TUMOURS. 



Joints are of a cartilagiiiovis or oiTeous fabric ; fatty tumours 

 frequently form in the midft of adipofi; fubftance ; and I 

 have feen forne tumours growing from the palate, and having 

 a flendcr attachment, which in ftriifture refcmbled the pa- 

 late. Somctimts, however, they do not refemble in ftruc- 

 ture the oarts from which they grow. The inftance, juft 

 mentioned, ot ..he p»nduious portion of fat growing from 

 the peritoneum, will ferve as a proof: the vefTels, which 

 had /hot into it, made the tumour into fat, whilft the neck 

 was a fibrous and vafeular ftrufture. I have feen ofleous 

 tumours uneonnefted with bone, or periofleum j and, in- 

 deed, in general, the ilrufture of a tumour is unlike that of 

 the part in which it is produced. Therefore, we feem war- 

 tanted in concluding, that, in many cafes, the nature of the 

 tumour depends on its own aftions and organization ; and 

 tliat, like the embryo, it merely receives nourifhment from 

 the furrounding parts. 



" If, then, the coagulable part of the blood be from any 

 caufe e*ufcd, if the adjacent abfoi-bents do not remove it, 

 and the furrounding veiTels grow into it, the origin of a 

 tumour may be thus formed. It may be right," (ays Mr. 

 Abernethy, " to refleft a little on the caufes which may 

 occafion a depofition and confequent organization of the 

 coagulable part of the blood ; as fuch refieftions throw 

 light on the nature and growth of tumours, and lead to the 

 eftabhfhment of principles, which are applicable to tumours 

 in general. The depofition of the coagulable part of the 

 blood may be the effeft of accident, or of a common in- 

 I flammatory procefs ; or it may be the confequence of forae 

 j difeafed aftion of the furrounding velTels, which may in- 

 I fluence the organization and growth of the tumours. 

 ! " In the former cafes, the parts furrounding the tumour 



may be confidered fimply as the fources from which it de- 

 ' rives its nutriment, whilft it grows apparently by its own 

 inherent powers, and its organization depends upon aftions 

 I begun and exifting in itfelf. If fuch a tumour be removed, 

 the furrounding parts, being found, foon heal, and a com- 

 plete cure enfues. But if a tumour be removed, whofe ex- 

 iftence depended on the difeafe of the furrounding parts, 

 which are ftill left, and this difeafe be not altered by the 

 ftimulus of the operation, no benefit is obtained : thefe 

 parts again produce a difeafed fubftance, which has gene- 

 rally the appearance of fungus ; and, in confequence of 

 being irritated by the injury of the operation, the difeafe is 

 in general increafed by the means which were defigned for 

 its cure. It appears, therefore, that, in fome cafes of tu- 

 mours, the newly formed part alone requires removal ; 

 whilft, in others, the furrounding fubftance muft be taken 

 away, or a radical cure cannot be effefted. 



" There is yet another circumf1:ance deferving attention," 

 fays Mr. Abernethy, " before I proceed to the particular 

 confideration of the fubjedl ; which is, that a tumour, once 

 formed, feems to be a fafficient caufe of its own continuance 

 and increafe. The irritation which it caufes in the contiguous 

 parts, is likely to keep up that increafed aftion of the veffels, 

 which is neceflary to its fupply ; and the larger it becomes, 

 the more does it ftimulate, and of courfe contribute to its 

 own increafe. 



" Suppofe then a tumour to have formed and increafed ; 

 it will continue to grow, and to condenfe the furrounding 

 cellular fubftance, and thus acquire for itfelf a kind of cap- 

 fule. Tumours are more clofcly or loofcly cooneiSted to the 

 furrounding parts ; which circumftancc L-ems to depend 

 '.ipcn the degree of fti'Tiulus which they occafion, and the 

 inflammation which they thus excite. This irritation per- 

 haps may be the caufe why fome tumours, which are flow in 

 tbcir firft increafe, grow rapidly after they have acquired a 

 Vox. XXXVI. 



certam fize." See the Surgical Works of John Abernethy, 

 F.R.S., &c. vol. li. p. 7, et feq. 



