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result in the secondary appearance of the disease, in which the skin generally ulcerates from distention, the tumour sloughs and is discharged. It appears to be propagated in a peculiar manner and independent of absorption; for we meet with the secondary tumour in a part which has no possible connection by absorbe nts with the one primarily affected. Thus we have known the eye the seat of the primary disease and the lungs secondarily affected; the testicle is its most frequent seat, and the liver will exhibit the next scene of its ravages. The parts secondarily affected differ very much in appearance from the primary tumour; the latter is often much firmer in consistence, and will contain cysts or cavities filled with a glutinous fluid, whilst the former are converted into a medullary substance, in many parts of a consistence not much thicker than cream. Thus, like cancer, the glands secondarily affected do not al. ways possess the characters of the primary tumour. On a former occasion we mentioned those circumstances in which it differs from cancer, * and endeavoured to point out those dissimilarities which exist between it and other diseases which have been confounded with it under the term fungus hæmatodes. This name has been applied to an immense variety of diseases, which agree in a few leading points, and it appears as if the subject was likely only to be cleared by detaching the more conspicuous varieties, and marking their peculiar characters. For this reason we should prefer calling the present, medullary sarcoma to fungus hæmatodes, since the former appellation very accurately expresses the common appearance of the tumour.
Mr. Abernethy's account of carcinoma, the last species in his arrangement, is the most valuable part of the essay, containing the most succinct yet comprehensive history of the disease we possess. Indeed the essay seems to have been undertaken with a view to establish the characters of this disease, by separating from it a few which agree with it only in
* London Medical Review, Vol. iii. p. 109.
external appearances, and others, which although equally destructive and intractable, are nevertheless perfectly different, and require to be discriminated before any progress can be made in this difficult part of medical science. Some of these, being less destructive than cancer, do not require the same active remedies, which renders a knowledge of the characteristic signs of the latter the more important, that we may know it at an early period, and when the disease is in a small
a compass, and the operation on that account less formidable. We would gladly transcribe his history of carcinoma, but we are compelled to pass on to his instructive description of the schirrous structure:
“ It is difficult to convey correct ideas of the structure of carcinoma by words or even by drawings. In the generality of instances the diseased part is peculiarly hard, and there are intermixed with it, firm, whitish bands. There is indeed no other striking circumstance which can be mentioned as constantly claiming attention in the structure of this disease. These firm whitish bands sometimes extend in all directions from the middle towards the circumference of a carcinomatous tumour, like rays from a centre, having little intervening matter; sometimes they intersect it irregularly, having interposed between them a firm brownish substance, which may be scraped out with the finger. Sometimes they form cells, containing a pulpy matter of various colours and consistence; and sometimes these bands assume an arborescent arrangement, rainifying through the diseased substance.”
We lament that no writer has attempted to analyze the peculiar schirrous structure; we mean, endeavoured to determine to which of the natural tissues that compose animal bodies it is peculiar, for we believe that the different organic alterations are referable to certain structures. The few continental wri. ters who have attempted such investigations, have decided that cancer occurs in such a variety of organs, so different both in function and structure, that it is peculiar to none but in volves the whole. There are however, peculiar tissues which enter into the composition of all organs, such as vessels, nerves, cellular membrane, &c.; and the circumstance of this disease affecting all organs would seem to us to prove that it belongs to one of those structures which contribute to the formation of every part. If we were to hazard a conjecture on the subject, we should fancy it appropriate to that fibrous tissue which composes the cellular membrane, and that from the following circumstances. The appearance and disposition of those membranous bands, which are considered as the criterion of schirrous structure, are very similar to that of the fibrous tissue which composes the cellular membrane. They are firm, and white, and fibrous, divided by septa or forming distinct cells, having generally fat deposited in the interspaces. The appearance of a section of a schirrous tumour may not inaptly be compared to that of a lemon, the membranous bands gradually diverging like rays from a centre, until they are lost in the surrounding cellular substance. Again, schirrus generally commences in parts abounding in cellular membrane, as the surface of the body, and in glands, into the composition of which much of this substance enters. Thus we find it in the mammary gland, and those of a conglomerate structure in general, whilst it is not known in others of a more compact or conglobate form. It is never met with in the kidneys, very rarely in the testicle, and we doubt if ever true schirrus be found in the liver, for that morbid alteration which has been so denominated, differs very essentially from the characters of schirrus in other organs. When the disease attacks membranous or muscular parts, it commences in the cellular membrane that connects them. Thus the schirrous pylorus commences between the peritoneum and muscular coat, and the bands are seen to extend along the cellular membrane that connects the muscular fibres. If schirrus were an entirely new formation, we should expect that it would be contained in some cyst, sioce that is the case with most of the sarcomata; whereas schirrus is diffused and scattered into the surrounding parts: and lastly, the universality of cellular membrane will account for the propagation of the disease in every organ, and the failure of most operations performed for its removal.
