Volume 1

Text-book of the principles and practice of medicine / by the late Charles Hilton Fagge and Philip Henry Pye-Smith.

  • Charles Hilton Fagge
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of the principles and practice of medicine / by the late Charles Hilton Fagge and Philip Henry Pye-Smith. Source: Wellcome Collection.

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    groin contained a large mass, notwithstanding that the penis and the scrotum appeared to be unafiected. But it may he doubted whether the microscope might not have thrown fresh light upon the matter. Thiersch records a case in which a nodule seemed for a time to be subcutaneous, but really had its origin in the sweat-glands. Some carcinomata seem definitely to arise from the cells belonging to the glands of the skin or mucous membrane, rather than from those which cover the surface. Further, it is conceivable, as was suggested by Remak in 1854, that a fragment of germinal epithelium, embedded in other tissues from foetal life, may afterwards develop into a cancerous tumour, instead of forming an innocent dermoid cyst. According to Thiersch it is no uncommon thing for cancer to arise in the wall of such a cyst after it has existed for many years; and Waldej'er cites an instance in which a similar change occurred in a congenital sacral tumour. Even recently, however, some pathologists have maintained that although epithelial cells are formed only in contact with pre-existing epithelium they yet arise out of cells which are not themselves epithelial. Klebs speaks of an epithelial infection, by which, for example, in a healing ulcer the rete mucosum of the skin at its margin is supposed to convert the cells of the adjacent granulations into epithelial cells. But, as Waldeyer remarks, there are striking instances in which a cancer fails to impress its own characters even upon epithelium with which it happens to come into relation. Thus, although the secreting cells of the liver are directly concerned in the development of some of the primary carcinomata of that organ, they are pushed aside by secondary nodules, and take no part in their formation. In 1867 Koster propounded the view that the cells of cancerous growths in the skin are formed from the endothelia of lym})h-channels. This, how- ever, has met with no support; Waldeyer says that he has re])eatedly seen cancer-bodies lying in immediate contact with perfectly unaltered endothe- lium, and although he admits that they often penetrate into lymph-channels and occupy them, he maintains that it is far from being always the case. On the whole, if we are not to cling to the notion that the epithelial cells are solely devloped by germination or fission from pre-existing epithelium, it would seem to be more easy to accept the view that they arise out of ordinary leucocytes. The tissues in immediate contact with a primary cancer are very commonly infiltrated with leucocytes; and, if they do not contribute to the new growth, their presence requires some other explana- tion. It is more likely that they are the results of a reactive or inflam- matory process, of which a more intense degree is seen as ulceration of the growth. Waldeyer observed that the cancer-cells themselves are altogether passive Avhen ulceration occurs; they break down and escape with the discharge. But there can be little doubt that the putrid and oflfensive character of the ichor which exudes from an open cancer is due to the extension inwards of a septic contagium along the epithelial columns and through the alveoli, which, as we have seen, communicate with one another. Caseous decay. —Carcinomata are liable to certain retrograde changes beginning within their substance. Like sarcomata and almost every other kind of hard growth, they are apt to undergo caseation. Whether this is altogether spontaneous—an indication that the cancer-bodies have reached their natural term of life—or whether it is due to interruption of blood- supply, has not, apparently, been ascertained. It often affects all but the narrowest possible growing margin of a tumour, especially of a