Surgical pathology

Front matter

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Preface

Surgical Pathology is not a separate subject, but merely the bringing together and emphasizing of those aspects of pathology that have been found to be of particular interest and importance to surgeons. Those beginning to specialize in surgery, frequently find themselves confronted by problems difficult to solve by recourse to the ordinary sources of information. It is for them that this book has been written.

Unhampered by convention and past precedent, the number of books upon the subject being small, the author was free to choose for himself what subjects he would consider, the order in which they should be arranged and the proportion of space assigned to each. Proceeding, therefore, along somewhat new lines, he presents not only accepted facts and theories, but lays before his reader, in concise form, the other theories that may have been suggested, weighing their relative values and criticising them.

The matter has been arranged in logical order and sequence, each part leading up to and explaining what follows. For example, much of the contents of Part I, which deals with “Congenital Conditions of Surgical Interest,” is indis-° pensible to an intelligent understanding of Part II that deals with ““Tumors,” as it contains all that is said about the Mixed Tumors, Branchiomas, etc., while the facts about the more simple Tumors being chief burden of Part II, scarcely anything need be said about tumors in Part III.

Two kinds of subjects have received particularly full consideration—those that experience has shown to be necessary to the student, and those concerning which the author has special knowledge. An overwhelming amount of his surgical consultations have had to do with morbid conditions of the Mammary Gland—which seems to be an organ much misunderstood and maltreated— hence particular attention and considerable space have been devoted to it.

A sincere attempt has been expended upon making the text interesting as well as profitable, and in order that its readability might not be diminished by repeated interruption, it has been broken as little as possible into chapters, sections and headed paragraphs.

In these days of frenzied activity, it is but rarely that a technical book is accorded the distinction of thorough reading. The stress of modern professional life is such that there seems to be but little time for that leisurely study that leads to scholarly attainment. Men rarely wander along the quiet paths of learning, but keep to the bustling highways, seeking for short cuts at high speed, as though their intellects like their bodies could be transported by automobile or aeroplane.

This book furnishes no short cut to knowledge or wisdom. It may be used as a book of reference, but it has been written to be read from cover to cover; for the breadth of knowledge to be thus gained as the student is led on step by step to the full understanding of the subject. It is not an encyclopedia, and

, v vi PREFACE it should be understood that the mere reading of occasional scattered paragraphs will result in little benefit beyond refreshing the memory, and may defeat the very purpose of the writing by making any single part appear too brief or too inadequate.

The author is indebted to a number of friends for helpful suggestions given from time to time; for reading and criticising parts of the manuscript; for the loan of specimens and photographs, and for other kindnesses, and to them he again expresses his gratitude and tenders his sincere thanks.

A full index is supplied, as well asa bibliography in which most of the citations in the text, as well aS a few useful ones not there mentioned, will be found.

JosEPpH MCFARLAND. .

PHILADELPHIA.

Part I Page

Congenttar Conditions of Sutgical Interest; «.. . . 325. 8 ee we I I. Congenital Malformations Depending upon Conditions Inherent in the Embeya:

and Showing Hereditary Influence... . . ee I

#&. Arrested Development. . .... 4... 9... eer ee ter 2 Ws, Shae ee gs

I. In the Facial Region . . . ses I

Persistent Facial Fissure. . . . re

DF 120 oi ES ell a ee ea ec a 0 8 Clett Palate: :-... 3) SNES ae homcescinsbi., <3 a ye: ii Inthe (Cervical’Rerion.» . . 6 5... 3. : erie .. a 2s, Fe oy Ni, 15 TRAE ape ema CEO Oe eee Seams he c's he eo eb ws oh ne 17 Spina Bifida or Rachisehists ban Buyout ten ae Aen ply DVS In the! Ventral Region..> 2... ... &. Mag? cfc 5 ga eg2O Thoracoschisis; 32... 2 Al «le Br Rhe A. hace orks ha Le 26 Gastroschisis.. jratiereers oP o at sch oe ae a ee.

