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
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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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    by Mr. Coote. Mr, Csosar Hawkins,* also, had before described similar cases. He says of one, you may sec, in addition to the usual vessels, that several apparent cells exist. 'Some of these were filled with coagidum ; their structure appeared identi- cal with the other veins, of wliicli they formed, as it were, anem-ismal pouches. . . Theie were, however, besides these, some other cysts, which contained only serous fluid, and which were, to all appearance, close-sluit sacs—serous cytts—their size being about that of peas. In other instances, no erectile or na?- vous structui'e can be found, but the commimication existing between one or more among a cluster of cysts and some large blood-vessel, makes it probable that they had the same origin. Thus, Mr. Coote traced a vein, as large as a radial vein, opening into the cavity of a cyst, which formed one of a large cluster removed by Mr. Lawrence from a boy's side. The mass formed by these cysts had existed from birth; some of them contained a serous fluid, others a more bloody fluid. In another similar cluster removed from a boy's groin, one cyst appeared to commu- nicate with the femoral vein, or with the eaphena at its junction with the femoral. In one case mentioned by Mr. Hawkins,J when a cyst in the neck was opened, arterial blood gushed out. In another the patient died with repeated haemorrhages * Medico-Chirurgical Transactions, vol. xxii.; and Medical Gazette, vol. xxxvii. p. 1027. t The specimen is in the Museum of St. Bar- tholomew's. X Clinical Lectures in the Medical Gazette, ol. xxviii., p. 843. from a cyst in the neck, and this cyst was found after death to be one of several, into some of which the blood-vessels of the isthmus of the thyroid glands opened. It is difficult to hiterpret the formation of such cysts in nsevi, or in connection witli them or with veins. It may bo that, as Mr. Hawkins believes, cysts are formed in these, as they may be in many other tumours, and that gradually, by the absor]jtion produced by mutual pressure, they are opened into communication with one or more of the veins, or of the sacs connected with the veins. Or, as Mr. Coote suggests, it may be that certain of the dilatations of the vessels are gradually shut off from the stream of blood, so as to form shut sacs; and that after this their contained blood is absorbed and replaced by serous fliud. Lastly, respecting the production of cancerous disease in the tissue of erectile tumours, it seems to be generaUy regarded as a frequent event, and these are commonly believed to afford the most frequent instances of mahgnant growths superven- ing on such as were previously innocent. I will not doubt that such events have hap- pened. Especially, in one case recorded by Mr. Phillips,* the transition appears to have been very clearly traced. Yet, I think that in many of the cases which have gained for erectile tumous then* ill-repute, a clearer examination would have proved that they were, fi-om the beginning, very vascular medullary cancers, or else medul- lary cancers in wliich blood-cysts were abmadantly formed. * On Vascular Tumours, in the Medical Gazette, vol. xii., 1833. P.S.—The frequent confessions of ignorance and of imperfect knowledge contained in the foregomg pages may have suggested to readers, as to myself, that it would have been better not to pubhsh these lectm-es. Yet, the necessity of such confessions may justify, in some measure, the pubUcation, while much of the imperfection of our pathology of tumours is due to the rarity of the opportunities of studying some among them. Even in the field ©f a large hospital, one may pass years without an occasion for investigating certain of the points which it is most desirable to determine. In seven years I have been able to collect com]5lete records of nearly tliree hundred cases of tumours, and to Ulustrate most of them with microscopic and other sketches. From such materials the statements I have ventured to make have been derived. But sucli materials are very in- sufficient For example, as I have stated in the last lecture, I have had no good oppor- tunitv of examinhig an erectile tumour; of some others I have seen only one or two instances in the recent state ; and some tumours, whose characters as described by good pathologists I cannot doubt, I have never yet seen. ^„ , -rj, „„k. A good end, therefore, may be served by the publication of the lectures if I have only shown where our knowkidge is most imperfect, and where it may bo readdy improved it others will engage in the necessary inquiries, or will supply with more an.ple ma enals those wV.o are engaged in them. While wisliing for such help 1 wdl not onn( o (hank inanv who have already given it; and especially my colleagues a banit l^''* J' whose cases I have been allowed to study and to pubhsh, wilh all the advantages of then assistance. Wilson uiid Ogilvy, 57, Skinner Street, snowhill, London.
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