TUMOURS. 



tonvenient, and are much expofed to frequent caufes of irrita- 

 tion, by which their enlargement, and even external ulcera- 

 tion, may be promoted. 



The folidity and fimple ftrufture of the furrounding parts 

 make the extirpation of thefe tumours very eafy of accom- 

 plilhment. A great portion of the flcin which covers them, 

 thin as it may be, ought to be faved and laid down imme- 

 diately upon the fubjacent parts. It is only when the fkin 

 has been enormoufly diftended, that it becoTnes neceflary to 

 cut away the redundant quantity of it. No endeavour fhould 

 ever be made to cure encyfted fwellinpyi of the fcalp by 

 opening them, or applying cauftic. TheTafeft method is to 

 remove them altogether with the knife. The furgeon need 

 not be afraid of extending his incifions under the deepeft 

 part of the fwelling ; for if he be careful to cover the de- 

 nuded part of the cranium with the (kin which he is to fave, 

 no exfoliations will generally follow. They do not necef- 

 farily follow, even when the preffure of the fwelling has 

 caufed an abforption of fome of the fubjacent bone. Del- 

 pech is of opinion, that, as the fcalp is very difpofed to ery- 

 lipelatous inflammation after wounds, furgeons ought not to 

 cut out encyfted tumours of that part, unlefs they produce 

 ferious inconvenience. On this point, however, we think 

 differently ; becaufe we regard the objeftion to the opera- 

 tion, on the fcore of the danger of eryfipelas from the 

 ■wound, as exaggerated, and by no means fufficiently valid to 

 juftify leaving the tumour to itfelf. The difeafe would then 

 continue to increafe ; the operation required hereafter would 

 confequently be more ferious ; and, in the event of the tu- 

 mour ulcerating, both more difficult in its execution, and 

 more uncertain in its event. 



In another part of the Cyclopaedia, the reader will find a 

 few obfervations on the encyfted tumours which frequently 

 form upon theeye-hds. See EvE-LIDS, Enc^edTumours of. 



Of Fatty Tumours, Adipofe Sarcoma, or Lipoma. — Fatty 

 tumours, often termed alfo lipomatoiu, or adipofe, are formed 

 t)y an accumulation of fat in a limited, and generally very 

 circumfcribed, extent of the cellular fubftance. The ftruc- 

 ture of a lipoma is abfolutely the fame as that of the adipofe 

 fubftance, fuch as it appears to be in thofe fituations where 

 fat naturally collects ; with this difterence, however, that 

 the interftices of the cellular membrane, thus affefted, are 

 of confiderable fize, and obvioufly enlarged. The integu- 

 ments, which are diftended, and rendered much thinner, con- 

 ftitute a true fac fpread over the mafs of fat, of which the 

 tumour is compofed ; nothing appearing to be interpofed 

 between them and the fwelling itfelf. There are fome cafes, 

 where the partitions of the cellular fubftance, which fepa- 

 rate the cavities in which the fatty matter is depofited, are 

 thicker aud more compaft than in the natural ftate ; and 

 when a feftion is made of thefe fwellings, the expofed fur- 

 face prefents a marbled appearance of a yellow and white 

 colour. Delpech remarks, that this fpecies of lipoma is 

 more difpofed to become cancerous, than the common forms 

 of it ; but of this, very rational doubts may be enter- 

 tained. In fa£l, our experience teaches us that true adipofe 

 tumours have as little tendency as any fort of fwelling to 

 change into true carcinoma, or that difeafe which is cha- 

 rafterized by the peculiar alteration of ftrudlure, feen only 

 in fcirrhous afTeftions. 



Fatty fweUings are moftly of an oblong pyramidal ftiape, 

 and have a narrow pedicle, which is itfelf of a fatty texture ; 

 but fometimes they have a bafe, which is as broad as the 

 whole mafs of the tumour. 



Lipomatous or fatty tumours are met with in perfons of 

 all ages ; but they are moft frequently obferved in adults. 

