TUMOURS. 



cavky is filled with a fluid, that has more or lefs cor.fiftence, 

 is pultaceous, and of a white or yellowifh colour, being 

 compared fometimcs to pap, fometimes to liquid honey, and 

 in other inilances to fuel imperfeftly melted. Hence, the 

 names of atheroma, meliceris, z.nA Jleatoma, by which they 

 are commonly diftinguilhed. The contents of thefe encyfted 

 fweUings have different proportions of fat ; and hairs are 

 alfo frequently found in the cyft, their infertions into it 

 plainly admitting of demonftration, notwithftanding the 

 difficulty arifuig from the tenacity of the contained matter. 



I. We obferve fome cyfts fonned of albumen converted 

 into a fibrous texture, and whofe organization is more or 

 lefs imperfeift. Particulai- cyfts of this latter kind are com- 

 pofed of feveral concentric layers, which are only flightly 

 adherent together, and the organization of which is un- 

 equally advanced. In fuch a cafe, M. Delpech has found 

 the external layers made up of a perfedlly fibrous texture ; 

 while the veftiges of an organized ftrufture were much lefs 

 evident in the fubjacent layers, and altogether wanting in 

 thofe moft deeply fituated, which were purely albuminous. 

 The contained matter is <if an albuminous or gelatinous 

 quality. 



4. Other cyfts are what Delpech calls fibro-cellular ; 

 their fides are very thick, extremely compaft, and fome- 

 times even offified in certain parts. The contents are almoft 

 like ferum, occafionally tinged vs'ith blood. 



5. Excepting this laft fort of cyft, which is clofely con- 

 nefted with the furrounding cellular membrane, and almoft 

 identical vi4th it, there is, of e^•ery kind of cyft, a portion 

 of the furface which fcarcely has any adhefion to the circum- 

 jacent parts. In extirpating fuch tumours, if the furgeon 

 makes a perpendicular cut through the pai-ts, covering their 

 external furface, he can afterwards completely detach them 

 ■with the utmoft facility. In (hort, they can be feparated 

 with a fpatula, or any other blunt inftrument, without any 

 difleftion. 



6. Sometimes inflammation attacks the cellular membrane 

 around the cyft, and tenninates in fuppuration. One or 

 more fpontaneous openings ferve at firft for the difcharge of 

 the abfcefs ; but thefe are at length joined together by the 

 effeft of ulceration, and the whole mortified cyft floughs 

 away. The fame thing is occafionally feen, when cauftic 

 has been applied to the (l<in covering the moft prominent 

 part of the fweUing. The appHcation not only produces an 

 efchar of the integuments, it caufes alfo an acute inflamma- 

 tion of all the cellular fubftance around the tumour, and 

 mortification of the whole cyft, which comes away in a mafs. 

 Likewife, when the furgeon has been fearful of cutting out 

 every portion of a cyft, and only opened it, or removed a 

 part of it, with the defign of completing the deftruftion of 

 the reft by local applications, it has often happened that the 

 remainder of the cyft has fpontaneoufly floughed away, 

 while the furrounding cellular membrane was in a ftate of 

 acute inflammation. 



7. Liftly, an encyfted tumour, treated in the preceding 

 manner, has often prefented phenomena refembling thofe of 

 cellular fubftance, and admitted of being cured in the way 

 which was defired. Healthy fuppuration has been efta- 

 bliflied ; granulations have arifen ; the cavity has been gra- 

 dually leflened; and a folid cicatrix has at length been 

 formed. But it has much more frequently happened, that 

 the cavity has not been obliterated ; but become filled with 

 painful, bleeding, fungous excrefcences, which have caufed 

 an apprehenfion of cancer, and a neceflity for no longer de- 

 ferring the extirpation of the difeafe. 



