Though of small size, and not possessed of malignant action or
disposition, is a tumour of very great interest, on account of the
excruciating pain with which it is accompanied. It is mostly situated
in the subcutaneous cellular tissue, but not unfrequently in the
intermuscular cellular substance; one tumour of this species which I
have removed was so deep as to be in immediate contact with the sheath
of the posterior tibial nerve. The tumour, generally of the size of a
garden pea, rarely exceeds that of a cherry. It is invested by a dense
ligamentous cyst, to which it intimately adheres; but occasionally
the capsule is thin and cellular: in many instances its surface is
perfectly smooth, in others it is slightly nodulated. It is not
connected with any large nervous trunk; but minute nervous fibrillæ
can occasionally be traced expanding on its surface, and apparently
entering its substance. Internally it is composed of numerous whitish
fibres, of considerable density, ramifying irregularly throughout
its structure; and betwixt these is insinuated a firm substance,
generally of a grey colour, and frequently of an almost cartilaginous
consistence. Such is the structure most frequently observed; but in
this morbid formation, as in all others, the appearances may be said
to vary in almost every instance. Sometimes the fibres are indistinct,
and of a yellowish or dirty grey colour; and the interfibrous matter
is often found to vary in density and colour in different tumours,
being at one time dense and almost transparent, at another opaque and
cartilaginous, and sometimes rather soft, brownish, and occasionally
tinged with blood. From attentive examination, it appears extremely
probable that the enlargement is at first produced by infiltration of
lymph betwixt the fibrillæ of a nervous twig, which becomes separated
and inclosed by the deposit—that they afterwards increase in size—that
the interfibrous matter is deposited in greater quantity, and is
farther condensed—and that thereby the nervous filaments are still more
separated and extenuated. In short, it would appear that the fibrous
matter is nervous, though altered, and that the interposed substance
is organised and condensed lymph. The tumour, at first extremely
minute, enlarges slowly; when deep, it can only be obscurely felt,
and its existence is with difficulty discovered by manipulation; but
the attending symptoms are so peculiar, and so forcibly developed,
as to lead the surgeon at once to an accurate diagnosis. When it is
subcutaneous, the skin is rendered slightly prominent, and the size,
density, and loose connections of the growth, are readily ascertained.
The slightest pressure causes the most excruciating torments, and
totally unmans the patient, even though induced by the most trifling
movement of the adjoining muscles. From a fearful and well-grounded
knowledge of this circumstance, the patient is extremely anxious to
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