Volltext: The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea (1)

462 
BONE, PATHOLOGICAL CONDITIONS OF. 
opinions of the highest and most respectable 
authorities, although we cannot coincide with 
them in classing cancer as a species of osteo¬ 
sarcoma. Pathologically they are distinct and 
different diseases, appearing in patients of dif¬ 
ferent ages, habits, and conditions of health, 
and exhibiting totally different phenomena ; 
and practically they are not alike, for it would 
be as insane to attempt the removal of a bone 
contaminated by an adjacent cancer, as it 
would be cruel to refuse the chance of an ope¬ 
ration to one afflicted with true osteo-sarcoma. 
The disease is only malignant in its tendency 
to re-appear, nor can it be previously ascer¬ 
tained by the symptoms, or subsequently by 
examination of the tumour, whether it is likely 
to show this disposition or not. Those nodu¬ 
lated tumours that occur on the fingers and 
wrists of children, and which are so admirably 
described and delineated by Bell,* almost in¬ 
variably reappear in some other situation after 
removal. This we have seen remarkably ex¬ 
emplified in the case of a little girl who was 
admitted into hospital with the two fore-fingers 
and thumb affected with this disease : they 
were amputated, but in nine weeks afterwards 
both the radius and ulna were attacked, and 
the arm was cut off. In seven weeks both 
clavicles were engaged, and the little patient 
was sent to the country, from which she never 
returned. Besides the development at an early 
age, a rapidity of growth, accompanied by in¬ 
tensity of pain, is considered as indicative of a 
most unfavourable disposition in the system. 
Yet is the contrary no assurance of safety, for 
we have seen a case in which the disease had 
lasted for five years and without much suffer¬ 
ing, return after removal, and destroy the pa¬ 
tient in less than twelve months. In general, 
however, the remark seems to be grounded on 
experience. The presence of a deep and foul 
ulceration within the tumour is rather unpro¬ 
mising : in Mr. Cusack’s six cases of excision 
of the lower jaw, the disease returned in one 
only, and in that this kind of ulcer had pre¬ 
viously existed. It may, too, be laid down as 
an unvarying rule that the secondary appear¬ 
ance of osteo-sarcoma is more painful and 
more rapid in its progress than in its first and 
original attack. It is uniformly fatal. 
The first approaches of osteo-sarcoma are 
usually insidious, and as it is in general not a 
very painful affection, it may (particularly in 
children) escape observation at its very earliest 
periods. Any bone may be attacked by it, but 
in the adult it is more frequently situated in 
the spongy extremities of the long bones and in 
the lower jaw, whilst the phalanges, carpal and 
metacarpal bones, the radius, the ulna, and the 
clavicle furnish the best and most frequent spe¬ 
cimens in the younger subject. It occurs often 
idiopathically, and on the other hand it occa¬ 
sionally follows or seems to follow a fracture 
or other injury, as if the disposition existed in 
the system, and only required some stimulus 
to direct it to any one situation. It commences 
usually by a small, firm, immovable tubercular- 
like tumour appearing to spring from some part 
of the bone : soon after another of these may 
make its appearance, but these, in the first in¬ 
stance, are free from pain and insensible to 
pressure. As it increases, the pain assumes a 
dull and aching character, in the jaw frequently 
mistaken for tooth-ache, in other bones for 
rheumatism. The degree of suffering, however, 
is not a very strong characteristic, for it will 
depend on the rapidity of growth, the disten¬ 
sion suffered, the sensibility of the parts com¬ 
pressed, and a number of other circumstances 
too obvious to require detail. In ordinary 
cases, it has been remarked that the pain ob¬ 
serves a more than progressive increase with the 
size of the tumour, particularly if its growth has 
been accelerated by any accidental injury. In 
the advanced stages it is always severe, and 
in some instances dreadful. In one of Bell’s 
cases, it is stated that there was no hour of the 
night or day in which the patient’s wild cries 
could not be heard miles off. In most in¬ 
stances the sufferer is completely deprived of 
sleep, and in some he complains of nocturnal 
exacerbations. 
Once formed, it grows with greater or less 
rapidity, often appearing stationary for some 
time, and then suddenly and quickly increasing : 
sometimes, on the contrary, it increases rapidly 
from the commencement, and we have removed 
an osteo-sarcoma of the lower jaw, which at¬ 
tained to the enormous weight of 4 lbs. 1 oz. 
avoirdupoise in the short space of eight months. 
Whilst the tumour is comparatively small, the 
skin is pale and glassy and stretched, and blue 
veins are seen meandering on its surface : when 
large, its colour is dark red, verging to purple, 
and multitudes of these little veins appear upon 
it. It is, generally, firm to the touch, solid 
and heavy; but occasionally an examination 
with the fingers discovers the osseous covering 
of the tumour to be very thin, and it yields on 
pressure with a peculiar sensation of elasticity, 
such as one might conceive parchment to con¬ 
vey if not stretched very tightly. At length it 
gives way, and a foul ulcer is formed, dis¬ 
charging an unhealthy fetid pus, often mixed 
with blood. The character usually attributed 
to this ulceration is fungoid, but we have never 
seen it thus. It commences generally in the 
centre of the tumour by a slough, and gradually 
makes its way outwards to burst by two or 
three apertures, and we have seen an immense 
osteo-sarcoma of the lower jaw completely tra¬ 
versed by ulceration, one opening being in the 
mouth and the other at the inferior and most 
depending part of the tumour. These ulcers 
are usually hollow, attended with loss of sub¬ 
stance, and we have not observed one that 
could have been easily mistaken for fungus 
hæmatodes. 
Independent of any malignancy inherent in 
the tumour, it is evident that osteo-sarcoma may 
destroy life by being so situated as to compress 
some important or even vital organ, more par¬ 
ticularly if such situation precludes the possibi¬ 
lity of removal by a surgical operation. Such, 
for instance, was Mr. Crampton’s case, in which 
the diseased growth sprung from the roof of the 
* Loc. citât.
	        
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