An Account of a Very Large Tumour in the Fore Part of the Neck, etc. By Dr James Douglas

the Stones, the Sea Shells and other Marine Bodies found at Land; and am now upon that of the Plants; having only that of the Brute Animals, that of the Humane Bodies, and that of the Arts, to finish. Now as to this, at the same time that I will have more Regard to the Performing it in such a manner, as to render the Design Useful, than to the hurrying it to an End; and you and the rest of my Friends may depend upon't, that I will not lose one single Hour that I can spare from the Exigences of my other Affairs, till I have accomplish'd the whole. I am SIR, Yours, &c. J. Morton. V. An account of a very large Tumour in the fore part of the Neck, &c. By Dr James Douglas. I Lately had the opportunity of opening a Woman, about 50 years old, who had a very large Tumour, or hard Swelling, in the fore part of her Neck, possessing all the space between the whole extent of the lower Jaw and the upper part of the Sternum, with a considerable rising in its middle; laterally its point inclining to the Left side, tho the biggest part of the Tumour was on the Right. The Skin on the Apex of this protuberating part was thin and shrivell'd, of a colour different from the rest, and lookt as if the Swelling would have broke in that place. The Skin was exceeding thin, having no Fat under it, only in a cavity between two Lobes, to be afterwards described, on its Right side, there was a small appearance of some; for the Skin being less stretcht there, the Cells of the Membrana adiposa were not quite emptyed. The fleshy Fibres of the Latissimus colli were scarce visible. The Mastoidæus and Coraco-hyoideæus were extremely thin, and in their ascent they adhered very firm to the subjacent Tumour. The Sterno-hyoideæus and the Sterno-thyreoideæus, that run up the fore part of this Swelling, were distended so thin, that it was difficult to separate them from it, especially the last named. The Right Carotid Artery, in its ascent to the Head, run along its outer edge, which encreasing, did much obstruct the current of the Blood that way. The Internal Jugular, the Par Vagum, and the Intercostal Pair went also over some part of this Swelling in their descent to the Thorax. Two of the Lymphatick Glands of the Jugular Vein were swelled to the bigness of little Eggs, being placed at some distance one from another, with a hollow between, where some Fat was found; these two Lobes made the Tumour very uneven also on its Right side. These Muscles, the Jugular with the two Glands adhering to it, and the rest of the fore-named Vessels being removed on both sides, I could easily observe the bigness, the figure and the circumscription or limits of this preternatural Tumour, with all its adhesions to the adjacent parts. In Magnitude it seemed to exceed that of two Flits joined together. Its figure was almost triangular, with a broad Basis under the Chin, sloping a little on each side, as it descended to the upper part of the Sternum, where its point was pretty narrow; its surface was made uneven, by three risings, of which the largest was turned to the Left side; the other two being placed on the Right, as above remarked. It adhered by Membranous Filaments to the Maxillary Glands, to the Digastrick Muscle, and to the Stylohyoidans; under which, on the Right side, a small portion of it, in the form of a Nipple, did intrude itself as it were under the Tongue; in the upper and fore-part it also adhered to the Os hyoides. Laterally it was connected to the Levator Scapulae, and lower down to that part of the Cucullaris that terminates into the Clavicle, backwards to all the the fore-part of the Aspera Arteria, between its third or fourth Cartilaginous Ring and the Os pectoris, as also to that Muscle of the Head called Rectus Internus major, and to some part of the Scaleni; its lower part was engaged under the Jugulum, or lunated part of the Breast-bone, to which it adhered. It was easily freed from its connexions to all these different parts, but not so from the Glandula Thyreoidae, to which it adhered after a far different manner; for where the Thyroidal Glands are joined to one another, a little below the Cartilago Cricoides, on the fore-part of the rough Artery, there was no separating of it without cutting its substance; whence it plainly appears, that the Union of these Glands was the root or beginning of this excessive Tumour: And yet, which is very remarkable, the Glands themselves kept their usual figure, and were no larger than ordinary. This Tumour was hard and very firm, being exactly of the consistence of a Cow's Udder when boiled, yet in a few places it was softish, containing a liquid and thick Juice. Its Colour was chiefly of a Whitish Yellow, only in some places it was exceeding Red, from its having a greater greater store of Blood Vessels, and in others it was very White. I was not a little surprized to hear the edge of my Knife grate against something hard, while I was cutting it, which made me proceed with caution; not to spoil whatever it was that made the resistance; I therefore pared off all the soft part, and the hard substance that remained I boiled, and then cleared it very well, having left sticking to it at one corner a soft Cartilaginous Body, which possibly, had the Patient lived longer, would have acquired the same degree of Induration. It very much resembles a piece of white unpolished Rock Coral; but whether it may be reckoned osseous, or if it be rather the Viscid Humour of the Glands hardened and concreted into this irregular Chalky or Gravelly Substance, or whatever else it may be, I leave, Sir, to your better Judgment to determine. See Fig. 1. I remember about two years ago I found in the Prostates of a very old man a great many hard Bodies, like White Peas, being of a Substance exactly like this, only smoother on the outside; some of these were in the Body of these Glands, others adhered by small Roots to the Muscular Membrane that Invests them. Fig. 2. The first appearance of this large Swelling was about twenty years ago, caused by the breaking of a Vein, as the good Woman used to express it, in a hard and very difficult Labour. It increased but very slowly, not arriving to any considerable bulk till a few years before she dyed; it was never very painful, being a true Schirrhus: Many things by several Persons had been used and applied unsuccessfully. Its bigness at length became very troublesome, in impeding her Swallowing and free Breathing, and at last it quite choaked her, by compressing the Wind-pipe, upon which it lay. But besides this, I observed another remarkable accident, which did much hasten her end, being very painful and troublesome for a year or two before she dyed. The Uterus was entirely Shirrhous, and distended to that degree, that it filled up the whole Capacity of the Pelvis. Part of the Colon and Ileon adhered so firmly to it, that there could be no Separation without tearing: Both the Ovaria and the Tube grew close to it; and indeed the Confusion and Mixture of all these parts was so great, that if the Ovaries had not been swelled here and there with Hydatidal Tumours, I could not have distinguished them. The Neck of the Womb was pressed down so low, that upon a very gentle dilatation of the Labia it offer'd itself to view, being extremely hard, but yet smooth and even, and so closely shut, that I could pass nothing without cutting. It had squeezed the Vesica Urinaria so close against the Os Pubis, that it could contain but little or no Urine, which obliged her to make it often, and with pain. The pressure of this part backwards was so great upon the Intestinum Rectum, that the evacuation of Faces had been obstructed for the space of five weeks before she dyed. Indeed there was observed to come away per Anum for some considerable time a great deal of Pus and Slimy Matter, but that proceeded from the Uterus; for the Acrimonious Humour, which was wont to be discharged per Vaginam, having been pent up within its Cavity, by the close Constriction of the Collum Uteri, had corroded, and eat its way through the substance of the Womb into the Rectum, by which it had its vent: Which deplorable case I have more than once observed in Dissection. The thickness of the Womb was near two inches, and in its bottom there was a great deal of this Bumour, White and thick, which upon touching made the ends of my Fingers white and rough, by shrivelling the Cuticula, as if I had washed them with a strong Solution of some Acril Lixivial Salt. Thus the Caustick Salt lodged in Soap affects the Hands of those Women that wash Linnen. It was very hard to take the Uterus out of the Pelvis, by reason of its so close adhesion to the neighbouring parts. I had forgot to take notice, that the Facies Alvine, contained in the Guts, were but few, by reason she could not swallow any thing solid for a long time, but very hard, and in several distinct Clots. VI. Part