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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![Riul Sargioal Journal, and by Dr. Maclii- gan's extreme kindness I am enabled to illiisitrate it witli llnisliod drawings of the tumoiu's removed in the successive opera- tion. A gii-1, 22 years old, had a tumour, of three years growth, on the left lumbar region about an inch from the siiine. In 1832, it was about as large as a Jarganclle pear, firm, but elastic and moveable, and below it was a portion of indurated skin. Tlie tumour and diseased skin were re- moved, and the former possessed most of tlie characters of a simple fibrous tu- mour. After about twelve months the disease returned ia the scar. Three little tumours formed, and these with the scar were removed freely, in February, 1834. The extirpated mass bore a striking re- semblance to that previously removed. Between twelve and eighteen months later a third growth appeared; which, after increasing for a year and a half, was re- moved. It had the same elastic feel and fibrous appearance ; and the semitrans- . parent pmkish grey coloixr was the same as in the original tumour. After this operation no fresh growth ensued, and Dr. Maclagan informs me that the patient remains perfectly well. Mr. Maclagan has added the account of another case in which the essential features ■were quite similar; and to tliese I might add others. One was described by Mr. Syme, at a meeting of the Edinburgh Medico-Chirargical Society,* in which three similar tumours were in nine years removed from a patient 64 years old. Another, which I believe must be refei'red to this gi'oup, is accurately described and figured by Dr. Hughes Bennett.f But the references to these, and the accounts that I have given of other caaes, may suffice to prove the existence of a group of I tumours having these remarkable charac- ! ters in common :—1st. A general resem- , blance to the fibrous tumours in theii' ob- vious characters; 2d. A microscopic tex- ' ture resembling that of the fibro-plastic more than of ajiy other timnour, yet differ- ing in tlic absence of the many-nucleated cells ; 3d. A tendency to local recurrence after removal, and, in the worst extremity, to protrusion and ulceration, like a malig- nant growth ;t 4th. An absence of those * Monthly Journal of Medical Science, vol. ii. Ip. 19+. The report states that Professor IJnnnett 1 fonnd the microscopic characters of this tumour I similar to those of the fibro-plastic tumours of I Lebert. Probably this refers to the elon-^ated I ceils nlone. I have not, in any of these tumours, I /bund the larpe many-niiclented cells which I occur in the fibro-pIastic tumours. ] t On Cancerous and Cancroid Crowths, p. 87. i Mr. Syme particularly mentions this as a character belon^inf; to those which ho has seen. It looks, indeed, very like a sign of mal-Rnant events wliich, in cases of ordinary malig- nant growths, would coincide with this local recurrence, such as cachexia, and the affection of distant parts, or of the lym- phatics. How may we interpret their singular proneness to recur? Two views maybe taken of the facts.* The tumours may, from the first, be formed of a cluster or group, and then the removal of one of them only leaves the remainder to continue their growth ; or, 2dly, the apparent recurrence may be a real one, such as we suppose occurs in the case of cancers ; in which we presume that, in a first operation, every morbid structure already formed m a part is removed, and entirely new growths are produced in the same part. The former view is supported by whatever of resemblance exists between these and fibrous tumours, whose proneness to multi- plicity is remarkable; and by the fact that sometimes, after tlie removal of one of these, two, or a more numerous group, have ap- peared in the same part. Yet the objec- tions to this view appear to me more weighty. If we suppose, in any case in which six or seven tumours have been removed in succession from the same part, in as many years, that all began to grow at or about the same time, the last of these ought, according to the rate of growth of the rest, to have come into view much sooner. If the second tumom* were not discernible in the first operation, where, or of what size, was the sixth ?—or why did it require six or more years to come to the same bulk as the supposed coeval second tumom* acquired in one year ? It may be added that some of these tumours a]ipear to have recurred in the substance of a scar left after a former operation—in a tissue, therefore, wliich did not exist at the time of the previous operations. Nor must we overlook, in con- nection with this apparent aptness to recur, the fact that the later-formed of these tumoiu-s may assume certain charac- ters of the tlioroughly malignant growths which were not observed in the earlier. In one of the cases I have seen, the last tumour was, in general aspect, hardly to be distinguished from brain-like tumour, disease; but it may be only another feature of general resemblance between these and the sub- cutaneous fibrous tumours mentioned in the earlier part of the lecture. * Some would add a third, supposing that in all tlicse cases portions of the tiunour were left behind in the operations. But this is unrea- sonable. These ttnnours are not more diflicult to remove wholly than many are which never thus recur, such as the fatty, libro-cellular, and the like, llesidcs, in many of the cases I have cited, it is certain that the whole tumour was every time renuived. i](https://iiif.wellcomecollection.org/image/b21475398_0059.jp2/full/800%2C/0/default.jpg)
