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.
![ous; a serous fluid can be expressed f'n.iii their cut .surfaces. When super- ficial thoy often become pedunculated. Fibrous tumors are jiioue to uii(k'r<;o certain secondary degenerative changes —vi/. caleificatioii. luucdid eliaiiLTc. and ulceration. Seats of Predilection.—Fil^-oniata may occur wherever filtrous tissue is found in any of its forms, but the commonest seats are the periosteum, espe- cially that of the jaws, for the harder forms, when the tumor is called a fibrous epulis; in the uterus; in the neurilemma of nerves—then miscalled neuroma (false neuroma) ; in the subcutaneous tissue on terminal nerve-fihuiients, termed painful subcutaneous tubercles; in the rectum and naso-pharynx, forming fibrous polypi. Hard fibromata are also found in the testis or may sprin<r from the sheaths of tendons. The softer forms originate chiefly from the intermus- cular septa or the subcutaneous and submucous tissues, and are oftenest found in the scrotum, labia majora, or scalp. The soft fibroma was formerly called fibro-cellular: the ordinary nasal polypus is a typical example of this variety. Fibromata attack adults chiefly, but have been observed at all ages; they are usually single, but may be multiple when springing from the nerves (false neu- romata), the skin (molluscum fibrosum), and the uterus. Pure fibromata and fibro-lipomata sometimes form large renal tumors. Diagnosis.—In general terms, fibromata are ovoidal, hard, nodular, or bosselated, of uniform consistence, of slow growth, painless—cxce})t when involving nerves—movable, those in the breast and subcutaneous tissues being unattached to the skin or circumjacent tissues. In these situations, or when arising from the jaws or other bones, in their earlier stages it is difficult to dis- tinguish them from the harder sarcomata, the latter being often encapsulated. The slow growth, the regular contour, and the non-involvement of the overlying tissues in the case of fibrous growths are the chief points of distinction. Car- tilaginous and bony tumors present the same characteristics, but are much harder and more nodular. The softer fibromata are smooth, globular, elastic, soft, and painless. Treatment.—When possible, they should be completely removed, either by enucleation with their capsules, as in most of those occurring in the breast, the interior of the jaAv, etc., or sometimes by a dissection, which may be tedious. Recurrence never takes place except where a sarcoma—portions of whose mass in certain instances consist largely of fibrous tissue—has been mistaken for the benign growth. 2. Fatty Tumors, or Lipomata, consist of adipose tissue identical with normal fat. They are innocent, grow slowly, may reach a large size, are usu- ally single, but occasionally multiple, are almost never painful, occur chiefly during adult life, and do not recur after removal. Composed of masses of fat- vesicles bound together by delicate connective tissue in Avhich the blood-vessels ramify, they are usually surrounded by a thin capsule which is attached by fibrous septa to the skin. Fatty tumors may undergo such secondary changes as calcification, mucoid softening, inflammation from pressure, and, as a result of this in some rare instances, ulceration. Seats of Predilection.—On the shoulders, back, nates—possi])ly from the hyperemia induced by pressure of the suspenders, from sitting, etc. Diagnosis.—A fatty tumor forms a circumscribed, usually painless, lobu- lated, soft, pseudo-fluctuant, inelastic, flattened growth—if subcutaneous, caus- ing dimpling of the skin when this is pinched up, due to the passage of the fibrous septa from the skin to the capsule. It is best distinguished from chronic abscess—with which it may be confounded—by its dimpling and by](https://iiif.wellcomecollection.org/image/b21217014_0234.jp2/full/800%2C/0/default.jpg)
