A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland.

James Copland

Date:: 1844-58

Credit: A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$many present insulated portions of the colour and consistence of boiled yolk of egg. As the tumour increases, the softening and disorganisation cha- racterising the successive stages of its growth takes place. Disorganisation generally com- mences in the central parts: cavities now form in il, chiefly containing blood ; and, when the blood is washed away, and the tumour is placed in water, numerous membranous shreds and filarilents are seen floating in these cavities. 6. If the fungoid mass is situate near the sur- face of any internal viscus, discolouration of, and adhesion to, the part covering it, followed by ulceration, take place. But the ulcerative pro- cess, instead of giving rise to loss of substance, produces a fungous growth, and, as well as when the tumour forms exteriorly, the increase of bulk, which had hitherto been slow, now becomes rapid. The fungus which thus forms is soft, easily torn, of a dark red or purple colour, of an irregular shape, and bleeds profusely when slightly injured ; and differs from the firm dense structure of the cancerous fungus. It resembles, when small, the softer kinds of polypous vegetations which form on mucous surfaces.— When the primary hae- matoid tumours are situated towards the surface of the body, they increase in size more rapidly than when seated internally. They generally soon lose their uniform round and smooth appear- ance ; they project very considerably, and at last become irregular at their surface. Their consistence diminishes, particularly in the pro- jecting portions, where the soft elasticity passes into obscure fluctuation. The veins running over or from the diseased mass assume a varicose appearance; an erysipelatous-like redness of the prominent parts supervenes, followed by lividity, adhesion of the integuments to the tumour, ulcer- ation, and soft reddish fungous excrescences. The growth of the tumour is now remarkably rapid. The surface of the fungi exudes a thin foetid sanies, often with blood, wliich is sometimes dis- charged in great quantity ; hence arose the name fungus humatodes, which applies only to the ad- vanced stage of the malady. When the fungus is very large, its more prominent parts often lose their vitality, and separate in most offensive sloughs. 7. In some cases the voluntary nerves have been connected with the diseased mass, and have participated in the change of structure; but they have not been found changed beyond the limits of the tumour. In the eye, the optic nerve is always changed in structure; and in a case re- ferred to by Mr. WAnDnop, the anterior crural nerve passed into the centre of the diseased mass, and was so completely lost in it, that it was im- possible to distinguish between the two structures. This appearance being general whenever large nerves enter into the hicmatoid tumour, has led M. Maunoiii to infer that the cerebriform matter composing it is nothing else than a morbid accu- mulation of the nervous pulp. This opinion is combated by IM. LonsTi.iN, who avers that he has met with cases in which, particularly in early stages of the disease, the nerves passed through the tumour without experiencing any change. I am, however, disposed to doubt this, at least as respects the fully developed disease : if they jiass through, 1 believe, from the dissection of a case vvhicli occurred to me, lliat they are always changed, and identified with the morbid mass : if they pass merely by it, or between insulated portions of it, no change will be observed. 8. The most remarkable characteristics of this disease are—1st, The frequently simultaneous occurrence of a number of the tumours consti- tuting it in different parts of the body ; the least connected with each other, either by structure or function: and, 2d, That when an apparently isolated mass of the disease is met with in an ex- tremity and extirpated, it always soon afterwards manifests itself in some distant part, either exter- nally or internally ; the subsequent disease being even more rapid in its progress than that preceding it. The simultaneous appearance of the hajmatoid tumours, or their successive manifestation, al- though sometimes observed to take place in the course of the absorbent system, seem not to be always propagated through this medium ; for, in the case of the diseased mass appearing first in one of the lower extremities, the subsequent occurrence of it may not be in the glands above the originally affected part, but in some distant or internal organ, as in the lungs, liver, in an upper extremity, &c. This was well evinced in a most remarkable specimen of the disease which came before me several years since in a lad of about fifteen; who presented in all the extremities, upper and lower, in the parietes of the thorax and ab- domen, in his neck and head, a number of those tu- mours, certainly not under fifty. They varied from the size of a walnut to that of a large orange ; many of them were of simultaneous origin, and those which were the latest in appearing did not occur in the seat of the glands of the absorbents leading from the primary tumours. A somewhat similar, and still more remarkable case, in respect of the great extent and number of the tumours, both internal and external, I had lately an oppor- tunity of seeing frequently with Mr. Bushell. 9. Often, however, when the original mass is advancing through the changes 1 have de- scribed, the absorbent glands become aflPected by the disease, and the internal viscera, and the whole constitution, are contaminated; or, per- haps, it would be more correct to say that the original contamination is thereby so far heightened as to occasion a more general formation of this diseased structure. When the absorbent system is affected, ]\Ir. Wardrop states, that usually one or more glands swell in the vicinity of the pri- mary tumour, and that this takes place sometimes at an early period of the disease, and occasionally not until the primary tumour is far advanced. In some cases the diseased glands grow to a great size, whilst in others they are but slightly en- larged. Occasionally the primary affection makes little progress, whilst the disease of the glands advances rapidly.— The structure of the glands thus secondarily affected is entirely converted into the cerebriform matter, exhibits a homogeneous j)ulpy mass, and is contained in a cellular capsule. Mr. Wahduop has never observed a fungus arise from the diseased gland. 10. This morbid ])roduction may appear in one part only, or in several at the same time, or in distant j)arts successively, 'i'lie tumours which first appear may be called jirimnry ; those which occur afterwards, either in the absorbent glands or in remote parts, may be named cnnseciitii^e. But the disease may terminate fatally without any more than a single mass being developed.$