The Goulstonian Lectures on the Origin and Relations of New Growths
Authors: J. F. Payne
Journal: BMJ (1874)

LECTURE I.-COo/i,titzne.Z .r,-isuo of Yaznour-growt/z ot//s Ifh r Proy a d IgZi5e;/1asi . 1 noS.formation of nexv growths has, doubtless, iixany points of contact xx-itli the process by xwhich existing parts of the body are increased in size.In the first place, those tissues or parts of the body x,vhich are specially disposed to hypertrophy are, with certain exceptions, also very liable to become the seat of tumours.For instance, no tissue is so con- 4tautly liable to hypertroplhy as the adipose ; and precisely here do xve luiid( very coimmon and sometimes enormously large tumours.No doubt, the iincreasinig skill and confidence of surgeons has made extremelylarge ttlumloturs less common of late years ; but the largest tumour (so far as I knov) on r-ecor(d is a fatty tumour, of which a drawving is preserved in the imiuseum of the Harvard Univer-sity at Boston.The description of it miiay be not wvithout interest.Ain enilarged draxving of a xvoman, in xvhom there was formed a itimour that was, l)erhaps, as large as any that has ever been recorded.Th1le estimated weight of the tumouralone, at the tine of her death, xvas not far fi-om 275 lbs., ancltlheveight of thepatientwxvithout it vas probablynot IOO lbs.The age of the patient at the time of her death, in I854, was 36 years.In 1838, beiu g then in the sixth month of her first pregnianicy, she wvas kicked in the right iliac region by a coxv, and to this accident she always referred her troubles.She, howvever, xvent her full time, and was conifined in June, suffering afterwards habitually from soreness of the side and xveakness in the loinis.In September, 1840, a second child was born.Six weeks before labour, she lifted a heavy kettle, svooned, andl, on recovery, found a small tumour protruding fiom the vagina.Iler health wvas delicate for the next eleven moniths.In I841, she aborted at the third month, after a fright.Three days afterwards, she took cold, and had tenderness and fulness of the abdomeni, the right sidle becoming so sensitive that the bed-clothes xvere 4)plpressive.Iii 1843, a dead child xvas born at the full period, and after a severe labotir.The vag,inal ttiinour at this time p)rojectedl three or fotir incIses beyond the labia, as onie inch and a half to txvo inches in dliameter, andi its attachment was beyond the reach of the finger.Subsequently to this labotir, the xvhole tumour sloughed off.Difficulty of passing the iti-irie also folloxwed, and the catheter was used for some months.During tllis attack, a soft immovrable tumour axas felt a little to the right of the linea alba, andI almost filling the right side of the abdlomen, and from that time the abdomien enilarged pretty rapidly for a year.Abouit four years after the tuimaour appeared in the abdomen, anotlier slioved itself in the right labiunm, extending-to the niates.ihis last X -as soft andl elastic, andl, for a yearor two, it could be retturned xvithin the lpel-is or abdomen; but, subseqtiently, it enlargedpaoripassit Xvith the abdlominal tumour, and both fluctuated so distinctly that the case xvas tlhought to be one of dlropsy.The tumours w-ere tapped or incised eight times, but no fluidl xvas dischlarged.The abdominial tumour hacl produlced the most distressing dlysp)rica, so that she could scarcely breathle except wxhen on her hlan(ds anid knees.As the tunmour of the hip enlarged, lioxwever, the dyspnoea was relieved, as well as the general aniasarca, and a niumbness of the loxver extremities, from which she liad suffered much.At thse uigent solicitation of the patient, the tumour upon the hip was op?elnedl an(I the finger passedl in, but a soft tissue only was felt, xery uiitchl like the omenitum.After thue relief above referred to, the patient's health inmproxved.She again became pregnant, and, in 1848, vas delivered at the ftill period, artificial means being required, and the child dying during the labour.'WIhen this xvas over, she returned to her former condition.13efore this last pre-nancy, when she wvas in a sitting posture, which s,he sometimes attemptedl, the abclominal tumour restedl tipon her thighs andI as far as her knees; there being no marked increase of size before dlelivery, nor diminution afterxvards.The tumour of the hIip wvas fifteen inclhes long, ten inches in diameter at its longest part, and four inclies in diameter at the pOilit of its co iiiection w -lIil the p irinco-ischiatic region.About I85O, the patient weighecd, oni a platform-scale, 269 lbs.11cr