788 



CYST. 



affords us any facility in distinguishing one 

 kind of cyst from another, we hold them alike 

 inadequate to lead to correct views of the sub- 

 ject. The plan which we propose to follow 

 may not afford any increased facility in dia- 

 gnosis, but it is, we apprehend, founded upon 

 a more stable basis than either of those to 

 which allusion has been made. We mean to 

 consider cysts with reference to the mode of 

 their developement; and although we do not 

 pretend that this arrangement will afford much 

 greater facility than at present exists for the 

 diagnosis of the species, yet it appears to us to 

 be the most natural classification which, in the 

 present state of our knowledge, we are enabled 

 to offer. A considerable assistance in the dia- 

 gnosis of these organs may be obtained from 

 the adoption of the following principles, which, 

 though not unerring in their application, will 

 afford a very near approximation to the truth, 

 in the majority of cases. Those firsts which 

 are external, subcutaneous, and exactly glo- 

 bular, with a thinning of the dermis, which 

 seems to adhere to their surface, commonly 

 contain sebaceous matter of a whitish colour, 

 friable and semi-concrete ; those which occupy 

 muscular interstices in the neck, the back, or 

 the extremities, have, commonly, thin parietes, 

 are cellulous, of irregular form, and contain 

 either serosity or albuminous pus, in which 

 are seen floating opaque flocculent particles ; 

 those which surround articulations and ten- 

 dinous sheaths true appendices of synovial 

 tissues are strengthened externally by fibrous 

 laminae, lined by a serous tissue, and contain a 

 more or less pure synovial fluid ; those which 

 are developed under the anterior annular liga- 

 ment of the carpus sometimes contain small 

 whitish bodies, in appearance not unlike a 

 grain of boiled rice ; those which occupy in- 

 ternal cavities, attaching particularly to the 

 liver, usually contain hydatids, and to the 

 ovary contain a variety of products, sometimes 

 serous, sometimes sanguinolent, sometimes 

 gelatinous. 



Until a better method of diagnosis is pre- 

 sented, the situation of the organ will therefore 

 facilitate to some extent the knowledge of its 

 contents. No one, however, will rest satisfied 

 with this means, nor underrate the necessity of 

 pursuing the investigation of these organs, until 

 we are in a condition to state with more cer- 

 tainty the elements for their diagnosis. 



We believe that all cysts may be ranged 

 under one of the three following categories. A 

 cyst may be a simple enlargement, or exagge- 

 rated developement, or other modification of 

 an existing organ. It may be produced by the 

 irritation excited by the presence of a foreign 

 body, whether that body be a shot or other 

 substance introduced from without, or a tu- 

 bercle or other abnormal product developed 

 within the body. It may be a new formation 

 not before existing in the economy, and pre- 

 existent to the matter which it may be after- 

 wards found to contain. 



The last of these categories has not usually 

 constituted an element in the consideration of 

 the mode of formation of cysts, and the sub- 

 ject has in this #ay been divested of the 



difficulties which it must otherwise present. 

 Many accurate observers have expressed a 

 belief that cysts were a consequence of the 

 irritation occasioned by a foreign body ; in this 

 way a large proportion of these organs must 

 be entirely excluded from consideration, or 

 must be treated of under the term acephalocyst. 

 Another class of observers, admitting the exist- 

 ence of the foregoing, have added another 

 variety : they have assumed that the parietes 

 of an alveolus of cellular tissue are attacked by 

 some "morbid affection" by which all com- 

 munication with the adjoining cells is cut off; 

 that the parietes of this alveolus, under the in- 

 fluence of irritation, acquire the power of secret- 

 ing a product entirely different from that which 

 they furnish in their natural condition ; that the 

 accumulation of this morbid product causes 

 a progressive distention of this small cavity, and 

 a thickening of the cellular laminae in the midst 

 of which the tumour is developed : in other 

 words, that the tumour so produced acts in 

 the same manner as a shot or other body in- 

 troduced from without. In the opinion that 

 all cysts are so produced, they are fortified by 

 the belief that, by the process of maceration, of 

 inflammation, or of suppuration, it is possible 

 to reduce the parietes of these organs to their 

 " original element, cellular tissue." Such was 

 the opinion of Morgagni, Haller, Louis. The 

 opinion propagated by Bichat, that a certain 

 uniformity in structure obtains in all cysts, 

 that they are all analogous to serous mem- 

 branes, will, it is believed, be found incorrect ; 

 there are many cysts which in structure and 

 function are essentially different from serous 

 tissues, for instance, some are fibrous, cartila- 

 ginous, osseous, others are cutaneous, others 

 covered with hair. 



Our first class contains the greater number 

 of those subcutaneous tumours which are so 

 commonly seen under the integuments of the 

 cranium, the face, and some other parts of the 

 body, and which contain meliceric, athero- 

 matous, steatomatous, or other matter. It has 

 been over and over again demonstrated that 

 those follicles which open upon the surface of 

 the body may have their aperture obliterated : 

 the secretion from the internal surface of the 

 organ may still proceed, and they occasionally 

 attain a considerable volume; in this way 

 "steatomatous" tumours are produced. The 

 matter contained in these tumours has been 

 analysed by Thenard, who obtained the fol- 

 lowing results. 



One hundred parts submitted to desiccation 

 were reduced to forty, which treated by alcohol 

 were, in fact, dissolved : the alcohol in cooling 

 deposited a fatty matter, which was easily 

 melted and was similar to adipocire. The 

 residuum, which formed sixteen parts, was of 

 an albuminous nature; consequently there were 

 twenty-four parts of adipocire. This adipocire 

 did not crystallise like that of the biliary cal- 

 culus in man ; it was deposited in flakes like 

 those of putrid animal matter dissolved in 

 alcohol : yet, in the matter of the cyst, it was 

 in the form of very brilliant micaceous laminae. 

 These cysts frequently appear very thick, but 

 thi great thickness is a consequence of their 



