782 MEDICINE, SURGERY, ANATOMY, &c. 
« As the knowledge of this discase in its 
incipient state may be of importance, I will 
give a description of this case ; which I ap- 
prehend will not be found inapplicable to the 
general appearance of the disease, when it 
arises spontaneously, without any ptevious 
operation, upon a part not endued with great 
sensibility. 
_ € The tumour was not painful. . It had 
arisen toa considerable size Pefore the patient 
was aware of its existence ; and it was first 
pointed out to him by his friends, who ob- 
served, that the posterior part of one shoulder 
was become larger than the other. 
«« It did not interrupt the motion of the 
muscles upon which it was situated ; the pa- 
tient being able, as he informed me, to fol- 
low his laborious employment of a black- 
smith as well as usual. 
«« Tts situation seemed to be between the 
integuments and external muscles, a litte 
below the joint of the shoulder, covering a 
great part of the scapula. 
“© Its form and size may be understood by 
the following measurement, which I took 
with a marked tape: from the base on one side 
to that on the opposite side, where the breadth 
was the greatest, carrying the measure over 
the summit of the tumour, it measured 12 
inches. The measure -taken across the tu- 
mour, in the same way, at its smallest breadth, 
was 8 inches. Its base measured 23 inches. 
«¢ When examined by gentle pressure in va- 
rious ways, it seemed to be of an uneven 
density. In some parts an alternate pressure 
gaye the sensation of a deep seated fluid. 
When grasped by the fingers in other parts, 
one might perceive an irregtilar hardness. 
This examination gave no pain. 
«© It was moveable, but ina slight degree : 
not so much as a wen formed by an enlarge- 
ment of the adipose membrane. 
«< The cutaneous veins, which ran over 
its surface, were enlarged. 
«© Some idea of its growth may be obtained 
from the following particulars. It was first 
examined in July 1800, and it was then judg- 
ed to be about half the size at which I found 
it. The patient had been lately at Harrow- 
gate, and had used a hot bath there, which 
he apprehended had much increased the size 
of the tumour. 
«© The intézuments did not seem to be 
rendered thinner by the distention of the fun- 
* gus, which I conceived to be lodged beneath 
and within them. 
«© The skin had been irritated by some 
stimulating applications which had been 
made toit. I direeted the application of the 
cerat. lap. calam. to remove this superficial 
inflammation ; and advised the poor man to 
do nothing else, as I conceived the disease to 
be incurable. ey 
«1 saw this patient again in February 
1802, and was informed by him, that he had 
been under the care of some irregular practi- 
tioners, supposed to be skilful in the cure of 
cancers. ‘The tumour was much enlarged, 
and beginning to ulcerate. His countenance 
was fallen and his strength seemed to be dé- 
clining.” 
The author has now seen 16 or 17 
cases of this complaint, but has not been 
able to effect a cure in any of them, ex- 
cept by amputation of the limb, where 
the seat of the disease’ was in the extre- 
mities. Several instances are mentioned 
in which the mamme were affected with 
enlargements of this kind. Extirpation 
was had recourse to but did not suc- 
ceed. 
“« When the disease occupies merely the - 
adipose or celiular membrane lying upon the 
surface of the muscles, the tumour is not 
usually painful in its beginning, nor does it 
impede the motion of the muscles on which 
it is seated. But when deep seated in the 
limbs, it causes pain and weakness of the 
part affected. 
«* The fungus, as it increases in bulk, 
does not render the integuments uniformly 
thin, as in the case of an abscess, In one 
pt the tumour, when pressed with the 
ands, will afford the sensation of a deep 
seated fluid, while another part feels hard 
and uneven. 
«« In an advanced stage of the disease, the 
integuments, and aponeuroses of the muscles, 
(if the fungus is situated beneath this part) 
are burst open, and the fungus which rises 
through the aperture sometimes appears black, 
like a mass of coagulated blood. At other 
times the appearance more resembles an ex- 
coriation. Under both these circumstances 
hemorrhages ensue. 
“« In this process, the integuments do not 
become uniformly thin, and of a red colour, 
as when purulent matter is making its way ; 
but they continue to feel thick as usual round 
the fungus that has burst through them. 
‘« This fungus is an organised mass, and 
bleeds wherever it is broken. 
«© When the parts containing the fungus 
are divided, they are found to be ina morbid 
state. The adipose membrane forms a great 
number of pouches, filled with the fungus, 
upon the removal of which the pouches bleed 
copiously, from eyery part of their internal 
surface. 
«« Wherever the fungus comes into con- 
tact with the muscles, they lose their natural 
redness, and become brown. They also lose 
their fibrous appearance, and cannot in every 
part be distinguished from the adipose mem- 
brane, though a distinction is in general 
evident. 
«© The growth of this fungus cannot al- 
ways be repressed by the strongest escharo- 
tics. Neither the hydrargyrus nitratus ruber, 
the hydrar. muriatus, the antimon. muria- 
tum, nor the undiluted vitriolic acid, have 
been sufficient for this purpose.” 
A plate is annexed from a drawing of 
one cf those cases. 
