The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee.

Date:: 1846

Credit: The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

249/1246 page 225

$'7. Inflammation, cither eliminatory in its effects, or not. 8. Fibrous transformation. 9. Extension of the disease to contiguous textures, by infiltration. Such are the changes produced on the adjacent tissues during the pro- . gress of carcinoma ; but the carcinomatous tissue itself, being (like normal textures) the seat of nutrition, is (like them) susceptible of its disordered ictions. Of these, the principal is congestion ; — arising either from irrita- ion of the arteries, or obstruction of the veins. The first consequence, as nay be supposed, is a change in the colour of the diseased mass; which timay either assume a florid hue, or a purple, brown, or black tint,—accord- ung to the cause of the obstruction; but—owing to the delicacy of the • vessels in the adventitious growth, the trifling support received from the - substance in which they ramify, and their imperfect communication with ?ach other—extravasation of blood almost always follows;—frequently causing a sudden increase of the non-ulcerated tumour. The subsequent changes of the effused blood, are strikingly similar to those observed in .cerebral haemorrhage. The liquid portion is gradually absorbed, with the lsematosine; the discoloured fibrin remains behind, in a sort of cavity ined with a smooth and delicate membrane; while the circumjacent can- cerous matter acquires a yellow tint. At a more advanced period, the •lot disappears; the lining of the cavity is more distinctly serous in its character; and its contents are of a serous, or glutinous nature. Such is, . loubtless, the origin of the greater part of the cysts found in the interior if carcinoma.3] Attendant Symptoms.—This disease is attended, in general,—almost 'rom the very earliest stage,—with severe pain b;—sharp, lancinating, and 5 if the most dreadful kind. The pain certainly does not depend upon in- : lamination; for it will occur where no inflammation can be discovered. \_Hcemorrhage.—Haemorrhage, which does not ordinarily occur before ilceration has set in, is sometimes one of the earliest effects of the dis- ease. Thus, the discharge of a few drops of blood from the nipple, in •• cirrhus of the breast,—a tolerably frequent occurrence,—has, in some rare i nstances, been the first morbid phenomenon observed. Profuse menor- 'chagia, in not a few cases, precedes all other symptoms of uterine cancer; md in a case of pharyngeal carcinoma, which we observed some years [ last, the patient persisted in affirming, that severe haemorrhage from the . .hroat was the first circumstance that drew his attention to the part. In i similar manner, haemoptysis is frequently the first occurrence announcing uberculous disorganization of the lungs. But we would not be understood o mean, that effusion of blood is really the very first abnormal effect of he heterologous formation : others have probably led the way; but, from heir trivial character, escaped the attention of individuals who are not in he habit of carefully watching the variations of their health. Admitting this to be the fact, the practical value of haemorrhage, as a symptom, is by io means lessened. Derangement of Function.—Derangements of function form an import- mt item in the symptomatology of carcinoma; and, of course, vary with a “ Cyclopaedia of Practical Surgery ” ; Article “ Cancer”, by Dr. Walshe; Vo- ume 1 ; Page 612. b Scirrhous formations, in their early ' stage, are not endowed with any marked sensibility. It has been remarked, how- ever, by numerous observers, that pain is rcry commonly experienced about half an hour after these tumours have been ex- amined. When pain is excited immedi- ately after or during pressure, this, accord- ing to some writers, is owing to the pre- sence of intlammatory action in the tissue surrounding the cancerous substance. . “ Cyclopaedia of Practical SurgeryArti-. clc “ Cancer Volume 1 ; Page 634. y$