On examining the affected parts after death or amputation, the
tumor itself is found to consist of a soft substance, somewhat like
the brain, of a greyish colour, and greasy appearance, with thin
membranous-looking divisions running thro’ it, and cells, or abscesses,
in different places, containing a thin bloody matter, occasionally in
very considerable quantity. There does not seem uniformly to be any
entire cyst surrounding the tumor, for it very frequently dives down
betwixt the muscles, or down to the bone, to which it often appears to
adhere. The neighbouring muscles are of a pale colour, and lose their
fibrous appearance, becoming more like liver than muscle. The bones
are uniformly caries, when in the vicinity of these tumors. If large,
they are found rough, and broken off into fragments; if small, they are
generally soft and porous. This tumor is sometimes caused by external
violence; but often it appears without any evident cause.
I know of no remedy which has a power of checking the progress of the
complaint, or removing it. Friction, with anodyne balsams, sometimes
gives relief in the early stages; but it does not seem to retard the
progress of the disease. Extirpation is the only remedy which has a
prospect of being successful; but it is only adviseable in the early
stages, whilst the disease is entirely local, and has not extended to
the neighbouring glands; for, after they become affected, the chance of
recovery is greatly diminished. It is, however, sometimes difficult to
persuade patients at this time to submit to amputation, or extirpation,
because the pain and inconveniences are inconsiderable; but the
operation ought to be urged with all the eagerness which a conviction
of its absolute necessity, and its precarious issue, if delayed, will
inspire.
After making these observations, I shall illustrate the subject with
the following cases, the first of which is intended to show the
difficulty of extirpating the disease, when the operation is delayed
after the first appearance of the tumor. In the second, we see the
destruction which the bones suffer by it, and the extent of parts
which it may affect. The third gives us an instance of the affection
of the glands: And the fourth, of the most advanced stage, or that in
which distant parts have suffered. The last is an instance of the good
effects of an early operation.
CASE I.
William Stirling, without any very evident cause, perceived a small
tumor on the top of the shoulder, about midway betwixt the termination
of the neck and the articulation of the humerus. This gradually
increased for some months, and by the time when I saw him was
larger than a goose’s egg: It was spongy and elastic, and attended
occasionally with pain.
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