Lectures on tumours : delivered in the theatre of the Royal College of Surgeons of England / by James Paget.

  • Paget, James, Sir, 1814-1899.
Date:
1851
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Licence: Public Domain Mark

Credit: Lectures on tumours : delivered in the theatre of the Royal College of Surgeons of England / by James Paget. Source: Wellcome Collection.

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    LECTURE L Classification of tumours—Their distinction from adapted hypertrophies, and from those connected with infiammato'-y exu- dations ; their property of independent growing ; their independence in develop- ment, maintenance, and degeneration. Relation of tumours to certain hypertro- phies of organs, and especially of the thyroid and other glands : their arbi- trary distinction Jrom these. Division of tumours into innocent anil malignant. Characters of malignant tumours: (a) assumed heterology of texture; (b) in- filtration ; (e) proneness to ulceration; (d) peculiarities of the ulcer; (e) multi- plication and reproduction; (f) indiffe- rence to locality. Value of each and all of these characters. Theories of the origin of tumours. Division of tumours generally innocent, into cysts and solid tumours; and of cysts, into simple or barren, and com- pound or proliferous : subordinate groups of each. Division of solid innocent tumours into fatty, fibro-cellular, fibrous, fibroid or fibro-plastic, cartilaginous, osseous, glandular, and vascular or erec- tile: subordinate groups of each. General distinctions of tumours and outgrowths. Objections to this method of classifica- tion : its greater advantages. Mb. President and G-entlemen,—In the courses of lectures which I have had the honour of delivering in this College, I have endeavoured to illustrate four prin- cipal serieB of those specimens in the Museum which are devoted to general pathology. Following still the arrange- ment of the Museum, I propose now to epeak of Tumours, the examples of which form one of its richest and most interest- ing series. I will first, with your permission, speak of the general nature and classification of tumours—of the method by which, without pretending to the accuracy of the zoological arrangement of species, which we may seem to imitate, we may vet place these diseases in groups, and give to each group a name. The class of diseases which includes the tumours may be reckoned as a part of the great division named Hypertrophies or Ov,.-rgrowths. All its members consist in additions to the organised materials of (ho body, and appear to be expressions of a morbid excess of its formative force; but, in the case of each hypertrophy, the mode is peculiar in which this excess is mani- fested. If we compare any tumour with one of the hypertrophies that are least morbid—with one of those, for instance, in winch the excessive growth is adapted to some emergency of disease, as an hyper- trophy of the heart is adapted to some emergency of the circulation—we shall, I believe, always see between them this chief difference; that, to whatever extent the adapted hypertrophy may proceed, the overgrown part maintains itself in the normal type of shape and structure; while a tumour is essentially a deviation from the normal type of the body in which it grows, and, in general, the longer it exists the wider is the deviation. A striking illustration of this contrast may be found in some of the cases of fibrous tumours that grow into the cavity of the uterus.* Such a tumour may resemble in its tissues the substance of the uterus itself, having well-formed muscular and fibrous tissues; and, so far as the struc- tures formed in excess are concerned, we might regard the tumour as the result of an hypertrophy not essentially different from that which, at the same time and rate, may take place in the uterine walls around it. But an essential difference is in this—-the uterus, in its growth around the tumour, maintains a normal type, though excited to its growth, if we may so speak, by an abnormal stimulus : it exactly imitates, in vascularity and muscular development, the pregnant uterus, and may even acquire the like power; and at length, by contractions, like those of parturition, may expel the tumour, spontaneously separated. But the tumour imitates in its growth no natural shape or construction: the longer it con- tinues the greater is its deformity. Nei- ther may we overlook the contrast in re- spect of purpose, or adaptation to the general welfare of the body, which is as manifest in the increase of the uterus as it is improbable in that of the tumour. Herein we seem to discern an essential * Such as (e. g.) No. 2682 in the College Mu- seum. Respecting the conditions in which the changes in the uterus here described are likely to occur, see Rokitansky, I'athologische Anato- mie, in. 545.