An Account of a Very Large Tumour in the Fore Part of the Neck, etc. By Dr James Douglas

An Account of a Very Large Tumour in the Fore Part of the Neck, etc. By Dr James DouglasAuthor(s): James DouglasSource: Philosophical Transactions (1683-1775), Vol. 25 (1706 - 1707), pp. 2214-2219Published by: The Royal SocietyStable URL: http://www.jstor.org/stable/102669 .

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t 1^ l! ) the Stones, the Sca Shells and other Mafine Bodies fbund at lSand; and am nover upOtl that of the Plants; lzaving only that of the Brute Animalss that of #he Huznq Bodies>- and that of VIIC AWs; to ilth. X >*fa5 W *Ss ar rtle fatsle itinxe t11at f svill lwsetmrdPtevrid to t4¢ Perf56X)llg 3t in fiUCl1 a manner, was to .render the Defign ITit-u} than to the lourrying- it to an End ; a;axdrou-and the refx of my Frlends nlay depelld uyont7 tllat 1 wi

IlOt loSe one &ngle Hour that I can fiare frorn ttle Exi- gences of my other ASasrss tl51 I I1RYe accomplilh'd tilc whole. I arn

S 12?, Cogrs^ bo

JF Mortor*

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Y. Az dScoAnt of 4 aery ldrge tatosr isl the fore ptrt sfthe Neck, &cJ '23y DrJalncs Douglas.

T Lately Icad the opportunity of opening a Womans ] about§° yearJ Clid} wdio hadaverylargeTumourf or hard Sweilir5g} ;r1 the iorF parL tS her t5eck; poICtIElag all vlle fpace bt tween ttle wllole txtent ot lbe ower Ja;w and rhe up-pcr part of ttze 5tternz, wiib a conEsable riEng in its middle; laterally its poineinclirxing tothe tcft fit3eX tho the biggett part of the Tusnour s"483 0[& the Wight. Tbe Skin oxl the Spex ot this protul>ratng part was thin ?Jld thrin ell$d of a colellr diStent irom the rett, and looRt as if the Swelling would hant broke in thaht place.

t 1^ l! ) the Stones, the Sca Shells and other Mafine Bodies fbund at lSand; and am nover upOtl that of the Plants; lzaving only that of the Brute Animalss that of #he Huznq Bodies>- and that of VIIC AWs; to ilth. X >*fa5 W *Ss ar rtle fatsle itinxe t11at f svill lwsetmrdPtevrid to t4¢ Perf56X)llg 3t in fiUCl1 a manner, was to .render the Defign ITit-u} than to the lourrying- it to an End ; a;axdrou-and the refx of my Frlends nlay depelld uyont7 tllat 1 wi

IlOt loSe one &ngle Hour that I can fiare frorn ttle Exi- gences of my other ASasrss tl51 I I1RYe accomplilh'd tilc whole. I arn

S 12?, Cogrs^ bo

JF Mortor*

*t s sr *_ s * *0* \ Mt |^>

Y. Az dScoAnt of 4 aery ldrge tatosr isl the fore ptrt sfthe Neck, &cJ '23y DrJalncs Douglas.

T Lately Icad the opportunity of opening a Womans ] about§° yearJ Clid} wdio hadaverylargeTumourf or hard Sweilir5g} ;r1 the iorF parL tS her t5eck; poICtIElag all vlle fpace bt tween ttle wllole txtent ot lbe ower Ja;w and rhe up-pcr part of ttze 5tternz, wiib a conEsable riEng in its middle; laterally its poineinclirxing tothe tcft fit3eX tho the biggett part of the Tusnour s"483 0[& the Wight. Tbe Skin oxl the Spex ot this protul>ratng part was thin ?Jld thrin ell$d of a colellr diStent irom the rett, and looRt as if the Swelling would hant broke in thaht place.



( 22t5 )

The Skin sras excceding tllins having no Fat under t, -only-in a^cavity between two Lobes, to be <iterwars de- -fcribed, on its Wigilt ilde, there vwas a fulaII appearance of fome ; for the Skxn lteing lefs ftretcht there, tbe CeIl3 Of the Me7ntrdna adipofS were riot quite etnptyed.

The fleXhy Fibres of the Latil4 coGi were Ccarce v fible.

Tlle l;flfoidre and Csraco-hysidre were cxtremely thin7 and in theiraCcent they adtaered sery firm to the I;Rbjlcent Tumour.

