_On the Spongoid Inflammation._
The disease which I am now going to consider, has either not been
described at all by any author, or has, when it was noticed, been
considered as of a cancerous nature. It is perhaps one of the most
alarming diseases to which we are subjected; because, as yet, we know
of no specific remedy; and an operation can only be useful at a time
when it is very difficult to persuade the patient to submit to it.
I have named it the spongoid inflammation, from that spongy elastic
feel which peculiarly characterises the disease, and which continues
even after ulceration takes place.
This disease begins with a small colourless tumor, which, if there
be no thick covering over it, such as the fascia of a muscle, or the
aponeurosis of the foot, is soft and elastic, but tense if otherwise.
It is at first free from uneasiness; but, by degrees, a sharp acute
pain darts occasionally through it, more and more frequently, until
the sensation becomes continued. For a considerable time, the tumor
is smooth and even, but afterwards it projects irregularly in one or
more points; and the skin at this place becomes of a livid red colour,
and feels thinner. It here readily yields to pressure, but instantly
bounds up again. Small openings now form in these projections, through
which is discharged a thin bloody matter. Almost immediately after
these tumors burst, a small fungus protrudes, like a papilla, and this
rapidly increases, both in breadth and heighth, and has exactly the
appearance of a carcinomatous fungus, and frequently bleeds profusely.
The matter is thin, and exceedingly fœtid, and the pain becomes of the
smarting kind. The integuments, for a little around these ulcers, are
red, and tender. After ulceration takes place, the neighbouring glands
swell, and assume exactly the spongy qualities of the primary tumor. If
the patient still survive the disease in its present advanced progress,
similar tumors form in other parts of the body, and the patient dies
hectic.
On examining the affected parts after death or amputation, the
tumor itself is found to consist of a soft substance, somewhat like
the brain, of a greyish colour, and greasy appearance, with thin
membranous-looking divisions running thro’ it, and cells, or abscesses,
in different places, containing a thin bloody matter, occasionally in
very considerable quantity. There does not seem uniformly to be any
entire cyst surrounding the tumor, for it very frequently dives down
betwixt the muscles, or down to the bone, to which it often appears to
adhere. The neighbouring muscles are of a pale colour, and lose their
fibrous appearance, becoming more like liver than muscle. The bones
are uniformly caries, when in the vicinity of these tumors. If large,
they are found rough, and broken off into fragments; if small, they are
generally soft and porous. This tumor is sometimes caused by external
violence; but often it appears without any evident cause.
I know of no remedy which has a power of checking the progress of the
complaint, or removing it. Friction, with anodyne balsams, sometimes
gives relief in the early stages; but it does not seem to retard the
progress of the disease. Extirpation is the only remedy which has a
prospect of being successful; but it is only adviseable in the early
stages, whilst the disease is entirely local, and has not extended to
the neighbouring glands; for, after they become affected, the chance of
recovery is greatly diminished. It is, however, sometimes difficult to
persuade patients at this time to submit to amputation, or extirpation,
because the pain and inconveniences are inconsiderable; but the
operation ought to be urged with all the eagerness which a conviction
of its absolute necessity, and its precarious issue, if delayed, will
inspire.
After making these observations, I shall illustrate the subject with
the following cases, the first of which is intended to show the
difficulty of extirpating the disease, when the operation is delayed
after the first appearance of the tumor. In the second, we see the
destruction which the bones suffer by it, and the extent of parts
which it may affect. The third gives us an instance of the affection
of the glands: And the fourth, of the most advanced stage, or that in
which distant parts have suffered. The last is an instance of the good
effects of an early operation.