Druitt's surgeon's vade mecum : a manual of modern surgery.

  • Robert Druitt
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Druitt's surgeon's vade mecum : a manual of modern surgery. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    leave a scar, not to continue to grow like a tumour or even to remain stationary. We do not know the immediate causes of tumours, and it has been suggested that malignant growths may be due to the action of an organism, but it is hardly IDcely that a bacterium capable of pro- ducing an epithelial cell in a bone will be discovered. Pathologists therefore, being unable to insert the cause of tumours in their definition, to separate them etiologically from inflammations, adopt the negative method and say—that the new tissue of which a tumour consists is not the result of an inflammatory process. Clinical course.—For the patient the most important division of tumours is into simple and malignant. A simple tumour is circumscribed, generally encapsuled, and mov- able among the surrounding tissues ; it generally grows painlessly, slowly, and never by invasion or infiltration of neighbouring parts; it is but slightly vascular; it may reach a great size and produce serious and even fatal symptoms by pressure on important iiarts, or make life a burden by its size and weight, or inflame and ulcerate or slough ; but, except from some such accidental circumstance, it produces no effect upon the general health; if removed with common care it does not recur; and it shows no tendency to infect lymphatic glands or distant parts. Histologically sim^Dle growths usually consist of weU- formed adult tissue. A maliirnant tumour, on the contrary, does not feel circumscribed, is not encapsuled, and is more or less adherent to surrounding parts; it generally grows rapidly, and chiefly by infiltrating the tissues around ; it is often very painful, and always much more vascular than a simple tumour. When springing from bone or other deep part it may reach an enormous size, but when superficial it often ulcerates whilst small; during its growth the patient becomes markedly anremic and loses flesh and strength rapidly, i.e., it causes cachexia; if removed by incisions which apparently go quite clear of its edge, it often recurs in loco, and either before or after removal of the primary growth secondary tumours appear in the nearest lymphatic glands, or in distant parts of the body, or in both situations. The minute structure of a malignant growth is usually embryonic and most atypical. Upon the above points the differential diagnosis rests ; assistance may sometimes be given by age and heredity. Owing to the way in which they infiltrate, the apparent is not the real margin of malignant growths, and cells swept from them by the lymph-stream may stick here and there in the neighbouring tis- sues, liecurrence in loco is certainly due to the leaving behind and continued growth of some of these germs. Infection of lijm]}]iatic (jlands is due to the carriage to them of cells from the growth by the lymph-stream ; it is extraordinary how many months sometimes elapse before enlargement of the glands is evident. Again, tumour cells and small masses frequently migrate or grow into blood-vessels, and are carried by the blood-stream to distant parts. Most commonly they stick in the first set of capillaries reached (hmgs or liver), but they may pass through these and settle elsewhere. Tlie secondary growths may be few or very numerous, and vary greatly in size; usually they are smaller than tlie primary. Cachexia is always secondary to the growth of the tumour and often to its ulceration or generalisation. Pain, anxiety, discharge, septic absorption, the breathing of putrid gases, &o., aid in its production ; but malignant growths seem to have a special effect behind all this. n 2
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