On cancer of the scrotum in chimney-sweeps and others : three lectures delivered at the Royal College of Surgeons of England / by Henry T. Butlin.

  • Butlin, Henry T. (Henry Trentham), 1845-1912.
Date:
1892
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Licence: Public Domain Mark

Credit: On cancer of the scrotum in chimney-sweeps and others : three lectures delivered at the Royal College of Surgeons of England / by Henry T. Butlin. Source: Wellcome Collection.

    18/68 (page 10)
    but to this there are occasional exceptions. In two cases which I have had under my care in the Handel Ward, Middlesex Hospital, the disease started in the glands in the groin, the skin became adherent to the iniiltrated glands, and then ulcerated. The ulceration extended, and each patient died from hsemorrhage caused by the ulceration involving the main vessel, in the one case the femoral, and in the other the external iliac artery. This statement is confirmed by the more detailed relation of one of the cases, and an account of the healthy condition of the scrotum. It is quite curious, considering the great importance of these cases, and the light which a study of them may throw on certain difficult questions in the pathology of cancer, how little attention they have attracted. Thiersch alone, of the various authors I have examined, mentions their occurrence, and assumes that the glandular enlargement was secondary to an actual epithelioma of the scrotum, which had not ulce- rated, and which lay beneath the surface of the integument— in fact, to an overlooked primary disease. He refers, of course, only to the case described by Paget, for the other cases had not then been published. In some circumstances this explanation might be accepted as reasonable, but, to us here, it would appear really impossible. The importance of the first case as an example of primary epithelioma of the glands was fully appreciated by Sir James Paget. The patient was a chimney-sweep, so that a primary affection of the scrotum was suspected and sought for with the greatest care, but there was not even a wart on the external organs of gene- ration to which the suspicion of primary epithelioma might have been attached; and the cases of Mr. Lawson afiford the strongest confirmation of the possibility of the occurrence. Excluding the possibility of such malignant disease of the external generative organs as is apparent to sight and touch, even when directed with the greatest care by the most skilful eyes and hands, it must be admitted that the aflfection of the glands in these cases may have been secondary to a primary disease in some other part of the body. The lower extremity and the rectum present themselves as possibilities. The lower extremity is, however, really not tenable; primary malignant disease in such a situation could not have been overlooked, and the disease of the glands in both groins is not consistent with the supposition. The rectum is almost as improbable. The groin glands are seldom afiected in such case, and cer- tainly not until the disease is so far advanced that the bowel disease forms the most prominent trouble so far as the patient is concerned. Again, there is the question of a simultaneous or almost simultaneous affection of glands, such as occurs in some cases of sarcoma, but there is really nothing in these cases in com- mon with cases of general sarcomatosis. In the absence of an evident primary source from which the lymphatic glands could have been affected, the possibility of primary cancerous affection of the glands must be taken into account. Such cases are not of very unusual occurrence under the terms lymphadenoma (Hodgkin's disease), lympho- sarcoma, and primary sarcoma of lymphatic glands. We are familiar with such primary malignant affections of the glands of the neck, the mediastinum, and theaxiUa; therefore the 17 ser Epiihelialkrebs, 8. 66, Leipzig, 1865.