MORRID GROWTHS - § 1. Of Local Enlargements.—Local increase of size, as one of the objective phenomena of disease, requires careful study. It may be found in any part, whether of the trunk or the extremi ties; it embraces the whole class of abnormal growths, but it may also be caused by hypertrophy of natural structures or a deposit of fat; or it may be due to an effusion of serum, of blood, of lymph, or of pus; or it may depend on periosteal thickening or inflammation of bone.
In simple hypertrophy there are no symptoms of disease present except those attendant on increase of size ; the natural structures hold their due relation to.each other, and are all increased in equal proportion.
Adipose tissue is more liable to general than to local increase. It is in the abdomen where its accumulation is most likely to occur; the parietes, when pinched up, feel sensibly thicker when the deposit of fat is in the subcutaneous tissue, and an elastic fulness of the whole region, with considerable flaccidity, is given by its occupying the folds of the omentum. We are led to the con clusion that this is the true nature of such an enlargement by the absence of indications of disease, beyond the existence of dyspeptic symptoms, and by the persistence of general roundness and fulness of the limbs which we know to be incompatible with organic disease.
The presence of serous effusions gives rise in the head to the chronic hydro. cephalus of childhood, with its unnatural enlargement; in the thorax it causes bulging of the intercostal spaces and enlargement of one side of the cheat; in the abdomen it produces ascites and ovarian dropsy; in the scrotum it occurs as hydrocele; in the limbs it is the evidence of general dropsy or of local oedema.
An accumulation•of blood contained within the distended vessels, or in a pouch communicating with them, is found as aneurism or varicocele. When extravasated, it quickly coagulates and forms a firm tumor of undefined out line, as may sometimes be seen after a strain, or more distinctly in the testicle as hiematocele ; within the cavities it can only give rise to symptoms of the presence of tumor when it exists as an aneurism.
Effusion of lymph, as the consequence of local inflammation, is commonly followed by the formation of pus ; but it may remain stationary at the first stage, and be removed by absorption, the tumefaction being very generally increased by the coexistence of serous effusion around. Such swellings are to be met with among the muscles, but more especially in the lymphatic glands.
Pus can of necessity only exist after inflammation ending in suppuration ; but yet large collections of matter sometimes form when the signs of inflam matory action are almost wholly wanting, and this is especially true of scro fulous subjects. As with serous effusions, the presence of pus may cause bulging of one side of the chest; in the abdomen, collections of pus are more commonly local, and limited by surrounding adhesions of the peritoneum ; one form of abdominal suppuration is entirely without the peritoneal cavity, psoas or lumbar abscess, pushing outwardly over the edge of the pubis in front, or aboye the sacrum behind. In addition to these, the parietes of the cavities may become the seat of local collections of pus, from diffuse cellular inflam mation, or caries of bone. Similar events occur in the extremities, and espe cially in the proximity of the ends of the long bones of scrofulous children. The lumbar abscess, already mentioned, is very frequently connected with caries of the spine. Inflammation of the glands not unfrequently terminates in abscess, especially in scrofulous subjects, with whom those situated in the neck seem more liable to suppurate than any others.
Periosteal thickening and inflammation of bone are more commonly met with in the long bones of the extremities than elsewhere; the former so often forming rounded painful nodes on the shin-bone, the latter giving rise by the deposit of fresh osseous matter, to enlargements of very irregular form and outline.