No. 105.

VOL. V.

LECTURES

ON THE

PRINCIPLES, PRACTICE, & OPERATIONS OF SURGERY,

BY PROFESSOR SAMUEL COOPER. Delivered at the University of London, Session 1832-1833.

LECTURE LXXIV., DELIVERED MARCH 25, 1833. GENTLEMEN,-The specific and malignant disease, known by the name of cancer, may begin either as a molecular deposition in the tissue affected, from a derangement of its nutrition, or as a deposition of the heterologous matter upon what Professor Carswell terms a free surface, as, for instance, that of a serous membrane; here it is, then, in the form of a secreted matter. It generally has two stages, namely, that of induration, or scirrhus, as it is termed, the first shape in which the disease usually presents itself; and that of ulceration, which is a later condition of it.

It would lead, I think, to less confusion, if scirrhus, a term originally denoting any kind of hardness, were restricted to the induration, which is characterised by the texture peculiar to cancer, and marked by a decided tendency to cancerous ulceration. Had this rule been observed by the old surgeons, some parts of their works would have been more remarkable for correct descriptions, and more intelligible than they are found to be, with reference to the pathological condition of various textures, described as being affected with scirrhus. I believe all well informed surgeons of the present time only use the term scirrhus in the sense that I have explained.

The disease, in the stage of scirrhus, is also sometimes denominated occult cancer; and, in the ulcerated stage, open cancer, or sometimes carcinoma. I think that when the latter word is employed, the generality of surgeons now signify more particularly the ulcerated form of the disease. There is no uniform custom, however, about this point; and sometimes carcinoma is only synonymous with

cancer.

Scirrhus, at its commencement, occupies a VOL. V.

minute and limited space; it may be confined to one of the acini of the liver, as Professor Carswell has ascertained; in the breast, it is commonly of a globular form, and irregular and craggy, as it were, on its surface. It afterwards enlarges, though rarely in the degree or with the quickness exemplified in many tumours of a different nature; it also continues to be moveable for a certain time; but has a tendency to become fixed by attachments to the neighbouring textures, at an earlier period than what is observed with respect to most other swellings.

Scirrhus is likewise remarkable for its excessive firmness, its cartilaginous, or, as it is sometimes expressed, its stony hardness. The substance of it, however, is not one uniform, homogeneous mass, but it is intersected by septa, or bands, the interstices of which are filled with a yellow, grey, or light brown, pulpy, friable substance. These bands, or septa, are observed to diverge, as they proceed from the centre of the disease, sometimes radiating, as pathologists are fond of expressing themselves, a considerable way into the surrounding textures, so as to extend the same morbid action to them. The septa, now described, have a tough consistence, and are very much like a ligamentous tissue.

When a section is made of a scirrhus, a central point, or nucleus, may be observed, from which these dense ligamentous bands proceed towards the circumference. Sometimes the larger bands subdivide into smaller ones, which follow a course similar to that of their trunk, and ramify very regularly, or the bands may pursue from the first an irregular and intricate course, often uniting with and crossing one another, so as truly to present, when minutely inspected, a retiform appearance.

Frequently, in a more advanced stage of the tumour, the greyish matter, interposed between the firm tough septa, appears broken down or removed, its place being occupied by a glairy or a turbid fluid, by a very soft, pulpy, semi-liquid substance, or blood itself.

Gentlemen, I may next inform you, that primary scirrhus and cancer are most commonly noticed in glandular or secreting organs, -as the female breast, the skin, the mucous

B