721 
SURGERY. 
parts, which probably retain a disposition to assume a simi¬ 
lar morbid alteration, Mr. Abernethy very judiciously recom¬ 
mends a more extensive removal of them, than was practised 
in the above example. 
Mr. Abernethy thinks this kind of sarcoma more malig¬ 
nant than the preceding species; but not so much so as the 
following. 
6 . Tuberculated sarcoma consists of an aggregation of 
small, roundish tumours, of var.ious'sizes and colours, con¬ 
nected together by a kind of cellular substance. The size of 
the tubercles is from that of a pea to that of a horse bean, or 
sometimes larger; their colour is of a brownish red, and 
some are of a yellowish tint. 
Mr. Abernethy has chiefly seen this disease in the lymphatic 
glands of the neck. The tumours ulcerated, became painful 
incurable sores, and destroyed the patients. Tuberculated 
sarcoma is so terrible a disorder, that it may be deemed a fatal 
one: fortunately it is uncommon. 
7. Medullary sarcoma. This is commonly seen affect¬ 
ing the testis, and has been termed the soft cancer of that 
part. The tumour resembles the structure and appearance 
of the medullary substance of the brain. 
In consequence of the diseased state of the testis, the in¬ 
guinal glands on each side become affected with the same 
morbid change, and acquire a very enormous size. The 
skin covering the disease in the groin gives way, and the 
most prominent of the enlarged glands inflame, and are gra¬ 
dually detached in the form of . sloughs. Hemorrhage suc¬ 
ceeds the separation of each slough, and can only be sup¬ 
pressed by means of continued pressure. After all the dead 
portions have been thrown off, the skin heals, and continues 
cicatrized till the distention of another gland renews the fore¬ 
going process, and the patient is at length exhausted. 
Dissections after death evince, that the glands in the pelvis 
and abdomen are affected with the same disease. Indeed, 
the facility with which medullary sarcoma is propagated 
along the absorbent vessels, is one of its most striking pecu¬ 
liarities. 
The medullary sarcoma is often considered to be exactly 
the same sort of disease as the fungus haematodes; but they 
appear different in the medullary sarcoma, after the parts 
have sloughed out, the place heals, until another similar 
swelling bursts the skin; but, in fungus haematodes, the 
fungus always grows larger and larger, without being mate¬ 
rially retarded by sloughing and no healing process ever 
occurs. 
Fungus haematodes, or the bleeding fungus, commences 
by a small fluctuating, colourless tumour, painful when 
occupying the mamma, not painful in other situations,—ad¬ 
vances to a considerable size, breaks and protrudes from its 
opening small fungi, which grow rapidly and bleed con¬ 
siderably. It changes into a liver-like structure the muscles, 
makes carious the bones, and spreads rapidly along the 
glands. Its base, from where the fungi grew, is of a soft 
nature, somewhat like brain. This disease attacks young 
persons, and is always fatal; unless completely extirpated 
with the knife. This even commonly fails, because the dis¬ 
ease has often spread along the glands into remote parts be¬ 
fore any operation is decided on. No structure, but the 
brain, seems free from fungus haematodes. 
We shall throw together the remarks we have to make on 
schirihus, on cancer, and on carcinomatous tumours. A 
cancer is an open ulcer which discharges a copious and 
peculiarly fetid matter; its surface is very uneven; its edges 
irregular, and both its edges and its base extremely indu¬ 
rated. It is accompanied by violent lancinating pains, fre¬ 
quently bleeds, forms every now and then fungoid granu¬ 
lations, and has a tendency to involve in its structure “ nearly 
every part with which it comes in contact. It always begins 
in a small spot, and extends from thence in all directions 
like rays from a centre.” A cancer is incurable by art, and 
there are but one or two instances on record in which it has 
been removed by the powers of nature. In these a deep- 
seated mortification occurred which threw off the whole 
sore. Extreme emaciation and great disturbance of the or- 
Vot. XXIII. No. 1603. 