The SternohWoidtm and the Sterno-tEyrcoidvs, tlla4£ run up the fore part of tilis Swelling mrere diftended fo thin, that it was ditficult to Separate tllem from ita efpe- cially tlle 1aR named.

The Right Carotid Arterys in its afcent to thP HHsad) runalongits outer edge) WllIch encrafinC, <:9id much ob{truEt the current of the Blood that way.

Tlle {rlternal 2#gtsldrX tlle Par V)gxmX and the Inter- cofial Pair went alSo over fome part of this Swvelling in thelr deScent to theWrax. Two of theI,ymphatck Clands of the 2<getdr Vein were fwelied to the bigneX of little Eggs, being placed at fome diIlance one from arlother; wirll a llollow bet¢ween, where bme Fat 67aS fbund; theSe two Lobes made tbe Tumour lrtery une;en alSo on its Right fide

TheSe Mufc!ess the 7Agxlar with tlle *vvo Gltuds ad hering m it, and the re{t d the foreXnarned YelEels be2ng removed on both fiues) I could catily obirnre tlze biDreSv the figure and the circumCcription or linits of tllis perer- natural TunlourX with all its adlzzlions to the xn3<cen1t parts

In Magnitucle it Seemed to excend tItat of two rfts Joyrled together.

-its figure was alvmoLl triangiliarX wiell a brea1 Bafis under the Cllin, I:oping a lit.le on esWb fide) as > dea feended ao the upper part of the Ste>4X# where ts polnt

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( ^^t6 ) v as t*;retty narrovv-; lts furface wa5 made utleven, by tbree riElngis cf sYhictz the largeft was turned to the l.eft fide ; the other t%'O ketng E)laced on the Rights as- above

em^arkccl.

Ic adheied by Nfembranous Filaments tO tlle AIax- illar Glarlds, to tlle l)JgaJ}rxak M.lfcle, arld to tlle S8tylv- hysidegs; undevsv$wsct, ¢n tlze Rigllt iide, a G11 pcxrZ tion of itv in the fOrtn of- a WitzpleX did intrude itSelf as il were und^r tlle Totague>; in the- up?er and forepart it alfo adh^red to tllt Os hynides.

Laterally it wZas conne&ed to the Levator (DcapeSr, and lower (lo>?n to t]zat lrarr of tlle cgllarz tllat terlni-- rzats into tlle Claz>tcle, bacltsvards to a11 tlle tlle fore- pa rr or the Arpera Xrterit, bvtween lts tllird or fourtll Carriia ginous Ring and the 0 peGorzX as alSo to tlaat NsuCcl; of tlze Head called ReXw I£tcrxs ajor, and to fome part of the .Scaleni; its loxer part was engaged underthe 7s,gulx,) or lunated p>rt of the Brea(l bones to svllich it adt?ered.

ft svas cafi!y fead sro>wAn lts conrlexions to all--theSe cliffcrrr parts, but not fo-Erom the Glandgl Thyreeidre, to whlch it adhared a=tFr a far diffrerent m-anlzir ; tor \N I:ere tlle hj broidal {3z.S*nds are joynWd to one another, a ittle bAlolv thW Cartil.lgG Crivozdes, on tlze fore-part ofthe Ougz Arety, vhGr: ;vas no Ceparating of -t without cutw

tinC,its [abAa^W>e ) s-bence i"- plainly appears, that thc Un3tJn of chefc Glci nd s was .the root or ; beginning ot this esoelllz§>e Tuzzour: Ai-ld yet, xrtiich is very rezzarkable, tze Glands rllenzlfelves kvpt tl-elt uEual figure, anld were

larger*tllan crdinarv. This Tumour was hald and v-ery firm,- leing cxaAly of

the confilLlevlce of a Covvs Udder sshen boyledX yet in a

sv pEaces was foftilh, contail1ing a Irquid and tIaick

Ju rlbe .s Colour Xwas c'f*Sy of a Wlltith Yelloter, c?, lv in

fome placcs it YYS3S excceding Rcd, ttczm its llas-$Xg a gr¢atcr



( 2217 ) greater fiore of Blood VeXelsX and in others it was very White.

