DISSERTATION IV.
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.