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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![The respective tendencies to ulcerate can, l]ierefbr.>, be counted only as constituting dili'erences of degree between the innocent and the malignant tumours. We may speak of a liabilit y in the one case, of a proncness in tlie other: in the innocent, the idce- ration lias tlie marks of disease in tlie growth ; in the malignant, it appears ratlicr as a consequence of natural degeneration or molecular deatli. 4th. The softening that often precedes tlic ulceration of malignant growths can hardly be considered separately fi'om the minute account of their structm-e. I there- fore pass it by, and proceed to their fourth distinctive charactei-, which is to be noticed in the modes of their ulceration. Tl lis is, that the ulcer, which forms m, or succeeds, a mahgnant growth, lias no appa- rent disposition to heal; but a morbid substance, like that of wliich tlie original growtli was composed, forms the walls or boundaries of the ulcer; and as this sub - stance passes through tlie same process of ulceration which the primary growth passed througli, so the mahgnant ulcer spreads and makes its way tln'ough tissues of all kiuds. In contrast with this character of malig- nant growths, it is observable that beneath and around an ordinai-y idcer of tlie natu- ral tissues, or of an innocent tumom',we find the proper tissues unclianged ; or, perhaps, infiltrated and succulent witli recent lymph, or the materials for repair ; or somewhat indurated with lymph ah'cady organised. Tlie base and margins of a cancerous ulcer are themselves also cancerous; those of a common ulcer are infiltrated with only reparative or inflammatory material. In like manner, if ulceration extend through an innocent growth, it may destroy it aU; and no similar growth will form in the adja- cent parts, replacing that which has been destroyed : but, in the ulceration of cancer, while the cancerous matter is being con- stantly discharged, by sloughing or uk^era- tion, from the surface, new matter of the same kind, and m more abundance, is being formed at some distance from the surface; so that, in a section thi'ough an ulcerated cancer, one does not arrive at healthy tis- sues till after passing through a stratum of cancer. 5th. Malignant tumours are, again, cha- racterised by this,—that they not only enlarge, but a])parently midtiply or propa- gate themselves; so that, after one has existed for some time, or has been extir- pated, others like it grow either in widening circles round its seat, or in parts more remote. Mere mviltiplicity is not a distinctive character of njaiignant diseases ; for many innocent tumours may be found in the same person. But in the conditions and circum- >5 stances of the raultiphcity there are cha- racteristic difierences. Thus, when many innocent tumours exist in the same person, they are, commonly, or always, all in one tissue. Thus a man may have a hundred fatty tumours, but they shall all be in his subcutaneous fat: many fibrous tumours may exist in the same uterus, but it is so rare, that we may call it chance, if one be found in any other part in the same pa- tient : so, many cartilaginous tumours may be in the bones of the hands and feet, but to these, or to these a.id the adjacent bones, they are limited. There is no such limitation in the cases of midtiplicity of malignant tumom-s. They tend especially to aliect the lyiupliatics connected with the part in whicli they first arise; but they are not Umited to these. The breast, the lymphatics, the skin and muscles, the hver, the lungs, may be all, and at once, the seats of tumours. Indeed (and here is the chief contrast), it is more common to find the many mahgnanttumours scattered through several organs or tissues than to find them limited to one. Moreover, if there be a midtiplicity of innocent tumours, they have generally had a contemporary origin, and aU seem to make (at least for a time) a commensm'ate pro- gress. But the more ordinaiy course of malignant tumours is, that one first appears, and tlien, after a clear interval of progress in it, others appear; and these are followed by others, which, with an accelerating suc- cession, spring up in distant parts. Gth. A sixtli distinctive chai-acter of malignant tumours is that, in their multi- plication, as well as in their progress of ulceration, there is scarcely a tissue or an organ wliicli they may not invade. In regard to their midtiplicity, I have just illustrated their contrast in this point with the innocent tumours ; and a similar contrast is as obvious in the characters of the xdcers. It is seldom that a common ulcer extends, without sloughing, from the tissues it has first aiiected uito any other; rather, as a new tissue is approached, it is thickened and indurated, as if to resist the progress of the ulcer. But before a can- cerous ulcer the tissues m succession all give way, beconung first infiltrated, and then, layer after layer, degenerating and ulcerating away with tlie cancerous matter. One may see this very well in bones. Specimens are to be found in nearly all Museums, of tibia; (for example) on the fi'ont sm-faces of which new bone is formed, in a circumscribed round or oval layer, a line or two in thickness. This bone, which is comjiact, hard, smooth, and closely united with the shaft beneath it, was formed under an old ideer of the integiuuents of the shin. But, on the other side, specimens](https://iiif.wellcomecollection.org/image/b21475398_0010.jp2/full/800%2C/0/default.jpg)