Congenital Ummbilicalemian #2... .% . 3: . 2. «wate 8 28 BCtOpia es wlan te Blew ame bs Re ian Crt cs Gale. * ie here Re Exstrophia Vesicae .... . ae ee a a es ae Te ey, Veoln the Genital Region... asm cys no or ot Pee eR cs eee RS Bpispadias:. «0.03 . MT er ei Sik Se es RA 35 VI. In the Perineal Region. ....... ON ere Ae as ES) Umpertqrice Anusi. Se oe souks iit Mae bee SU Eiypospadias. 2... «2. NR ty Mh ere ey bea het Ad ViTo“In-the Keproductive Organs -< .6. ses... Ah. eto uel Cae Cryptorchia; Ectopia Testis; Undescended T etude Ay cog ose tal feats eae CongenitalsHydrocele 09)... cs es in aoe te SS Congenital Inguinal Herniain the Male........ $a ea EG Congenital Inguinal Hernia in the Female... .... . at mh SS Double Vagina; Double Uterus; Uterus Bicornis. ....... 58 Atresia, Vaginae; Atresia Colli Utert. ¢/. o6. fo... hs 2 OO VIII. In the Mammary Region. ........ ce aaltae estan Sh et Maat ee Supernumerary Mammary Glands, ......... cf ei iaiende ae ee IX. In the Alimentary Canal. .... . Says oe Ha, ah ghee oh Cees 5g OE Stenosis Gfthe Oesophagis. «tue, ee Sel. Se Se Mae Os tg Hour-glass,Stomachy «. 5... Wiad sd Mo Pag Pee te Ss en Pyloric and Duodenal Stenosis. ...... eee ees | OS Stenosis of the Meum’. 2 775.545: . « i, eee. py the OA STENOsISTOMmtnCh COON rer wit, 1. . 20s fe pilde cies, Sec apie eed! B. Excessive Development’... ....°..... Reais SS Pd oh ey ee eee Supernumerary—(Cervical)—Ribs ....... + Jycle ARRON | dee aware tea Supernumerary Vertebrae........ eT TE Ee ee tak ee Fay Dans and TateHke BPMCDORGEE. fy 0k. ws es le ae | OF Supernumerary Digits—Polydactylia...... Re eee Stor: 69 Congenrcal Racal Tiymertniniy <6 s5 se Be et wpe, 70

II. Depending upon Accidental Dislocation of Tissue During Bmbayodal Development KG HoOntstay a. are, eee eer erg nS 5 yo ets) Coy ua 4, Sh as 72 Cholestedtoma’ “Pearlgeschwulst;” ““Margaritoma”’. . . 0... 2... - 73 vii vill CONTENTS

WlicecleItmmOrS: 2 cgdecy x. Gaeehiw acne der oh eke s aiMe el nee versa oy Ree et emo 78 Gite Mammary Gland’... i154 “aye 2 OR, = oe ee ee 79 Gi tHE OUSLY “li ce" 5 war: «ane Sone engl tating oe Oe peels cane eee 79 Wrthe Palate «... inci in ely Gl. ke See Se ore 80 Ofthe Pharynz and Tonsil». 0.02755 fa eo OR es 80 (Of tire Ships ‘and. Cheeks <0... 00) Fo. net oe Se 2 eg et oma 80 Ob theePituitaty. . wo ko ea GONE Se ie cas 8x Or the Midweyn Sa i KA be Ree, 0 oe chine ern 82 Ge the Salivary. Glands... 65. ..55 le. alee oe 84 We the. Nestis.and Ovary. oi. sos 6 oes letter 89 Of thé Diyrdid Gland .. 9... 2,428 ba te ee ee oe oe ee 89 Of the Uterus, Vagina and Bladder . . < ... Ss a % Sees Ge foe) Mpematd Gyets soo 6.5 ant eee 8a ys yk ee a eek ie eee QI Grthe somal Region. 6..-4 sa ese Pee een Ee tat Seren ee a 94 Of the Vulvar and Scrotal Regions. .... . PE ROP. | Se 94 @rdioe Penis. oo 6 ii es a a Wee ee eee 94 Gene rol st dk er le, he SO Re a ee ee 95 Of ithe Wrnary Bladder. 2 . 0. 2 6. oR sy es 95 Gtithe Abdomindl Wall... . <.- wus © FUlay eRe he, oe ae ree 95 @fsthe Mhoracie Wall. ste: 5 ical eee 1s Sisdinte te Soe co "ees 05 Ol thewNeck. . <2 s . 4s” RS Gd) eben eee ne en ee 95 ‘OV RAINS oe cl ae eM earls ko Se liege Mb om ee ga ays 96 @fithe Wouth. . 52.4 4 Oe. eek 5 ee ee gc eae 97 lithe Sedlp: hiv eke a Ge) Ge Bs 5 gee 98 Of the Hypophysis Ceebel rer wee ark se ip aoe ik. Sem eth 100 Adenoma ot the Mammary Gland... .°.. wo. $a ie ew es ee 100 Petal Adenoma of the Thyroid Gland .°. ... 25 2 Me wee gee 9 ee IOL Hypernephroma. ...... 1... Sean ae ta ay Reap lg lh ee ee IOI inherrant Pancreatic Tissue. 36 «")s oo 4a Se oe ee ee 108 Aberrant and Supernumerary Thyroids.. . ...- -- - ie ee ee ees 10g Abertant (repatic Tissue... sc) 0 4. 2a.) eee eee eee oe, ee ee 113 Aherratht Splenic Tissue 5, ....i 6g 0) ao © Ce eae, i II4 NperrantOvarian Dissuest-.\o. ths < yo ede MGs eet) comnts ees em II4 Ahenran¢-bndometrial Tisstie..s. 52° Ne es" Me use te con ees eee rr

