Imagens das páginas
PDF

it designate a firm fatty tumour, you must remember that the manufacture of stearine was not known at the time when the term steatoma first came into use, and that the old observers never entertained the notion, which the tumour teachers of the present day cannot get out of their heads — that a steatoma1 was a stearine- or indeed a fatty, tumour at all.

The improved nomenclature which was introduced at the commencement of this century, was based more upon comparisons which were instituted between the new-formations and individual parts or tissues of the body. The term "medullary fungus" (Markschwarnm) originally arose out of the idea that medullary cancers originated in the nerves and resembled nervous matter in their composition. These comparisons have, however, until recently been always very arbitrary, because they were founded upon more or less rough resemblance in external appearance, without a due appreciation of the more delicate peculiarities of structure, and particularly of the really histological composition.

Recently attempts have been made, and here and there even with great affectation, to make use of normal structures as aids in terminology. Many attach a certain degree of importance to this, and consider it more scientific to say epithelioma, where others say cancroid or epithelial cancer. Thus in France great stress has, it is well known, been laid upon calling sarcomata fibro-plastic tumours, because Schwann and his followers looked upon caudate corpuscles as directly producing the fibres of connective tissue— which, in my opinion (p. 43), is an error. But in spite of these errors we must consider the histological point of view as the true one, only it is not, I think, advisable, in accordance with this principle, at once to proceed to create new names for every thing, and by means of these new names to render things which have long been known TUBERCLE. COLLOID. 4G5

1 The ancients called any firm tumour (eg., an cnckondronia) a steatoma. —From a MS. note by the Author.

strange to the minds of people in general. Even new• formations which very evidently follow the type of some definite normal tissue, still for the most part possess peculiarities, whereby they may be more or less distinguished from this tissue, so that in the majority of cases at least, it is by no means necessary to see the whole of the new-formation in order to know, that this is not the normal, regular development of the tissue, but that on the contrary there is something in it, although it does not lose the type, which deviates from the ordinary course of homologous development. Besides there still remain even at the present time a certain number of new-formations, the external appearance or clinical character of which has, in part from the want of known physiological types, been retained as the basis for their names.

We still continue to speak of tubercle, and the name which Fuchs has invented as a substitute, the only new one, as far as I know, which it has been attempted to introduce in its stead, Phyma, is so very indefinite, so readily applicable to every "growth," that it has met with no great favour. Several other names have been recently used to a continually increasing extent, which are also nothing more than stop-gaps, as for example that of Colloid. This name was invented at the commencement of the present century by Laennec to designate a form of tumour which he described as analogous in consistence to half-set glue; in its well-developed form it constitutes a half-trembling jelly, colourless or of slightly yellowish hue, which on the whole conveys the impression of a nearly complete absence of all structure. Whilst people formerly declared themselves perfectly content, when tumours of this kind were designated jelly-like, or gelatinous, to many of the more recent observers it has appeared a proof of superior penetration to say, instead of gelatinous tumour or gelatinous mass, colloid tumour or colloid mass. But you must not think that those, who have these denominations the most constantly in their mouths, intend to express anything else by them, than what most others call simply a jelly-like tumour, or only jelly. It is just the same with it, as, in the time of Homer, with the herb MwAu, which was so called in the language of the gods, but by another name by men.1 It is, however, very advisable, that these really unmeaning and only high-sounding expressions should not be unnecessarily diffused, and that the habit should be acquired of conveying a precise meaning by every expression, and that therefore from the moment one really aspires to make histological divisions, one should no longer employ, when speaking of every jelly-like tumour, the term colloid which has no histological value whatever, but merely designates an external appearance which tissues of the most different nature may under certain circumstances present. Lacnnec himself inaugurated this somewhat pernicious practice, by speaking of a colloid transformation of fibrinous exudations of the pleura.

The chief difficulty, which here presents itself, consists in this, that people do not know how to discover any difference between the mere form and the true nature. The form ought only to be admitted as a decisive criterion for the diagnosis of new-formations, when it is conjoined with a real difference in the tissue, and does not result from accidental peculiarities of situation or position. If, for example, you wish to make use of the name colloid, you can do so in two ways. You can either employ it to designate nothing more than a kind of appearance, and then you will certainly be able to find different tumours which you can distinguish from other tumours of the same genus by means of the addition "colloid." You may therefore say: colloid cancer, colloid sarcoma, colloid fibroma PAPILLOMATA (CONDYLOMATOUS AND CANCEKOUSJ. 407

1 Oityss. X. 305. Note of the Stenograph.

[fibrous (connective-tissue) tumour]. Here colloid means nothing more than jelly-like. Or you must have a distinct notion of the nature, of the chemical or physical peculiarities of the colloid substance, or of the morphological nature of the colloid tissue, and then it will be impossible for you to class together two, chemically and morphologically, entirely different products, such as the colloid of the thyroid body and colloid cancer.

In just the same manner we see that a great number of tumours, when they are seated on the surface, give rise to excrescences, which, according to the nature of the surface, appear in the form of villi, papillae or warts. All these tumours may be comprised under one name and called papillomata, but the tumours which have this form often differ toto ccelo from one another. Whilst in the one case we have a true hyperplastic development, we find in another, at the base of these villi where they rest upon the skin or mucous membrane, some specific form of tumour. In many cases even the villi themselves are filled with a substance analogous to that of the tumour. This is a very important difference. If, for example, you examine a broad condyloma, the mucous tubercle or plaque muqueuse of Ricord, you will find, under the epidermis which still remains smooth, the papillae enlarging and ultimately growing out into branched figures so as to represent regular trees. Cancer, however, may give rise to excrescences of the same shape as these condylomata. This we see comparatively less frequently occur on the skin than on the different mucous surfaces. In these cases it may happen that real cancer is seated in the villi. Nor is this in itself indeed at all surprising. The papillae consist of connective tissue like the skin, or the mucous membrane, upon which they are seated; within the papillae therefore a cancerous mass may develop itself out of the connective tissue, as out of the connective tissue of the skin or mucous membrane. Moreover, it cannot be denied that this peculiarity of superficial formation very frequently explains certain peculiarities in the course of the disease, whereby a papillary tumour is strikingly distinguished from the same kind of tumour when not papillary. Any one may have a cancer of the bladder—if it be merely seated in the parietes—for a very long time, without any other changes being necessarily displayed in the nature of the secretion which must be evacuated with the urine, than those exhibited in a simple catarrh. As soon, on the contrary, as a formation of villi takes place upon the suface, nothing is more common than for hematuria to arise as a complication, from the simple reason, that every villus upon the walls of the urinary bladder is not clothed with a firm layer of epidermis, but lies almost bare under a loose epithelial covering. Into the interior of the villi ascend large vascular loops which reach quite up to the surface, and therefore every considerable mechanical irritation supplies a condition for the production of hyperajmia and the rupture of the villi. A spasmodic contraction of the bladder drives the blood up into the apices of the villi, in consequence of the shortening of the surface on which they are seated, and when to this is added the mechanical friction of the surfaces, nothing is more likely to ensue than a sometimes more, sometimes less considerable effusion of blood. But in order that such haemorrhage should take place it is altogether unnecessary that the papillary tumour should be cancerous. I have seen cases in which, for years, uncontrollable bleedings recurred from time to time, through which at last the patients died anaemic, and yet no trace of any cancerous infiltration of the base of the growth or of the villi existed, but the tumour was quite a simple papillary one, a benignant formation, which on the surface of the skin could

« AnteriorContinuar »