I was not a little fiurprized to hear the edge af my Xinife grate againft foulething hard) w?}lile I uZas CUttiDg

it) wthich made rne- prooeed vvsth catitioil; not to fposi

wbatev:er it vnas that made the refillaance ; I therefore

p.red cfFall -the foft part, and-t-he kard lilbItarlce t1ldt

remained I boyledX alad then cleared it lery vel1 hawio ing left fiicking to it at one corner a foft Cartilagi;5ouG Bod which poi¢i-bsy) had the Patient 11ved ionger9 wou'd have acquired the fame degree of Induration It very much rtiembles a pxece of svhite unpolsth£d A-ock Coral; but whether it may be reckonedoISeousa or- if it be rather the ViCcid Humour of the Glands bard-

ned anA concreted into this irregular Chalky or- CiX a- velly SubltanceX or w-hatever elfe it may beX I lease $i''>-t.

to your better Judgment to deternzine. Se-e Fig. 1+ 1 remember about two years ag4;) I found in the

Profates of a rery; old man a great many- hard Bodiess like White Pcas, being of a SubRance exaAly like this5 on!yfmoother on the outfsde; fome of thefe swere tn +lle Body of thcSeGlandsX others adhered by frnall Raoac to-t}e MuCcular Membrane that Invefts them, Fig. 2.

The fitEt appearance of this large Swelling W5S bOdv

tweniy- years agos cauSed by the breaking of a Vein) a.s

the good FJoman uSed to exprefs ieX in a hard anel sery

diicult Labour It increafed but very Mwly9 not arw

riving to any confiderable bulk till a fesnt years before

fhe dyed; it vras never veFy pai£ful, 6ti0g5 a trt3e

Scizirrh-axs: --Many things by feveral PerSons hacl been uLvd and applyed unfuceefsfallly. Its bigneX at leng1th became very trou8oleComeX sn inpeding her Swallos, ing and free Br-tathsug, and 3t laa it 4tllte choaked

her, by cotrlprcfiing the Wxnd pipe) u?on Which it

lay -

t}t-



( 22tS ) But befJes this I c)bferv-ed another remarkable ac

cldent which did rnucn hallen her endX being very -lp^)ainf,l and trollblefome for a year or two before {he dyed

lhPWterzs was entielyShirrhotes and diSendedto that degrecX tluvt it filled up the svnole Capacity of the

e;tv. Part s3f tile cploa and lleon adhered fo firmly to i ttnat ttnere could be no Separation svithout tear- izg: Both rbie lDvria alld the Tav grew clOre to it^; snd iadecid the Co-llfufion and Mixture of a11 theSe parts wab Co grea) tha-t if the Ovaries had not been fsvelled

here and - tncre With Hydatiual TumoursX - I could not hate dilitlzguithed tbem.

The Dleck of thc Womb was preSed down fo lows that upon a rery gentle dilatation af the Ldbia it oSertd itWelfto viesvX being estreamly hardX but yetfmooth and elren; anwd fo clo-zely -{hutX that I could paSs nothing

O .

Vb X1 5 Vut ruttlng.

It had iqueezed the Yefca 72rindrid fo cloSe againA the Os Pxba that it could contain but little 0 .D Llrine, - wbic'n obliged her tO make -it oftent and wit-h pqln.

The prelTure of this part backwards was fo great upon the Intertinn ReJxnBs that-the evacuation of Fces had been obAruAed for the fpace of tive weeks betore flzvr dXed.

Indeed there -was obServed to come away per Anvs for fome coliEderable tirmle a great deal of Ps arld Slimy Matter, 13ut that proceeded from the EJterS; for the ACririlonious iqumosurX which was wont to be diScharged per gwara) haYing been pent up within its Cavity) by the cloSe ConFridtion (3£ the CoWXa Uteris had cortoded, and eat its way through tt fubFance of the Womb intoz the Re#Xg, by which it had its vent: Which deplorable caSc I have more than orJce obServed in DiffieEtion.

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---r

( 22z9 )

The thicltnels of t-he VVomlo was n¢ar tXe lnche and irl itsbottom there was a great deal of th;t ESurwcur, White and thickf which upon tolacilir;e rzade tbe tuds tt my Fingers w}ite andrough) by lMtivellitg the (a ticxla) as if I hail wafheel them wsth a firong- Sola*tich of fome A-crid Lixivial Salt. Thus the Caullicit 3alt lo-dged in Soap afitAs the fAands of thofe Women tlzaz walh Linnen. tt W3S very hard to take the Uterxs out of the Pelv7s, by reafon of its fo clofe adhefion to the neighbouring parts.

It had forgot tQ take notice, that the ieses Alvin contained in the GutsX were but few, by reafon {he could not (wallow any thing Folid for a long timeX but wery hard and in Sereral diftin& Clots.



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An Account of a Very Large Tumour in the Fore Part of the Neck, etc. By Dr James Douglas