We regai-d the preceding account of the formation of 

 tumours as the moft rational and probable which has hitherto 

 been offered. 



All tumours, which are fuch as may be termed new- 

 formed parts, and did not enter into the original ftrufture 

 of the body, appear to be endued with inferior powers of 

 life, and are much fooner deftroyed by inflammation than 

 other parts, which always naturily exifted in tiie animal 

 frame. The knowledge of this faft has led to the method 

 of curing feveral kinds cf tumours, by the application of 

 ftimulatiug fubftances to them ; but it is not a plan of treat- 

 ment which will invariably anfwer. Some tumours are fo 

 large, that the conftitutional illnefs, which would arife from 

 the inflammation and floughing of the whole of their mafs, 

 would in all probability be fatal. Some fwellings are of a 

 malignant, irritable charafter, fo that applying ftimulants 

 to them is more likely to exafperate than cure the difeafe. 

 Hence, it is generally deemed imprudent to apply cauftics 

 to cancerous affedlions ; becaufe unlefs every particle of 

 fuch difeafes, and a good deal of the furrounding fubftance, 

 be deftroyed by the aftion of thefe violent remedies, the 

 cafe will not be benefited, but rendered ten times worfe. 

 Indeed, we may lay it down as a general maxim, that the 

 plan of attacking tumours with ftimulants and cauftics is a 

 bad one,- unlefs it be certain that every particle of the difeafe 

 can be in this manner eaCly and quickly deftroyed, without 

 too much local and conftitutional irritation being pro- 

 duced. 



Enc^ed Tumours. — In the midft of tlie fubcutaneous cel- 

 lular fubftance, of that which fcparatcs the mufcles, or even 

 of that which enters into the texture of different organs, 

 tumours' are obferved to form, whofe circumference prefents 

 a particular ftrudlure, and whofe cavity is filled with un- 

 ufual kinds of mutter. The parietes of thefe tumours are 

 compofed of a fort of membrane, named a ry?, and are con- 

 nefted with the furrounding parts by means of the neigh- 

 bouring cellular fubftance. This latter circumftance appears 

 to have attracted the attention of a great many writers, who 

 have conceived the formation of cytts, by fuppofing that a 

 cavity of the cellular membrane, in confequence of difeafe, 

 may have all its communications with the other cavities of 

 the cellular membrane deftroyed ; that it may acquire the 

 property of fecreliiig matter entirely different from that 

 which it fecretes in the natural order of things ; and tliat 

 the accimiulation of the depofited fubftance may produce a 

 progreffive detention of the fmall cavity. The layws ot 

 the cellular fubftance, in which the tumour developes itfelf, 

 are afterwards fuppofcd to undergo a kind of condenfaticr. ; 

 and by fuch theories, it is attempted to explain the con- 

 fiderable thicknefs of fome cyfts, the extraordinary appear- 

 ances of their organization, and the poflibihty of refolving 

 them into cellular fubftance by maceration, iiflammation, 

 fuppuration, &c. It is difiiciilt, obferves M. Delpech, to 

 adopt this opinion, and reconcile it to the foUowmg ob- 

 fervations. 



1. There arc fome thin tranfparent cyfts, which have 

 been termed yj'row, whofe inner furface is villous, and whofe 

 cavity is filled with a fcro-mucous fecretion, refemblirg 

 fynovia. In the fam.e cavity, hairs are frequently obferved, 

 which are of different lengths, and always curled ; the roots 

 being implanted into the fides of the cyft. 



2. There are other cyfts, which .ire generally of a thin, 

 but much more compaft, texture tKan cellular membrane, 

 being, as it were, almoft horny and half opaque. Their 

 inner furface is pulpy, and fometimes irregular. Their 



3 D c^"'y 