 The (houlders, the back, and the neck, are very common 



fituations for thefe fwelling?. But their occurrence is fo fi-c- 

 quent, that there are few furgeons who have not had many 

 opportunities of feeing them in almoft every region of the 

 body. We once faw an adipofe tumour which grew on the 

 thigh, and after it had been removed by Mr. Cline, in St. 

 Thomas's hofpital, was found to weigh between fourteen 

 and fifteen pounds. Sometimes adipofe tumours are formed 

 in pai-ts where there is naturally but a fmall quantity of fat : 

 thus Delpech has feen a fatty fwelling formed in the labia 

 pudendi, the ftrufture of which is very diff'erent from fat. 

 Sometimes adipofe fwellings are formed betwixt the perito- 

 neum and the parietes of the abdomen, in which circum- 

 ftance the tumours make their way outwards under the inte- 

 guments, drawing along with them the part of the pe- 

 ritoneum to which they are attached. Such cafes have been 

 improperly named by tlie French furgeons " hemies graif- 

 feufes." 



The caufes of the growth of adipofe tumours are not 

 known : the difeafe has been fometimes afcribed to blows, 

 and other kinds of external violence ; but we agree with M. 

 Delpech in believing, that this doftrine is altogether incor- 

 reft and unfounded. 



The ftiape and flow growth of adipofe tumours miglit 

 fuffice to indicate their nature; but they prefent other cha- 

 rafters, amongft which the confiftence of the mafs of the 

 fwelling deferves particular notice. Thefe tumours are not 

 elaftic, but of a peculiar foft feel, refembling what is per- 

 ceived on handling a bag filled with cotton. Their furface 

 is unequal, but the irregularities which are diftinguilhable 

 through the thin integuments have no firmnefs, and are obli- 

 terated by compreffion. Thefe circumftances, however, 

 are only ftrongly marked in fuch adipofe tumours as have 

 not yet acquired an immenfe fize, and which remain free from 

 every complication. When the fwelling has become ex- 

 ceedingly large, its weight, its magnitude, its preft^ure on 

 the furrounding veftels and integuments, materially obftruit 

 the circulation ; and an oedema then taking place between 

 the Ikin and adipofe fubftance, the confiftence of the latter 

 part may appear to be increafed. A manual examination, 

 however, made by a furgeon of experience, will ftill detcft 

 the kind of foftnefs which is peculiar to all fatty tumours, 

 and difcriminate it from the firmer feel of the cellular mem- 

 brane immediately under the (kin. Any previous attacks of 

 inflammation may produce the fame efFeft, and this even in 

 a more remarkable degree. Such attacks are very common 

 in thole adipofe fwellings whofe fituation particularly ex- 

 pofes them to frequent caufes of irritation. Thus, M. Del- 

 pech once faw a large lipoma growing in one of the labia pu- 

 dendi, the inceflant motion of which fwelling, together with 

 the friftion of the thighs againft it, and the irritation of the 

 urine, had frequently made the fl<in inflame, and caufed deep 

 ulcerations in the fides of the tumour. The fwelhng was 

 heavy and indurated ; the irregularities of its furface were 

 much firmer than ufual ; but in handling the mafs attentively, 

 the peculiar confiftence of lipoma could be diftinguifhed m 

 the deeper part of the tumour, and be difcriminated from 

 the hardnefs of the integuments and cellular fubftance. 

 Such induration is accidental ; it feldom affefts the whole of 

 an adipofe tumour ; when it occurs, it is always confined to 

 the layers of cellular membrane in which the adipofe fub- 

 ftance is lodged ; it originates from repeated external irrita- 

 tion ; and it fhould always be well difcriminated from the 

 hardnefs arifing from a cancerous difeafe. 



Adipofe tumours, for the moft part, grow in a regular, 



flow, and progrcflive manner ; and their vclTels are generally 



neither large nor nnmerous. Hence the removal of thefe 



fwellings is attended with little danger of any ferious degree 



7 o( 



