Tumbril

“ The _soft cellular tumours_ are composed mainly of spindle or round cells; they grow from the marrow of the spongy ends or from the periosteum of the long bones, the diploe of the skull, the pelvis, vertebrae, and jaws. As they grow they may cause little alteration in the contour of the bone, but they eat away its framework and replace it, so that the continuity of the bone is maintained only by tumour tissue, and pathological fracture is a frequent result. ”

“ While the formation of tubercle is at first a productive inflammation of which the cell clusters and nodules are the result, yet the tendency to necrosis, and caseation is so great that it must be looked upon as one of its most prominent features, and is rarely absent, whether the lesion exists in the connective tissue of the 431lungs, liver or other organ, in the lymph glands, in the respiratory or intestinal mucosa or submucosa, in the osseous cancelli, brain or skin. ”

“ Function of Lymph.—The tissues and organs of the body are traversed by a network of tubes which carry the blood. Inside these tubes is the blood proper, consisting of a fluid plasma, the colorless corpuscles, and the red corpuscles. Outside the blood tubes, in spaces between the cells which form tissues, is found another fluid, which is in chemical composition very much like plasma of the blood. This is the lymph. It is, in fact, fluid food in which some colorless amœboid corpuscles are found. Blood gives up its food material to the lymph. ”

“ The thick covering of the brain, the dura mater, is thus exposed, and if the presence of a tumour (or an abscess) has caused an excess of intra-cranial pressure, the membrane will bulge into the opening. The dura mater is then incised and turned down, and if the tumour is upon the cortex of the brain, and not too extensive, it is taken away. It may be necessary, however, to enlarge the opening made in the skull, and to break through a considerable mass of brain-tissue before the tumour can be removed. ”

“ In rare instances the synovial membrane presents nodular masses or lumps, resembling the tuberculous tumours met with in the brain; they project into the cavity of the joint, are often pedunculated, and may give rise to the symptoms of loose body. The fringes of synovial membrane may also undergo a remarkable development, like that observed in arthritis deformans, and described as arborescent lipoma. ”

“ Secondary Tumours.#--Next to tuberculosis, _secondary cancer_ is the most common disease of lymph glands. In the neck it is met with in association with epithelioma of the lip, tongue, or fauces. The glands form tumours of variable size, and are often larger than the primary growth, the characters of which they reproduce. The glands are at first movable, but soon become fixed both to each other and to their surroundings; when fixed to the mandible they form a swelling of bone-like hardness; in time they soften, liquefy, and burst through the skin, forming foul, fungating ulcers. ”

“ Wherever it mingles with any accidental or local complaint, it makes all the symptoms worse, and there is no structure nor organ of the body which is not obnoxious to its ravages. It is not merely in the tumid abdomen and the enlarged joint, but in the lungs, heart, liver, kidneys and intestines, in the eyes and brain, that its destructive effects unfold themselves. ”

“ Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue. It will be evident that this process only differs from healing by primary union in the _amount_ of blood-clot that is present. ”

“ It is generally admitted that the freshest tubercles, as found in the external coat of the smaller arteries of the pia mater, are composed of little else than a circumscribed accumulation of small, round cells, without a distinct reticulum. The giant-cells, the epithelioid cells, and the well-characterized reticulum appear as the tubercle increases in age. It is thought probable that the giant-cells represent the agglomeration of the small, round cells in pre-existing cavities, lymphatics, blood-vessels, or secretory canals. ”

“ Ductless blood-glands of various kinds (spleen, thyroid, thymus, inter- and ad-renal bodies) are very generally present, and modify in different ways the character of the blood as it circulates through them. Besides blood-vessels there is also a somewhat similar system of lymphatic vessels distributed throughout the organs and tissues of the body, which serves the purpose of re-collecting the fluid portion of the blood that has diffused from the blood-vessels for the nutrition of the tissues, and conveying it back to the blood vascular system. ”

“ Larger bodies, such as needles or bullets, which are not capable of being destroyed by the phagocytes, become encapsulated. In the granulation tissue by which they are surrounded large multinuclear giant-cells appear (“foreign-body giant-cells”) and attach themselves to the foreign body, the fibroblasts proliferate and a capsule of scar tissue is eventually formed around the body. The tissues of the capsule may show evidence of iron pigmentation. Sometimes fluid accumulates around a foreign body within its capsule, constituting a cyst. ”

“ Each organ has the shape of a biconvex lens, sunk to about half its thickness in the skin. The inner half is formed of radially-arranged gland tubes filled with small granular cells, and converging towards the centre of the organ. Into the connective-tissue walls of the tubes extend blood-vessels and nerves. External to the gland tubes there is a layer of long slender cells arranged perpendicularly to the surface, and more externally still a layer of ganglion cells. There is evidence that these organs multiply by division. ”

“ When the lympathic glands are diseased, the limb beneath is much swollen from œdematous effusion, the return of the blood and lymph being prevented; violent and excruciating pains are experienced in the course of the nerves of a limb; it also frequently loses its sensation, from those organs being either involved in the disease, or pressed on by the tumour. The vessels in the neighbourhood of the affected parts are materially altered, though they are seldom converted into encephaloid matter ”

“ When the action is more violent, and is not actively opposed, lymph is effused on the inner surface of the membrane, or is deposited amongst the ligamentous and cellular tissues external to the joint, in consequence of which, the membrane and external ligaments become thickened, and of an almost cartilaginous consistence. Serum is effused into the more superficial cellular tissue, filling up the hollows around the joint, concealing the protuberances of the bones, and producing a globular swelling. ”

