The pathology and surgical treatment of tumors

Front matter

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Preface To The Second Edition

During the time that has elapsed since the appearance of the first edition of this work, no great discoveries or advancements have been made concerning the nature and treatment of tumors. The parasitic origin of malignant tumors continues to attract the attention of pathologists and surgeons, but we have made very little progress in establishing this theory by actual facts. In the proper place will be found an account of recent work done in this direction, notably by Roncali, of Rome. The text has been carefully revised and many additions have been made. A new section has been added on Sarcoma of the Decidua. Many of the old illustrations have been eliminated, and are replaced by others intended to explain more satisfactorily the subjects they represent. Most of the new illustrations are original. The publisher has again placed the author under many obligations for his liberality in inserting so many new illustrations.

N. SENN.

Preface

The appearance of a treatise on " The Pathology and Surgical Treatment of Tumors " at this time needs no apology. Books specially devoted to this subject are few, and in our text-books and systems of surgery this part of surgical pathology is usually condensed to a degree incompatible with its scientific and clinical importance. Again, the attention and energies of pathologists and surgeons during the last quarter of a century have been directed more toward the foundation and development of the new science of bacteriology and the advancement and improvement of operative technique than to a more thorough investigation of the equally important though less inviting subject relating to the origin, nature, structure, clinical aspects, and treatment of tumors.

Every teacher of pathology and surgery knows how difficult it is to impart to the student a knowledge of the structure and clinical tendencies of the different kinds of tumors sufficiently accurate to enable him to make a reliable diagnosis at the bedside. The general practitioner often remains painfully conscious of this defect in his early training, and the surgeon is frequently in doubt when to apply his art or when to pursue a conservative or palliative course w T hen applied to for treatment by patients suffering from obscure tumors or tumors presenting one or more of the numerous complications to which they are subject.

The author has spent many years in collecting the material for this

work, and has taken great pains to present it in a manner that should

prove useful as a text-book for the student, a work of reference for the

busy practitioner, and a reliable, safe guide for the surgeon. For

the purpose of simplifying diagnosis a special effort has been made

to trace every tumor to its proper anatomical starting-point and histo- 6

PREFACE. 7

genetic source, and to make a sharp histological and clinical distinction between true tumors, inflammatory swellings, and retention-cysts.

The increase in volume caused by a tumor is due entirely to erratic cell-growth from a matrix of embryonal cells of congenital or post-natal origin ; the enlargement of a part or an organ caused by chronic inflammation which so often simulates a tumor is due to proliferation of pre-existing mature cells acted upon by pathogenic micro-organisms or their toxines, and to the vascular changes and cell-migration characteristic of inflammation ; while a retention-cyst essentially consists of an accumulation of a physiological secretion in a pre-formed glandular space, the result of a mechanical obstruction.

The classification of tumors in this work is in accord with this theory of the origin of tumors. The microbic origin of tumors is briefly disposed of, as it has not been established by any convincing experimental investigations or clinical observations. Should future research demonstrate a direct causative relationship between certain as yet unknown bacteria and the growth of some of the tumors, such tumors would have to be eliminated from this group of pathological products and be classified with the granulomata.

The first part of this treatise is devoted to a general consideration of tumors, and it is this part which is intended more especially for the use of students. Following the section on Classification, each class of tumors is considered separately, beginning with benign epithelial tumors and terminating with sarcoma, to which is appended a section on Retention-cysts. It will be observed that by following this course each tumor is brought to the notice of the reader three different times. Repetitions like these cannot fail in permanently impressing the subject upon the memory of the reader. It has been deemed advisable to discuss benign tumors first, as they do not deviate so far from the normal type of tissue-growth as do malignant tumors of the same germinal layer.

Retention-cysts are not true tumors, but they are discussed in the last section of the volume, as their differentiation from tumors is often exceedingly difficult, and in their structure and clinical course they resemble more closely tumor-formation than the products of inflammation. A description of each class of tumors is followed by a con-

8 PREFACE.

sideration of the topographical distribution of that particular kind of tumor in the different regions and organs of the body, with a description of the different operative procedures for their removal.

The intention of the author in illustrating the text so profusely was to keep constantly before the reader's eye the microscopical picture of the tumor, which in many places is contrasted with the normal structure of the tissues corresponding with the anatomical location of the tumor. The more difficult operations are fully described and illustrated. More than one hundred of the illustrations are original, while the remainder were selected from books and medical journals not readily accessible to the student and the general practitioner.

The author desires to acknowledge his indebtedness to Mr. W. B. Saunders, who has spared no expense in presenting this book to the profession, and to Mr. John Vansant and Mr. Thomas Dagney of his publication rooms, for valuable assistance in supervising the details of the preparation of the work ; also to Drs. Lecount and Mellish for a number of well-executed original drawings.

N. Senn.