ganic functions are the constitutional attendants of this 
malady. Cancer may succeed to various kinds of indura¬ 
tions and tumours; but its most common predecessor is the 
tumour called scirrhus. This is not merely a scirrhous or 
indurated swelling, but an induration attended with peculiar 
characters. These are accurately described by Mr. Samuel 
Cooper in his “ First Lines— 
“ The puckering of the skin, the dull leaden colour of the 
integuments, the knotted and uneven feel of the disease, the 
occasional darting pains in the part, its fixed attachment to 
the skin above, and muscles beneath, form so striking an as¬ 
semblage of symptoms, that, when they are all present, there 
cannot be the smallest doubt that the tumour is a scirrhus.” 
“ But, it is not to be denied, that the diagnosis is fre¬ 
quently more obscure. In some cases scirrhus is moveable, 
and not fixed to the subjacent parts; and the disease may 
be indolent, without much pain, or without discolouration 
of the skin. In the female breast the part first affected may 
be very small, and feel like a loose pea under the skin ; in 
other instances it may be more extensive and deeply situ¬ 
ated.” Neither is the swelling always irregular and craggy; 
Howard describes it as being generally roundish and renitent. 
“ He describes the skin, at an advanced period, as being 
smooth and shining, and having a reddish hue, inclining to 
purple. He tells us, also, that an external strongly marked 
cancer, when much distended, and tending to ulceration, but. 
not actually ulcerated, may be compared with a hard, pro¬ 
minent carbuncle, before it sloughs; for they have each a 
similar hardness, with a shining prominence; and if the can¬ 
cer be adherent to a broad base, there is posteriorly a similar 
firmness and immobility. 
“ The progress of a scirrhus, before ulceration takes place, 
is generally slow; but when this last process commences, the 
ravages of the disease mostly spread with great rapidity. 
“ A scirrhous induration is not prone to acquire the mag¬ 
nitude, which almost all other tumours are apt to attain, 
when their growth is not interrupted. 
“ Other tumours, especially when they have not been in¬ 
flamed, are commonly much more moveable than scirrhi. 
“ If we except the fungus haematodes, other tumours do 
not involve every kind of structure, skin, muscle, cellular 
substance, &c. *, and the integuments seldom become affected 
before the distention, produced by the size of such swellings, 
becomes very considerable. In scirrhous cases, the skin soon 
becomes contaminated, discoloured, and puckered. 
“ Some few tumours may be harder and heavier than a few 
scirrhi; but the reverse is commonly the case. 
“ In a scirrhus of the breast, the part affected is generally 
hard, heavy, and connected with the mammary gland; and, 
when moved, the whole gland moves along with it. 
“ In parts which have become scirrhi, the structure 
usually consists of a very firm light brown substance, inter¬ 
sected by membranous or ligamentous septa, which run in 
various directions. The membranous septa are more numer¬ 
ous, and of greater thickness in some cases than others. 
There is occasionally mixed with this structure a cartilagi¬ 
nous substance, and even bony matter, has been met with.” 
No cure having been discovered either for scirrhus or 
cancer, the only method of treating these diseases is to cut 
them out. In recommending such operations we must be 
guarded by the same reasons as regulate our practice with 
regard to other tumours; namely, by the consideration 
whether the patient is constitutionally affected, and whether 
we can perfectly remove all the diseased portions. When 
these cannot be effected, our object should be to palliate the 
the disease. Scirrhus may be kept under for some time by 
cooling applications and attention to health; and some have 
attributed good effect to the iodine ointment, but we think 
with insufficient reasons. 
Under the words carcinomatous tumour, cancer has been 
included. We shall here make use of it to express those ano¬ 
malous diseases which bear a resemblance to cancer, and 
which, though often as fatal, arise from common causes, such 
as long continued chronic inflammation. The appearances of 
these diseases, as well as the symptoms that precede them, are, 
8 X however, 