III. Depending upon the Persistence of Obsolete Embryonal Structures or the Debris Resulting from Their Imperfect Absorption. . . . 6. 1 1 e+ ee ee ees 116

Persistence of the Internal and External Branchial Furrows and of the Pre- Cervical, Sinus'..c sn hss KS cues fh cite a a es Oy eRe toe soe 116 Branchialt Pistulase:. fs 8c bend Sea ye rg ee rg 116 Fistulas Having an External Opening Only. . ... 00 65 2 4 ss 6 8s £17 Fistulas Having.an Internal Opening Only .. ..-. . 5 244 5 fe 120 Fistulas with Both External and Internal Openings... .....-.-:-: 120 Pranehtal Cysts... cade te ela Mo ote if Tlnacg tee cai cine nee 123 Branchioma, sil. 2 ieistk oo 8 Gikkl. ace ee. es fo aie iene ean ip re 125 Persistence of the. Thyro-Glossal. Duct: . 7) 2°... . 5/26 Gop eee Se ee 127 Cysts in the Substance of the Tongue ; ...' . . sh 4.) ee eete oa 9 eee 128 Cyets:of the. Floor of the: Mouth=—Randla’ it: .-.0 5...) 2 s', a e 128 Cysts ithe Mid-line of the Neck. .9. 6.5 .)60 6 40. Cee hs ee . hie 131 Miedian*CervicaliPustulam si... 0-5 Seachac).4cpoae Cale | cn eae oe ee nee 133 Persistenceior the Dental: Shelf." 5-2... CP. ye aes Bens 134 Adamantinoma ~ 9.) =. .!. - eer er, PORN PETE Se ae ae foc 137 @dontomas:. «Fins ee ee een teh eT eS 139 Dentigerous Cydia. << nis 3 AUF oo aecpetir won ise Bee eet ke 142 je) EO ee er Ae Me Bete dre 144 Persistence of the Himbryonal Tail... 63. 2) Say AS © it ee 145

: CONTENTS 1X

Persistence of the Omphalo-mesenteric Duct... . . eae tae 148 Mieckel s)Wiverticulam, . . 02)... ete es ieeats blo. kee 148 Pomscsneec: tueWrcnag . i a et ae ae ee ee ge eS 157 Pemiatence of Piiger’ Tubes:in the: Ovary.*'. . .". 2. 3 ws 06 4) va ote ESD Ovanen;Crat and Cystoma.. 2. ss see ie SAY ech Synge Sa ied, oe Se Persisting Vestiges of the Wolffian Body ..... . cu dbe wh kus Cea ee oe nO iin the’ Bemale.’ 2 <5 3... : Adit OR See Mh ay Se bec pe eo eee Ce My CMe Rae, ee. gl a ee a Le hate ee ie ae: In Either Sex. .. . Sieuit obese ay Soy he ai ae OO Persisting Vestiges of ne Wolffian Ducts. 2 EAS ha ae tr dae Ee ae TOS) In the Female. . ....... Pe Faerie Stiri? Fie mr ney Py, Persisting Vestiges of the a bn Ate as paa, Se hs blag St ob Gelae eee ee Inthe Female... . ... 6. . fo seid telaiied. ah a Chae Lorna Olle cig Vans aioe Rens REN Invthew Males. 4: chat be ete oe PaO Solid Tumors Arising from Wolffian and Other Wiattess MP ty SR ra ic pe ei {o: Inthe Female. ..... fh Rae oe Reece: 170 Adenoma and orsaeis: of he Spaeys Pe Oe oe ee 7 InethewMinle aes 5 oer fe. 8 x Fan ee Se eel eoha tt es ee Adenoma and Carcinoma of thie Reavis: Sak. ous Save ce ie on ee eT Persie Vestigesiof the Notochord, . . 2094.5 4 2 Adee ugh eas 174 Chordoata; .°*)..-: sai tats) obses aieh len om eRe Persisting Vestiges of ihe Dibaiecia st ‘We IWietsensphis Kths, Sent Rem, + eee Fay ah ALO Congenitally Cystic Kidney. ... . 176

