TUMOURS. 



part of the cyft. Then, external ulceration taking place, the 

 tumour empties itfelf ; and the part either heals up, with the 

 exception of a fiftulous opening ; or things are brought into 

 their original ftate by the formation of a perfect cicatrix, fo 

 that the encyfted tumour makes its appearance again. 



Some praftitioners have thought that encyfted tumours 

 might be cured by the employment of irritating injeftions, 

 like thofe fo fuccefsfuUy ufed in the treatment of hydrocele. 

 The experiments which have been made with them, how- 

 ever, have not generally anfwered ; and, if we refleft upon 

 the comparative ftate of things, it will appear that, in thefe 

 cafes, the objeA aimed at (hould not be the fame. In the ex- 

 ample of hydrocele, it is unneceflTary to deftroy the tunica 

 vaginalis, and tlie obliteration of its cavity is all that is 

 needed. Experience alfo proves, that, in confequeuce of a 

 very mild degree of inflammation, the cavity of the tunica 

 vaginalis is filled with lymph, which becomes organized, and 

 conneAed with the adjacent membranous furfaces. This 

 fuffices to render all exhalation for the future impoflible. 

 But encyfted fweUings have a peculiar organization, differ- 

 ent from that of any originally formed parts. We have no 

 reafon for fuppofing, that any flight inflammation will make 

 them pour out coagulating lymph that is capable of becom- 

 ing vafcular. They even feem fo indifpofed to be thus 

 affeAed, that nothing at aU refembling it happens, unlefs the 

 caufe of the inflammation is kept up with coniiderable per- 

 feverance. The inflammation alfo, when it is excited, 

 more readily produces mortification of the cyft, than the 

 other kind of alteration. In faft, it is obferved, that while 

 fome portions of the inflamed cyft become covered with 

 fungous granulations, others mortify and feparate in the 

 form of floughs. The whole of a cyft has not always the 

 fame ftruAure, and offified parts of it, for inftance, are not 

 likely to admit of that procefs, by which a hydrocele is 

 ufually cured. The hairs often growing in the cavity of an 

 encyfted tumour, muft generally have their attachments 

 deftroyed by the inflammation following the ufe of an irri- 

 tating injeftion, and they would then probably operate as 

 extraneous fubftances. 



Thefe circumftances tend to ftiew, that the practice of 

 making an incifion into the fwtUing muft be at all events 

 preferable to that of employing irritating injeftions. By an 

 incifion, all the contents may be difcharged, the whole 

 cavity of the cyft expofed, and fuch applications conftantly 

 made as are calculated to keep up the requifite degree of 

 inflammation. This method, alfo, gives the furgeon an 

 opportunity of deftro^nng particular portions of the cyft 

 with cauftic, if neceflary. In this way, he is fometimes 

 obliged to deftroy the large fungi, which frequently origi- 

 nate from the thickeft parts of the cyft, after it has been 

 opened and cauterized, or merely irritated by the dreflings. 

 Too often, however, the fuperficial ufe of cauftic is infuf- 

 ficient to leffen the fize of thefe fungous growths, and not 

 adequate even to reftrain their daily increafe ; while deep 

 cauterizations produce acute long-continued pain, fever, lofs 

 of reft, and great irritation of the whole extent of the dif- 

 eafe. The train of fymptoms, indeed, which the repeated 

 free ufe of cauftic may occafion, muft feem ftill more alarm- 

 ing, when it is recolleAed that the cyft of the tumour fome- 

 times becomes the feat of cancer ; and that all the ravages of 

 the latter difeafe in the ulcerated ftate may be the confe- 

 quence. In this circumftance, the praftitioner is obliged to 

 have rt-courfe to the extirpation of the fwelling, and this 

 (ometimes a long while after the cyft has been opened, and not 

 before the patient has fuffered a long feries of other painful, 

 Linavi'.iling meafures. Nor can thefe dangerous effefts be 

 rtvoided by opening the tumour with cauftic inftead of with 



a cutting inftrument. The more certain inflammation of the 

 cyft thus aimed at, is by no means fure of enfuing ; and it 

 wiU never follow, unlefs the cauftic aft ftrongly on the cyft. 

