An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![clironic inilaiiuiiatorv atVcetioii iiivolviii*^^ ilie surface of that organ), prerlis- pcse t»» the foniiatioii of lualignaiit growths. Age and sex predispose to tunior-forniation. Thus carcinoma is a rarity under thirty years of ao^e; the mannnary gland of the female is infinitely more liahle to carcinoma than that of the male, owing to their diflciing functional activity; while, on the otiier hand, the (esophagus, lip, and tongue in the male seem to he more lial)le to he attacked hy malignant disease than the same organs in the female. The depressing emotions long continued, such as sorrow or anxiety, generally considered as predisposing causes, can act only, as does age, by low- ering the vitality of the tissues, inducing as it were premature senescence: their action is therefore doubtful. Since malignant growths present some slight apjjarent resemblances to certain ])henomena of the infectious diseases, observers have of late years sought to ascribe their origin to bacteria. Still later, microscopic appear- ances simulating those presented by certain parasitic protozoa have led enthusiastic observers to the belief that the spheroidal or irregular bodies found in and between the epithelial cells are in reality developmental forms of certain sporozoa, and that their presence is not accidental, but causal. The arguments in support of this view rest upon the morphological resem- blances of these bodies to psorospermige and to the corpuscles of molluscum contagiosum. The diversity in size, form, and staining qualities of the sup- posed parasites, the lack of evidence that these bodies are either growing or developing, and the failure of all culture methods, have caused most authori- ties to believe that the alleged sporozoa of carcinoma are really degeneration- products of the epithelial cells. The possibility that carcinoma may yet prove to be of parasitic origin is not denied, but certainly no positive evidence in support of this view has been adduced. Growth.—This is dependent upon its structure primarily, and to a less degree upon the part in which the tumor starts. Oceteris jjaribus, the more embryonal the structure, the more rapid the increase and the more malignant the tumor, but tumors of similar structure pursue widely differing courses accord- ing to the organ in which they originate. This is partly due to their lymphatic and vascular connections, partly to the importance to life of the part involved or of neighboring parts which may become diseased by contiguity, or mechan- ically rendered partially or wholly useless ; thus a small carcinoma of the pylorus will terminate life by starvation; a tumor of the larynx will early endanger life by suffocation. Clinically, tumors are divided into the benign and the malignant. A benign tumor is usually composed of tissues resembling those in which it originates, and is circumscribed, because »usually encapsulated, Avhence its mobility among the circumjacent tissues. Its vascular supply is small: hence generally it grows slowly. It is painless; it never infiltrates surrounding tis- sues, but displaces them; it does not recur when thoroughly removed, does not give rise to enlargement of the lymphatic glands intervening between it and the venous circulation, and consequently does not affect distant parts. A malig- nant tumor usually consists of tissues widely different from those in which it originates; its growth is rapid, and therefore often painful; it infiltrates all the surrounding tissues, however resistant, even bone, because it is almost never encapsulated ; it thus early becomes immovable ; the superjacent skin is apt to become adherent, especially when the breast is involved; sooner or later it usually infects the group of lymphatic glands intervening between it and the venous circulation, and from these new centres or directly through the veins](https://iiif.wellcomecollection.org/image/b21217014_0231.jp2/full/800%2C/0/default.jpg)