IV. Depending upon the Accidental Creleseence a Palted Onesie During Embtyonal Devélopiient . 9... sh lew Se re Oe Le ee ee gh ee) Double Kidney... .. Slate Petes: test, Ys a! eset! ahh bewrees Ph glk ct pause TD Horse-shoe Kidney... ... . 180

V. Depending upon Conditions Bictrbisic to de Hsbava, pat re ie Mow. Part Nok Hereditary .....°. 182

I. In Large Part ie enstines & upon alcein: (dampaesnan| or Conatniieiae ty Amniotic Bands ...°.. . tN pists Uae” eeast: gn 7a 182 Encephalocele....... Bea” Din io TR ER Gan: ph ndetgh Bp hah Rak En Intra-uterine Amputations. ....... 187

II. Depending upon Crowding or Mal-position of nee F oh in care. Preaetutaally from Deheiency of Amniotic Fluid ... ... 5 ss) fe) ads state Ae geile Congenital Luxation of the Hips. ........ 5 bei o) go ae aa aie as Other Congenital Luxations ....... ole Sh RS ee eee 191 Club Hoots... =. ete EL ye Be ee I eo i ee) IQI (Chil) ETE 3 | sae ae aA ee enn tal cP She Er 1 be ate. Ws ee ae OA DCOMOSIE, Gm. EP as + Ab gk Ua Oe ao elev oR eke Yulee ene 6 Oe Torticollis, or oo pret ho ee ak A c. cac ae ae » Ee er re LOS Asymmetry of the Pectoral Regions sith Renagtin aba ey tk VI. Depending upon Injuries Inflicted upon the Fetus During Birth... ... . . . 107 Cephalohematoma. . . . OS ee a ee ee LO VII. Depending upon Disease of the Fetish in Hess sen A aye ae gle aneaetel pred ate omeemieal Eiyilrocephalus:... 2.6 6k ila ee be ee ee

Part II

TSE, ooS Gees ee eee eer ee er en eer rie reer em pha LoS 205 Keitarn MOOmSTICHAClONS 2.65 «cis 2 tueis +1 igla Me « sand wens bee ereias 205 Ole atiiea ne meOn MENON e solidi ontems fs. S lapels. te oVe leer vale iws eo xen Goel nee 229 at I Te oe i ar merce ec ce ls | 232 Tilson’... eg AiR ne ee el A er Ree Pt Rar kane ole 232 a ER SR te gat Bay 5 gh ES aig a: Min ce age-r@h 8 gh aw ety a A haa 241

EN CHA Se prota hae 62) a. t,t Oe fate a ot 6 1b pet soon fol! SANT, 243

CONTENTS spe Qatian te loa. eh t sou 6 Lipoma Angioma . ee Hemangioma. £°3 ..5°).... 4»

Lymphangioma, .- 2.40) + sans Endothelioma Myoma. é "5 eet. ce ie ts eee Risededyonia ETRE ee een ee Glioma

Lymphoma... .

Lymphatic hema Multiple Myeloma Chloroma Hodgkin’s Disease Mikulicz’s Disease ee ag ic, oes, Tap er te

Granuloma Fungoides, Mycosis Fungoides. .

Lymphadenoma.... .

Lympho-sarcoma. . . .

Malignant Tumors SCE 0 i i hie a a eS cat Small Round Cell Sircome et Large Round Cell Sarcoma . . spindle Gell'Sarcoma. 05 2 «0 we Sls Giant Cell Sarcoma. Aste (ae

Chromatophroma; Melanoma; Melanotic Sanons

Epithelial Tumors... . .

Condyloma Acuminatum ... .

Papilloma. ar Molluscum Conmaionuta Fee en tt eR

24 on eee

Squamous Cell Carcinoma; Sieumibde Epuhchowia:

Carcinoma Bauscellalare SU os Ate oe

Carcinoma Spinocellulare . . . . . .

Carcinoma Trichocellulare. . . .

Syringocystadenoma........

Adenoma Sebaceum. ........

Mucous Polypi. .... ...

Protozoan Infections - ~ ... .. .

Vermicular Infestation . . .

Soft Papilloma. .. .

Adenoma

Columnar or Cylindiical Cell Céricoma eee:

Carcinoma. .- fo. 48.

