TUMOURS. 



flufluating, doughy feel. The fluftuation is obvious 

 enough, when the cyft is thin, and the contained matter 

 ahnoft all liquid. This fymptom, however, is abfer.t, when 

 the fides of the fwelling are very thick and firm, and its 

 cavity is occupied by a pappy fort of matter ; but, in this 

 laft kind of cafe, the fhape of the mafs may be altered by 

 compreflion, and the tumour will retain every impreffion 

 made in it. If to thefe circumftances we add, that the tu- 

 mour is every where foft and compreflible, we have all the 

 proper fymptoms of this clafs of fwellings ; fymptoms by 

 whicli they may be molt frequently diftinguifhed from every 

 other difeafe that has any refemblance to them. 



The llationary condition of an encyfted tumour may laft 

 during life, if the difeafe be not expofed to external vio- 

 lence, and it be free from every complication. But, as we 

 have already explained, an accidental irritation may caufe an 

 inflammatioH, and fuppuration, and ulceration, of the cyft. 

 The confequence may alfo be inflammation and ulceration 

 of the integuments. In both cafes, the cyft may fpon- 

 taneoufly burft, the contents efcape, the cyft (lough away, 

 and the ulcer heal ; or elfe foft, painful, fungous granula- 

 tions may (hoot from the inner furface of the cyft, and 

 render cicatrization imprafticable. With regard to com- 

 plications, a cancerous affeftion, which is fometimes joined 

 with the organization of an encyfted fwelling, is the moft 

 afflifting : in this cafe, when ulceration occurs, the carcino- 

 matous fymptoms immediately make rapid and dangerous 

 progrefs. 



Encyfted tumours, like aneurifms, may deftroy the parts 

 of bones, upon which they make confiderable preflure. 

 Delpech, Precis Elementaire des Maladies Chiriirgicales, 

 torn. iii. ie£t. 8. 



A curious appearance is fometimes the confequence of an 

 encyfted tumour being filled with a fubftance refembhng 

 horn in confiftence ; for, when the cyft burfts, the indurated 

 contents gradually protrude, and iometimes form an appen- 

 dage very much hke horn. Some years ago, we faw a 

 complete horn removed from the fcrotum, by fir J. Earle, 

 in St. Bartholomew's hofpital. It had begun as a tumour, 

 which, after burfting, emitted from its infide the horny ex- 

 erefcence. The preparation is now in Mr. Abernethy's 

 mufeuni. 



In the Britifti Mufeum is preferved a curious fpecimen of 

 a horn, which grew from a woman's head, and, in all pro- 

 bability, was formed by a procefs fimilar to that which 

 we have mentioned. In Mr. A. Cooper's pofleffion is a 

 ftill more remarkable fpecimen, which was given to him 

 by Dr. Roots of Kingfton, and which in ftiape and fize 

 bears a clofe refemblance to a ram's horn ! It alfo grew 

 from the head, and had been preceded by another horny 

 excrefcence, fimilarly fituated and (haped, which had like- 

 wife been removed. We have fubfeqiiently been informed, 

 that the patient, who was a gardener, had afterwards a third 

 horn, which grew in the fame identical place. In this cafe, 

 we muft fuppofe that a portion of the cyft had not been ex- 

 tirpated in the previous operations, and that it retained the 

 power of fecreting the horny matter. Firft Lines of Sur- 

 gery, p. 142. edit. 3. See alfo Horny Excrejcences, in 

 this Cyclopasdia ; and fir E. Home on the fame lubjeft, in 

 the Pliilofophical Tranfadtions. 



We have already noticed the curious faft of many cyfts 

 containing hairs : we have now to mention the more fur- 

 prifing circumftance of teeth having been fometimes found 

 in the cavities of encyfted tumours. A remarkable example 

 was lately publifhed by Mr. S. Bai-nes, furgeon at Exeter. 

 The cafe was a double encyfted fwelhng in the orbit ; in the 

 extirpation of which difeafe> a (harp bony procefs was dif- 



covered, and removed, togeUter with the remains of the fac 

 which adhered to if. 



