfte. When the whole disease is removed recurrence is certainly unusual in either of these cllS68S6S t Mr! Lawrence has, at this time, under t'-eatment a yonnp woman in whom both upper jaws have been the seats of fil)io-p!astic tumours. He lias lately removed one of tin: tumours, with the Ki'eatcr part of the l iiflit upixT jaw hone; the other tumour Jippears subsidin}; ; and, whatever may be the issue of the case, the whole of its re- cent progress has been very unlike that of a m. lisrnnnt disease. two cases of what, at present, 1 nmst be- lieve to be the same form of tumour, that had a very different issue. A woman, fifty years old, was under Mr. Stanley's care, in 1847, with an ir- regidar, roundish, heavy tumour in her left breast, between two and tln-ee inches in diameter. It projected in the breast, and the skin over it was red and tense, and at one part seemed to point, as if with suppuration. Some axillary glands were enlarged, but not hardened. Tliis tumour had existed about nine months, had been the seat of occasional pain, and was increasing. It was considerd to be hard cancer ; but, on removal of the breast, was found to be a distinct growtli, completely separable from the mammary gland, whicli was pressed aside by it. Its character was obscured by suppuration in many pomts of its substance ; yet after a carefid examination of it m the recent state, and a repeated examination of the notes and sketches that I made of its struc- ture, I can only conclude that it was a fibro-plastic tumoui- suppm-ated. Eighteen months after the removal of her breast, this patient retm-ned to the hos- pital, with a large ulcerated tumour in the lower part of her left axilla, which had begun to form as a distinct tumour six months after the operation. Tliis was hke a large flat ulcerated cancer: it often bled freely. Her general health was deeply affected by it, and she died in two or three months after her readmission. The mahgnant character manifested in this case was yet more decidedly marked in another. A man, fifty-tlu-ee years old, of healthy appearance, was vmder Mr. Law- rence's care with an oval tnmoiu-, extending, under the mastoid muscle, from the angle of the jaw to the clavicle. Bloody senmi oozed from it through tlu'ee smaU apertm-es in the integuments. The anterior part of the tumoiu- felt as if containing fluid; the posterior part felt sohd, firm, and elastic. He had observed this timiour for ten months, havmg found one morning, when he awoke, a lump nearly as large as an egg, wliich regidai'ly increased. In two montlis it had become very large : it was punctured, and about one-third of a pint of reddish serum was discharged from it. In the suc- ceeding eight months it was tapped tliirty- four times more, about the same quantity of similar fluid beuig each time evacuated. It was also six times injected with tinctme of iodme, twice traversed with setons, and in various other ways severely treated. The only general result was, that it increased, anil seemed to become, ui proportion, more solid. When admitted under Mr. Law- rence, all the iJarts over the tiunour wore extremely (ensc and painfid, and cerebral](https://iiif.wellcomecollection.org/image/b21475398_0056.jp2/full/800%2C/0/default.jpg)