PART III Special Pathology

The Thyroid Gland

4 ee Ee re cy ey ee oe 2 t)

Cn wet OM SR OO A RT

CONTENTS

The Mammary-Gland., 3 s-.. v.06. a th a Cyere ar the Bietate: oo ok a ee Tumors of the Mammary Gland ........ ances ot cse See ety ss 3s. & ae te ae Ree

SANGOMAn es ted Hola Fesec Mae te, 4 eta Miscellaneous Tumors of the Breast... . .

The Infectious Diseases of the Breast. . . . .

Acute Infection .

Duberculosis, «25... ; Syphilis. . . ; ACtINOMYCOSIS 54. we ts Sporotrichosis’ 4... Beat 01 San 3 eae al The Nipples and Areolae . . .

Bacet/spMiseasesh 55 S's... a 3 The Male Uro-genital Organs . . .

Median Bar Fomnation”: ©. «= . 7).

Enlargement of the Prostate. .... .

Cancer of the Prostate... . .

Tumors of the Bladder... . .

Vesical Calculus. .3..... enaleGalculns ies 4 snl c.ched ws ac Hydronephrosis . .

Surgical Kidney .... . a. oe RAS Diseases of the Testis and Bpuictvenak st eke! ia Orechitis,. Epididymitis. <1)... ts « Muberculosistof the Testis 4 9%) ...0.... >.< Sy puilisiot theiWestis. <\% mek a8.

Tinmors of the Testis’; (ac5...5. 2 26 - as Sarcoma of the Testis. ... .

Carcinoma of the Testis... . .

Diseases of the Uterus . . ee ie!

Diseases of the Fallopian Tubes... . .

Tuberculosis of the Fallopian Tubes .

Tumors of the Fallopian Tubes. .......

Diseases of the Ovaries ...... , Cysts of the Ovary. .

Tumors of the Ovary. , The Alimentary Tract... .......

Dhe Mouth *.--.. ..:.« ee aphie sophagus. js i. 2.0 The Stomach . , Peptic Ulcer. AG Cancer of the Binaaach» acm Nay EY Sarcomaso: the Stomach... 2... «= ..3 ; Foreign Bodies in the Stomach. .......

Sie ROATaGenima were or Sn tention or le ee = The Pancreas .. . Peete Se at The Vermiform Apeenits. Be et ae The Intestines. eae tate b, Obstruction. sy foe aw A Internal Herniae. ... . Te erie Te Intussusception .

Volvulug 2... . te Se mart Strictures of the tetestine.

xl

- Malignant Stricture of the Intestine... ....+.++4%-s Sy ls eee ee Sarcoma of the Intestine... .. . er re ee as 608 Benign Tumors of the Intestine. .-. ...0).: .13.. + 373% = Se ee ee

Diverticula of the Intestine... . . ee OM mr ee See

Fistula in ANNO. 2.0 wes xf 52%: Re ee Ce re er

epab ponte ee tin ch Sa tis. Viren s gies) Wh Ra 5 ae sR Regeneration of Bone... .... - oe be SARA ORLA GIT ie ae care 614 Pitammmation GF Bone... 2c 04s aos ee NT te Ree ee Duperoulosis of the Bones, 2 <.. 6.0". «la 6 ok ca. e+ ve fee a ge eynuiero: the’ Bones 24 5 oes. ts ee ot eo ae a ix a, .0! Stale ee [net OL i ec ee ai a 627 Rb tevana OL (IDEs. sous 3) vate) ee am vee oleae eo eitos eee ve Gay (CaperiomarGn BONE 4, us kdog 6k gala Sb latin ey a ak ip” ot ip age ee er 632 Osteitis Deformans; Osteomyelitis Fibrosa; Ostetis Fibrosa Cystlen: Osteltia Hemorrhagica; Benign Bone Cyst, and Benign Ginzit Gell'Sarcoma,24.7"., aed ona 638 eRe THe Ve Os: Go aes Blaha ne eS, CT ae ih GaSe sige eee gee 644 PPOMIULIOMR Ss) <5 Oem ee es ws Sa ea es eae ad a mA 644 ete aah ates ska: ere eer ee es Se a ie 652 uonerculoris of the Jomte; . 24.0... bk) eo, Sete 5 ee Se 2 Gynuilis of the Joints . ... .°. . = Se ree Gere rer ae ee Bilsmopraphic Index. -. . . 4. - rua et areemtiee ) eer ee

GeneratIndex..' -95. 5. 248 .. SC ern Mee eee ee ae a Se yy