The present edition contains the result of Mr. Abernethy's experience in the palliative treatment of cancer. It is entirely of a dietetic nature, and refers to the influence which the state of the alimentary system has upon diseases in general.
“ There can be no subject which I think more likely to infuence the mind of a surgeon, than that of an endeavour to amend and alter the state of a cancerous constitution. The best timed and well conducted operation brings with it nothing but disgrace, if the diseased propensities of the constitution are active and powerful. It is after an operation that, in my opinion, we are most particularly incited to regulate the constitution, lest the disease should be revived or renewed by its disturbance. In addition to that attention to tranquillize and invigorate the nervous system, and keep the digestive organs in as healthy a state as possible, which I have recommended in the first volume, I believe general experience sanctions the recommendation of a mere vegetable, because less stimulating diet, with the addition of so much milk, broth, and eggs, as seem necessary to prevent any declension in a patient's strength.”
The remarks on encysted tumours, although not so full or systematically arranged as those on sarcomatous growths, contain many hints of much practical importance. These tumours consist of unorganized matter of various appearances and consistence, secreted by the internal surfaces of cysts of different textures and properties. The cysts, of course, are to be considered as the parts in which the diseased actions reside, and on that account claim our principal attention. It is an object in all tumours to know how far the cyst or capsule partakes of the diseased action, since this knowledge will determine how far its removal is necessary, and would very much facilitate the performance of operations. In many of the sarcomata the cyst appears to be inerely an adventitious growth and independent of the morbid actions, for in the adipose
sarcoma, if the contents of the sac be removed, the latter will adhere and not regenerate the disease. But in encysted tumours the cyst may be regarded as the nidus of the diseased actions, and hence its removal is indispensable in the cure. Mr. Abernethy has related some cases which fully prove the truth of these remarks.
There are two other circumstances which claim our atten. tion with regard to encysted tumours. The slightest irritation in them will produce the utmost constitutional derangement, and will often prove fatal. This will not appear very surprising, if we consider the immense surface contained in many of these cysts, and how much the constitution must sympathize with such an extent of inflammation. It teaches us also the danger of irritating wens, either of an irritable nature or occurring in irritable habits. Cysts of this nature, when exposed, are very liable to generate a fungus of so intractable a nature, that it furnishes an additional argument for the complete removal of the disease. Mr. Abernethy has related an instance of this kind, which seems very much allied to some of those cases, termed by Mr. Hey, fungus hæmatodes. He has also appended a history, which proves most strikingly the similarity of these cases with that disease which our author has denominated fungus of the brain, and corroborates very fully an opinion, which we formerly expressed, of the origin of such diseases in the rupture of minute blood vessels.
“A young man, who was out of health, and complained of stiffness and pain in the bottom of his belly, took to his bed, declaring his inability to move about. Suddenly a swelling formed above Poupart's ligament, which rapidly increased and the skin ulcerated. A frightful fungus seemed to present itself, an uncontrolable hæmorrhage ensued. When the case was examined after death, all that bulged out could be removed by the finger or sponge, and appeared to be coagulated blood rather than fungus; and at the bottom nothing was seen but the abdominal muscles, which had that bruised or brownish appearance which Mr. Hey has described.”