On examination, it was found to be in ttrudlure a tooth, 

 and much refembling in form and fize the fupernumerary 

 teeth fometimes found in the palate. The part which pro- 

 jefted into the fac was conical, and covered by fmooth, 

 fhining, white enamel ; the fac firmly adherent round a con- 

 trafted portion at the bafe of the cone, refembling ttv- neck 

 of a tooth ; and on the outfide of the fac, the appearance of 

 a root, truncated obliquely, with a paffage in the centre, 

 evidently containing blood-vclTels. It was by this pait that 

 it was connefted with the floor ^f the orbit. See Medico- 

 Chirurgical Tranfaftions, vol. iv. p. 316, et feq. 



Praftitioners are not acquainted with any effeftual means 

 of flopping the growth of encyfted tumours ; nor are the 

 endeas-ours to promote the difpcrfion of the cyft and its con- 

 tents by general or topical treatment, attended with any 

 fuccefs. It has been alleged, that, in cafes of what have 

 been called fero-mucous cyils, the removal of thefe cyfts 

 and their contents might be brought about, by exciting the 

 aclion of the abforbents with ftrong difcutient topical appli- 

 cations ; and inftances of this mode of cure have been cited 

 in relation to fuch fwellings formed upon the patella, or at 

 the extremity of the olecranon. But Delpech remarks, 

 that, in thefe cafes, the nature of the difeafe is miftakcn, 

 becaufe, in the fituations fpecified, there conftantly exifts a 

 fynovial membrane, a burfa mucofa, forming a kind of joint 

 betwixt the bony prominence and the ijiteguments. The 

 fynovia may accumulate and lodge in the cavity of tlie mem- 

 branous fac ; and if the membrane be not fo thoroughly 

 difeafed, as to render the abforption of the fynovial fluid im- 

 poffible, the natural functions of the part may be re-efta- 

 bUflied, and the fwelling admit of being flowly difperfed. 

 This is what is fometimes accomplidied by different local 

 remedies, particularly thofe of the difcutient clafs. But 

 if the fynovial membrane is more completely difeafed, its 

 properties may be fo altered, that the fecretion from it is 

 altogether of a different nature, and abforption is totally 

 obftrufted. Tliis is what fometimes occurs in perfons who 

 are in the habit of kneeling a great deal ; in them the fyno- 

 vial membrane is often confiderably thickened ; fometimes 

 it is partly offified ; and Delpech mentions, that he has even 

 found loofe fubftances in its cavity. Here we fee, that in 

 the firft inftance, an immediate cure is poffible, fince the dii- 

 eafe is not an organic alteration. But in the fecond ex- 

 ample, which more refembles the ftatc of encyfted tumours, 

 although it be only the change of a pre-exifting organ, 

 the aiteaion cannot be cured without deftroying the dif- 

 tempered part. Delpech, with a view of oppofing evident 

 fafts to fuch as are wrongly interpreted, or doubtful, ad- 

 verts particularly to thofe fero-mucous cyfts which fo often 

 form in the fubftance of the eye-lids. The apprelicnfion of 

 a fear upon the face, fays he, conftantly leads to a trial of 

 topical refolvents, before extirpation is attempted. Sur- 

 geons know, however, that the tumours arc not removed by 

 abforption ; and that, if the local applications fometimes 

 accomplifti the cure of the difeafe, it is by producing an 

 irritation of the flcin, which irritation extends ilfelf to the 

 cvft, where inflanmiation, fuppuration, ulceration, and 

 floughing, are the confequences. But, generally fpeaknig, 

 thefe effefts are not excited, and when they are, a cure of 

 the difeafe is not uniformly the refult. The inflammation, 

 carried to the reqnifite pitch to produce ulceration of the 

 cyft, may only aff'eft fome points of it, and perhaps merely 

 that portion which is next to the integuments. Every 

 where elfe the inflammation may be very flight, and quite 

 infuf&cient to caufe ulceration and floughing of the deeper 

 3 D 2 P^t 