 Befides, the aftion of cauftic is too variable tojuftify the 

 calculation, that its eff^ecls will reach to a precife depth, and 

 always eflFeftuaUy deftroy the cyft. See Delpech, Preci* 

 Elementaire des Maladies Chir. torn. iii. 



The inconveniences of opening an encyfted tumour ought 

 to make us give a decided preference to extirpating or am- 

 putating the whole of the fwelling, whatever may be the 

 nature of the cyft. Indeed, this method of treatment is 

 fup"rior to all others. The art of doing the operation fldl- 

 fuUy, confifts in detaching the tumour from the furrounding 

 parts without wounding the cyft. If the latter accident oc- 

 cur, the contents frequently flow out, the cyft coUapfes, and 

 the continuance of the difleftion is attended with more diffi- 

 culty. It is a great point to remove every particle of the 

 cyft ; and hence it is fatisfacTiory to take it out entire, that 

 is, without wounding it. When any portion remains be- 

 hind, the wound will frequently not heal, in confequence of 

 fungous granulations arifing from the difeafed part. Unlefs 

 the fwelling be large, a fingle incifion through the flcin is 

 fufficient ; but in other inftances, it is advantageous to 



make two femicircular cuts in tliis manner, ( ) ; firft, be- 



caufe it facihtates the removal of the tumour ; and fecondly, 

 becaufe it prevents a redundance of Ikin, which would take 

 place if none were removed, and which would have the 

 effeft of ferioufly retarding the cicatrization of the wound. 



After the operation, the edges of the wound are to be 

 brought together with fticking-plafter, and a comprefs and 

 bandage applied. 



The excifion of encyfted tumours, fuperficially Ctuated, 

 is moftly very eafy, as the cyft is only flightly connefted 

 with the furrounding cellular membrane. But there may 

 be more difficulty when the fwellings have been in a previous 

 ftate of inflammation ; when they are very large, or when 

 a portion of the cyft is deeply fituated, or clofely adherent 

 to otherparts. Firft Lines of Surgery, p. 144, edit. 3. 



We muft not quit the fubjeft of encyfted tumours, with- 

 out making a few remarks on thofe of the fcalp. 



The encyfted tumours met with in this part, are fituated 

 between the integuments and the aponeurofis of the occi- 

 pito-frontalis mufcle. Their cyfts are moftly of a hard, 

 horny confiftence, and filled with a pultaceous matter, being 

 what are termed cafes of atheroma- It is very common for 

 fuch fwellings to grow in great numbers. The intimate 

 union between the aponeurofis and the fkin caufes the latter 

 to be confiderably ftretched by the growth of tumours un- 

 derneath it ; but notwithftanding this effeft, and that the 

 integuments are alfo fometimes rendered very thin from the 

 fame caufe, they are feldom altered in appearanee, excepting 

 occafionally their exhibiting a livid colour, which is a fign 

 of their being about to ulcerate. When encyfted tumours 

 of the fcalp have flowly attained an immenfe fize, the fliin 

 covering them is diftended in fuch a degree, that it is either 

 quite bald, or at moft only has a very few hairs upon it, fo 

 widely feparated are the bulbs. It rarely happens that the 

 pretTure of the fwelling produces an abforption of the part 

 of the fliull underneath the difeafe ; but examples of this 

 kind have fometimes been obferved. 



Encyfted tumours on the top of the head, even when they 

 have acquired a confiderable fize, may be eafily concealed 

 by a hat, cap, or the head-drefs ; and, unlefs in a painful, 

 inflamed, or ulcerated ftate, caufe but little inconvenience. 

 But when they are fituated at the fides of the cranium, they 

 render the wearing of hats, or any kind of head-drefs, lefs 



conve- 



