III. Dermoids.
True dermoids are composed only of tissues found in the skin and mucous membrane. Sequestration dermoids, etc., are due to squeezing off of tissues where the lateral halves of the body coalesce. Implantation cysts are mechanically pro duced by the introduction of some tissue into a place where it does not belong and its further growth there. They are found especially in the fingers of persons who make their living by sewing. Tu bulo-dermoids are etiologically associated with canals which were used in foetal life; thus, the thyro-lingual duct, the post-anal gut, and the bronchial clefts give rise at times to this variety of dermoids. Ovarian dermoids possess the greatest size and variety of contents, but when other tissues than those of the skin are found they must be regarded as more purely teratoid growths, which oc cur not only here, but elsewhere in the body. Thus, Woodhead's case ("Prac tical Path.," '92) of the ovary contained nerve-fibres, multipolar cells, ganglion cells, etc., and does not properly belong here.
IV. Cysts.
Cystomata are caused by the abnormal dilatation of ducts or cavities already formed. They may contain one of the products usually found—bile, saliva—or modified products. The last gives their situation, but, as they are hardly tumors in the true sense of the word, they are not described in this section. Treatment.—The various methods of treatment have been reviewed in various parts of this work, and the reader is therefore referred to the INDEX.
For the treatment of malignant growths, however, the trend of modern thought but emphasizes the teachings of Gross, that the method of choice should be removal by surgical means as soon as possible, if this be practicable. Coley's mixture of the toxins of ery sipelas and bacillus prodigiosus is some-.
times useful in inoperable sarcoma.
Conclusions in regard to the use of erysipelas toxins in malignant disease of the New York Surgical Society: L. That the danger to the patient from this treatment is great. 2. Moreover, that the alleged successes are so few and doubtful in character that the most that can be fairly alleged for the treatment by toxins is that it may offer a very slight chance of amelioration. 3. That
valuable time has often been lost in operable cases by postponing operation for the sake of giving the method of treatment a trial. 4. Finally, that if the method is to be resorted to at all, it should be confined to absolutely inoper able eases. L. A. Stinson. A C. Cerster, B. F. Curtis (Annals of SurE!.. July, '96).
Conclusions in regard to Coley's treat ment of inoperable sarcomata: 1. There is a considerable number of cases in which sarcomata that had been given up as hopeless often after repeated operations have absolutely and entirely disappeared under this method of treat ment.
2. In some of these eases the patients have remained free from recurrence for upward of three years.
3. In several of the cases in which sar comata have disappeared after an attack of erysipelas the patients have remained free from recurrence for seven years and upward.
4. The proportion of eases of sarco mata in which the patients are cured by the injection of the mixed toxins de pends, among other things, upon the histological character of the growths. Spindle-celled sarcomata are the most hopeful.
5. The disappearance of sarcomata is not due to inflammation, but to an in tensely rapid form of fatty degeneration.
G. Degeneration and absorption may occur whether the toxins are injected di rectly into the tumor or into some dis tant part of the body. In the former case the effect is more rapid and the constitutional symptoms are more severe.
7. The method is attended by a con siderable degree of danger. It should, therefore, only be adopted in those cases for which there is no other remedy. The chief risk appears to be from collapse and pymmia.
S. The toxins are of no use unless the cultures are taken from a virulent case of erysipelas or are made virulent by passing the streptococcus through rab bits.