Surgical cases : with observations / by James Spence.

  • Spence, James, 1812-1882.
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: Surgical cases : with observations / by James Spence. Source: Wellcome Collection.

    5/18 (page 5)
    This can be readily accounted for by the local irritation produced by the ulceration of the opened out texture of the osseous tumour, the necrosis of portions of it which took place, and the profuse dis¬ charge consequent on these conditions. The history of the case in this respect may serve to enforce the good practical rule that in cases of tumours where removal by operation is objected to by the patient or deemed inexpedient, the safest plan is to refrain from meddlesome treatment. Another point of interest is to determine how far in such aggra¬ vated cases the originally simple character of the tumour should influence our views as to whether the local and constitutional symp¬ toms presented are really indicative of malignant degeneration, or merely depend upon excessive local irritation and continued dis¬ charge. To this point I have already alluded when stating the cir¬ cumstances which influenced me in my decision to amputate, even when there was glandular enlargement in the axilla combined with the appearance of malignant cachexy. There can be little doubt that even the most simple tumours do, under certain circumstances, occasionally degenerate and assume a malignant character; but, on the other hand, I believe that careful investigation will show that in a great majority of cases the frequency of such alteration in charac¬ ter in simple growths is more apparent than real, and that the pecu¬ liar frightful looking ulcerations noticed depend upon the results of excited action in a growth foreign to the organism, the intimate structure of which at least is endowed with no great degree of vita¬ lity or power of resistance to diseased action. The enlargement of the neighbouring absorbent glands is readily accounted for from the amount of local irritation, whilst the cachectic appearance of the patient is The result of the constitution suffering from the continued pain and discharge. This is well seen in large fibrous tumours of the mammae, where, the skin ulcerating, fungoid masses are pro¬ duced, which partially slough, and give rise sometimes to repeated hemorrhages. Such tumours present at first sight a most frightfully malignant appearance, and from the sallow complexion and anxious expression of the patient might readily be mistaken for fungus hsematodes, unless the originally simple character of the tumour was known, and thus a patient might be left to perish from a disease which can be permanently and easily remedied by a simple opera¬ tion. I think, therefore, that the original simple character of a tumour ought to form a most important element in judging of the propriety of operating in doubtful cases, and the mere existence of glandular enlargement, or the cachectic appearance of the patient, ought not to deter us from operating unless other circumstances, such as an unequivocal alteration in the character of the tumour or the evident inability of the patient to undergo the operation, contra¬ indicate its performance. Lastly, the dissection of the tumour pos¬ sesses some interest in regard to the growth and progress of osteo¬ sarcoma. Like other simple growths, it has no tendency to involve-