Thefe refleftions appear to M. Delpech to juftify the 

 conclufion, that encyfted tumours do not proceed from an 



accidental or mechanical modification of the cellular mem- 

 brane ; but that they are fo many ne^v -formed organs, 

 which are not endued either with tlie fame degree or the 

 fame mode of \'itahty as the furrounding parts. 



The caufes of the formation of encyfted tumours are en- 

 tirely unknown : it is obferved, however, that a ftrongly 

 marked propenfity to be afflifted with many fuch fweUings 

 exifts in particular individuals, which is a faft that would 

 lead one to fufpe<£l the operation of conftitutional caufes. 

 For inftance, it is common for thofe firm cyfts, which con- 

 tain a pappy matter, and which have received the appellations 

 of atheroma, meliceris, and Jleatoma, to be very numerous in 

 the fcalp, or other particular fituations. It is well known 

 alfo that the fibro-cellular cyfts, ufually named dropfy of 

 the ovary, are fometimes prodigioufly numerous, either in 

 one or both of thefe organs together. It is fuperfluous to 

 remark, that external violence, to which encyfted tumours 

 have been often afcribed, has in reality no concern with the 

 difeafe. Befides the evident difproportion between this 

 fpecies of caufe and fo great an organic change, it may be 

 obferved, that if a blow can fometimes be cited, as having pre- 

 ceded the formation of an encyfted tumour, the fame caufe 

 cannot be fpecified in other cafes, where twenty or more of 

 thefe fweUings originate in fucceffion. 



An encyfted tumour, at its commencement, is always ex- 

 ceedingly fmall, and of a perfeftly indolent nature. It is 

 not known whether, in this early ftate, the cavity of the 

 cyft already exifts. The fwelling ufually grows with re- 

 markable flownefs : indeed, it is often many years before it 

 attains a confiderable fize. It even frequently happens, that 

 after the tumour has become large enough to be manifeft, 

 the cyft remains ftationary for years, until fome irritation 

 occurs, which renders the difeafe painful, and accelerates 

 its progrefs. It appears that, in thefe circumftances, the 

 latter enlargement of the tumour does not depend upon a 

 briflicr fecretion of the kind of matter originally contained 

 in it, but rather upon fuppuration of the cyft. In faft, the 

 infide of the fac is then found to be inflamed or ulcerated, 

 and a certain quantity of pus blended with the pappy 

 matter, with which the fwelling had no doubt been pre- 

 vioufly filled. This cliange, however, feldom happens, 

 unlefs the tumour be, by its iituation, expofed to repeated 

 external violence. 



An encyfted fweUing is ordinarily of a fpherical (hape, 

 except when this form is altered by the diipofition of the 

 furrounding parts. The tumour is moveable in a degree 

 proportioned to the mafs of cellular fubftance around it ; 

 and its furface is in general fm.ooth and regular. Some- 

 times, however, bands of aponeurotic fibres prefs upon cer- 

 tain portions of it, as it enlarges ; and thus it is rendered 

 irregular. The fame alteration may be produced by great 

 inequality in the thicknefs and confiftence of the fides of the 

 cyft, or by their being weakened by internal ulceration. 

 It is not uncommon in the beginning, and even fometimes 

 in an advanced ftage, for the fweUing to have a very firm 

 feel, either becaufe the cyft is ftill of confiderable thicknefs, 

 and the contained matter not copious ; or elfe becaufe the 

 cyft is exceedingly tenfe, not having yielded to the diften- 

 tion of the matter within it. In this eircumftance, the 

 fweUing is not compreffible ; and if, at the fame time, its 

 furface Ihould chance to be irregular and tuberculated, and 

 efpecially if the difeafe ftiould alfo be painful, the furgeon 

 may eafily make a miftake, and imagine the cafe to be 

 cancer. The refemblance, indeed, is very great ; and M. 

 Delpech aftures us, that he has feen praftitioners of the 

 higheft merit deceived by it. But it more ufually happens, 

 that an encyfted tumour prefents, from the firft, a foft, 



fluctuating, 



