720 
SURGERY. 
own independent powers; and the future structure which it 
may acquire, seems to depend on the operation of its own 
vessels. 
“ The structure of a tumour is sometimes like that of the 
parts near which it grows. Those which are pendulous into 
joints, are of a cartilaginous or osseous fabric; fatty tumours 
frequently form in the midst of adipose substance, but in 
many cases the nature of the tumour depends on its own 
actions and organization; and, like the embryon, it merely 
receives nourishment from the surrounding parts.” 
The medical treatment of tumours appears to Mr. Aber- 
nethy to be identical with that of chronic inflammation, 
namely, to subtract the heat and blood topically from the 
part by leeching, and evaporating lotions, to excite, when 
inflammation subsides, counter-irritation, and to regulate the 
general health. 
Encysted tumours are so called, because they are contained 
in a cyst. They are formed of matters extremely various in 
appearance and consistence: sometimes soft, sometimes 
fluid, and in other instances ossified, or homy. 
When the contents of an encysted swelling are fluid, like 
honey, the tumour is named meliceris; when of a pappy 
quality, atheroma; when fatty, steatoma. These swellings 
have a soft or hard feel, according to the nature of their con¬ 
tents, but the consistence of the contained matter cannot 
always be ascertained by the touch, especially when the cyst 
is exceedingly thick. 
Sometimes the cyst is very thin, sometimes of considerable 
thickness, but in general, though not always, its thickness is 
proportioned to its age. It is often quite firm, like parch¬ 
ment or cartilage, and it commonly contains only one cavity; 
however, this is frequently intersected by several partitions. 
Ordinarily, they are not at all painful. At first, they are 
constantly moveable, and probably would continue so, if 
all external pressure were kept from influencing them, but, 
in time, they generally become more fixed, in consequence 
of being adherent to the skin and subjacent parts. The 
only way to cure these tumours is to cut them out. The art 
of doing this with adroitness, consists in dissecting the parts 
surrounding the tumour, without wounding the cyst. It is 
also a great point to remove every particle of the cyst; for, 
when any portion remains behind, the wound will not fre¬ 
quently heal, in consequence of fungous granulations, arising 
from the diseased part. 
“ A ganglion is a small hard tumour, unattended with pain, 
and composed of a cyst, which is of a firm tendinous texture, 
connected with a subjacent tendon, and filled with a fluid 
resembling the white of an egg. It is usually more or less 
moveable beneath the skin; its growth is slow, and it is sel¬ 
dom much larger than a hazel-nut. Its figure is commonly 
round, smooth, and even ; it seldom inflames, and still more 
rarely does it suppurate; but, when the latter event happens, 
an ill-conditioned ulcer is generally produced. 
Ganglions occur most frequently on the hands and fingers, 
and either over a tendon, or ligamentous expansion, with 
which the sac is connected underneath. But, there are in¬ 
stances of these tumours making their appearance in many 
other situations, and they sometimes attain a considerable 
magnitude. A ganglion has been known to cover the whole 
back part of the neck. These tumours appear sometimes to 
be the consequence of a bruise, or violent sprain. Occa¬ 
sionally they move along with the tendon, to which they are 
attached; while, in other instances, they seem fixed.” 
If pressure fails to remove a ganglion, its superincumbent 
skin must be drawn aside, and the ganglion punctured. The 
skin then being let free, forms a valve, through which the 
fluid escapes; but no air can be admitted which would ex¬ 
cite troublesome inflammation. Some have, by a blow, 
broken the ganglion without puncturing the skin ; and the 
fluid thus let out into the cellular tissue, has been absorbed. 
Sarcomatous tumours are such as are fleshy, and are of 
various kinds. Mr. Abernethy, to whom we are indebted 
fora very excellent classification of these productions, divides 
them into the following kinds:— 
1. Common vascular, or organized sarcoma, are such 
tumours as are organized throughout, but without any dis¬ 
tinguishable peculiarity of structure. “ This structure is met 
with not only in distinct tumours, but likewise in tire testis, 
mamma, and absorbent glands. 
“ When it has attained a considerable size, the superficial 
veins appear remarkably large; on which account, together 
with their curiously meandering course beneath the skin, 
they cannot fail to attract attention. 
“ These tumours are generally dull in their sensation; en¬ 
during even a rough examination by the hand, and electrify¬ 
ing, without becoming painful. They generally grow till 
the skin is so distended that it ulcerates, and exposes the 
new-formed substance; which, being as it were obliged to 
inflame, and not being able to sustain disease, sloughs and 
falls out; sometimes portions seem to be detached, and come 
away without sloughing. In this manner is the disease oc¬ 
casionally got rid of; but such is the constitutional irritation 
attending this process, and the disgusting feetor and frightful 
appearance of the part, that the surgeon generally recom¬ 
mends, and the patient submits to its removal at this junc¬ 
ture.” 
2 . Adipose sarcoma. This is generally formed in the 
midst of cellular and adipose substance. The capsule which 
surrounds it is very thin, adheres but slightly to the tumour; 
and the principal connection appears to be by vessels, which 
pass through it to enter the substance of the tumour. “ These 
vessels are so small and the connection so slight, that no dis¬ 
section is required to separate it; for when the tumour is to 
be removed, the hand of the operator can be easily intro¬ 
duced between it and its investment, and it is thus readily 
turned out of its capsule. In some instances, however, when 
inflammation has been induced, the capsules even of these 
tumours are thickened, and adhere so as not to be separable 
without difficulty from their surface.” 
3. Pancreatic sarcoma, so called, because it resembles 
the pancreas in its internal structure. It consists of irre¬ 
gular-shaped masses, connected together by a fibrous texture. 
This species of sarcoma is sometimes formed distinctly in the 
cellular substance, but, most commonly, occurs in the female 
breast, perhaps originating in the lymphatic glands. In ge¬ 
neral, the disease is chronic, and does not involve the ab¬ 
sorbent glands in the vicinity. But, in a few instances, this 
species of sarcoma, when situated in the breast, deviates from 
its ordinary indolent nature, and occasions severe and lan¬ 
cinating pain, an inflammatory state of the integuments, and 
an adhesion of them to the tumour. The axillary glands 
also enlarge. 
Pancreatic sarcoma is sometimes so irritable a disease, that 
Mr. Abernethy thinks it may frequently be considered as 
bad as a cancer. When the glands in the axilla become 
affected, one generally swells at first, and is extremely tender 
and painful; afterwards the pain abates, and it remains in¬ 
durated ; another then becomes affected, and runs through 
the same course. 
4. Cystic sarcoma. This name is applied because the 
disease contains cysts, or cells. Cystic sarcoma sometimes 
occurs as a distinct tumour, but is commonly met with in 
the testis and ovary. The cysts, both in the former and lat¬ 
ter part, are capable of being rendered red by anatomical 
injection. The cavities generally contain a serous fluid, but 
sometimes a caseous substance. Mr. Abernethy believes this 
last sort of case, when the testicle is concerned, is peculiarly 
intractable. 
5. Mastoid, or mammary sarcoma, so named from its 
resemblance to the mammary gland in structure. Mr. Aber¬ 
nethy has not frequently seen this kind of tumour, and his 
attention was called to the nature of the disease, by a case, 
in which a swelling, partaking of the above structure, and 
about as large as an orange, was removed from the front of 
the thigh. The wound seemed at first disposed to heal, but 
it afterwards degenerated into a malignant ulcer, which occa¬ 
sioned death in the course of two months. 
As this kind of tumour is gradually lost in the surrounding 
parts. 
