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
Catalogue details

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.

    264/1392 (page 206)
    spots, due to extravasations of blood. 'Tlioy liave been (•(tiii]i;iicil in color to the muscuhir tissue of the heart. Seats of Predilection.—The lower jaw, tlic htwcr cud of the fcimir, and tile licad of the tibia ; althouLlh they uuiy occur elsewhere. The courses ])ursued by the several forms of sarcomata are partly depend- ent u})on their structure, ])artly upon the organ or tissue which they attack. For exam[)le, tiie commonest form attacking the mamma, the spindle-celled, occurs most frequently between thirty and forty years of age, is at first enca))sulated—therefore freely movable—hard and nodular, grows with great rapidity, and sooner or later, from softening or the development of cysts, is apt to pi'esent points of uneciual consistence, some of the conse((uent bosses actuallv feeling ilucfuant. The tumor remains for a considerable time isolable from the mauuuary gland ])roper, thrusting this to one side. The skin does not usually become adherent, even when intracystic growths fungate, after having caused ulceration ; although, if the tumor is left to pursue its natural course, in time not only the skin but also the subjacent parts will be infiltrated, and death will ensue from sloughing or involvement of the lungs, liver, or other viscera; the axillary glands renuiin uninvolved. Examine the other extreme as exemplified by the course pursued by a giant-celled sarcoma, usually occurring in an adult over forty years of age, and attacking the body of the lower jaw, slowly expanding the bone into a smooth tumor, involving l)oth its inner and its outer surface, the bony walls of which are often so thin as to crackle under ])ressure, yet growing so slowly that years may elapse before it attains the bulk of a walnut; the growth does not become adherent to the surrounding tissues, and consequently rarely ulcerates; involvement of the lymphatic glands seldom occurs. From the preceding remarks it will be seen how difficult the diagnosis of sarcoma often is, varying as the symptoms do with the organ attacked. Occur- ring at all ages, sarcoma is more apt to attack the young—i. e. the tissues during the developmental period. Although it is the rule for sarcomata to grow rapidly, especially the secondary growths, yet some of the primary ones develop slowly, the rate of growth and bulk attained depending largely upon the tissue attacked. Those of the eye or brain are apt to be small, while those of bone often reach a huge size. While those which attack the subcutaneous tissue, the fascia, and the intermuscular planes are usitally surrounded with a capsule, there is none fi)r those s|)ringing from the surfaces of bones, nor for those arising in the interior of such organs as the lymphatic glands, the tonsil, etc., which are soon entirely infiltrated by the growth. Infiltration of the surrounding tissues, even those external to its capsule (Avlien such exists), is a peculiarity of sarcoma: this is especially true of the small spindle-celled variety (recurrent fibroid of Paget), which occurs chiefly in the subcutaneous tissue and sometimes in the breast, recurring in the course of many years a dozen or more times, while distant parts and the lymphatic glands rarely become infected. Attention has already been called to the early implication of the glands in sarcomata of certain organs, as the testicle, etc. The subperiosteal sarcomata are very apt to give rise to secondary tumors in other bones, the skin, the subcutaneous tissue, and the viscera, lymphatic involvement being the rare exception. Finally, certain of the softer sarcomata bv hemorrhafie into their substance become completely broken down and converted into cyst-like tumors filled with blood, partly fluid, partly coagulated. These if punctured bleed profusely, the hemorrhage being often difficult to control; without a microscopical examination it may be impossible to distinguish such a groAvth from a true heuuitoma (blood-cyst).