“ The nerves are diffusely and unequally thickened, so that small twigs may become enlarged to the size of the median, while at irregular intervals along their course the connective-tissue overgrowth is exaggerated so as to form tumour-like swellings similar to the trunk-neuroma already described. ”

“ If an animal is at rest, no lymph flows from the hind limbs. To obtain a sample of limb lymph it is necessary to massage the limb. If, however, the veins to the limb be ligatured, we obtain a flow of lymph. The ligature of course causes a rise of the capillary pressure, and it has been argued that this rise of pressure starts a filtration through the capillary wall and hence a flow of lymph. But the stoppage of the blood-flow also damages the capillary wall and tissue cells by asphyxiation, and the resulting lymph-flow is in all probability the resultant of many complex processes. ”

“ This thickening or condensation is the [52] result of what we call effusion of coagulable lymph. It will be rather difficult to explain the process; but lymph is that fluid understood to be the nutritious portion of our sustenance or system, and which is here yielded up by the vessels which absorb it, and which vessels abound, with few exceptions, in every tissue of our body. However, it will suffice to say, that where inflammation takes place, there is an alteration of structure, and that alteration is generally an increase. ”

“ The general character of tertiary manifestations may be stated as follows: They attack by preference the tissues derived from the mesoblastic layer of the embryo—the cellular tissue, bones, muscles, and viscera. They are often localised to one particular tissue or organ, such, for example, as the subcutaneous cellular tissue, the bones, or the liver, and they are rarely symmetrical. They are usually aggressive and persistent, with little tendency to natural cure, and they may be dangerous to life, because of the destructive changes produced in such organs as the brain or the larynx. ”

“ Other more or less benign tumors, which are often multiple, occurring simultaneously at different places are also frequently congenital, as for instance, growths consisting of lymph or blood vessels, cartilage, muscle tissue developing around small blood vessels, and fibrous tissue growths around nerves in certain areas of the body, furthermore pigmented moles. ”

“ Some grow rapidly, and prove troublesome in a few weeks or months; others remain without much increase for years, and produce little or no inconvenience. Occasionally tumours partly resemble the texture in which they grow; those of a fatty nature are frequently found to have their nidus in the adipose tissue; cartilaginous tumours project from the surfaces of bones or of a joint, are subsequently detached, and lie loose in its cavity; growths of a cellular structure internally, and invested by an apparently mucous lining, protrude from the surface of mucous membranes. ”

“ These return the lymph to the blood-current for future use. Nature "gathers up the fragments" here as elsewhere, and sees that the lymph or excess of the blood-supply is once more garnered into the vital stream of the circulation. If we ask how this lymph-flow is maintained from all parts of the body toward the great vein in the neck where the lymph joins the blood, we again light upon the question of high pressure in one side of matters and low pressure in the other side. ”

“ The granulation tissue which forms as a result of the reaction of the tissues to the presence of the virus is chiefly composed of lymphocytes and plasma cells, along with an abundant new formation of capillary blood vessels. Giant cells are not uncommon, but the endothelioid cells, which are so marked a feature of tuberculous granulation tissue, are practically absent. ”

“ Various forms of growth occur in the brain, the most common being tuberculous nodules, syphilitic gumma, endothelioma, glioma, and sarcoma. Less frequently fibroma, osteoma, and parasitic, hæmorrhagic, and other cysts are met with. The growth may originate in the brain tissue primarily, or may spread thence from the membranes, or from the skull. In relation to operative treatment, it is an unfortunate fact that those forms that are well defined and do not tend to infiltrate the brain tissue, usually occur at the base, where they are difficult to reach ”

“ After the absorbent veins of a gland cease to perform their office, if the secerning arteries of it continue to act some time longer, the fluids are pushed forwards, and stagnate in the receptacles or capillary vessels of the gland; and the thinner part of them only being resumed by the absorbent system of the gland, a hard tumour gradually succeeds; which continues like a lifeless mass, till from some accidental violence it gains sensibility, and produces cancer, or suppurates. ”

“ It may become cystic as a result of hæmorrhage or of myxomatous degeneration. It grows very slowly, is usually elliptical in shape, and the solid form is rarely larger than a hazel-nut. The nerve fibres may be spread out all round the tumour, or may run only on one side of it. When subcutaneous and related to the smaller unnamed cutaneous nerves, it is known as a painful subcutaneous nodule or tubercle. It is chiefly met with about the ankle, and most often in women. ”

“ In most of the organs in which they exist alone, as in those called white, they are very slow in their motion, because the sensibility of these organs is obscure and dull. Thus different tumours, to the formation of which they contribute, have, as we shall see, almost always a chronic progress.
There are often in the animal economy those tumours, that are commonly called lymphatic, though we are wholly ignorant of the fluids that form them. They are found especially in the neighbourhood of the articulations; but sometimes only the cartilages, the cellular texture, the bones, &c. ”

“ The lymphatic glands, situated amongst the fat and cellular tissue between the deep and superficial cervical fasciæ immediately above the sternum, may become enlarged. When the tumour is large, breathing is impeded by compression of the parts beneath, and pain and much inconvenience are endured on account of its limited situation and resisting investments. ”

“ Substances like paraffin, strands of silk used to bridge a gap in a tendon, or portions of calcined bone, instead of being encapsulated, are gradually permeated and eventually replaced by new connective tissue.
Embedded bodies may remain in the tissues for an indefinite period without giving rise to inconvenience. At any time, however, they may cause trouble, either as a result of infective complications, or by inducing the formation of a mass of inflammatory tissue around them, which may simulate a gumma, a tuberculous focus, or a sarcoma. ”