Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/475/
463 
BONE, PATHOLOGICAL CONDITIONS OF. 
orbit, projecting forwards on the eye-ball and 
backwards on the brain, both of which organs 
it must have destructively compressed.* We 
have seen an osteo-sarcoma of the lower jaw in 
a young boy occasion death by suffocation ; and 
another in a young female impede deglutition 
so entirely that she died or seemed to have 
died of actual starvation. This, however, was 
at a period before an operation for the removal 
of the jaw had been attempted, at least in this 
country, and both were considered as specimens 
of fungus hæmatodes. 
When the tumour re-appears after operation, 
it does so in a very short space of time, often 
before the wound has cicatrized and healed; 
and as its situation is in the immediate neigh¬ 
bourhood of the former disease, the fungus 
protrudes through the wound, and seems to 
grow from it. In these cases the progress to a 
fatal termination, which is inevitable, is per¬ 
haps, fortunately for the patient, extremely 
rapid also. Indeed in all cases of relapse, the 
growth of the tumour goes on much more 
quickly than in the original disease, and the 
patient’s sufferings are considerably augmented 
also. We have seen cases in which the pain 
was so intense and so unremitting, that, night 
or day, not a moment’s rest could be obtained, 
even under the influence of the largest doses of 
opium that could be administered with safety. 
Cancer. Fungus hæmatodes.—We have al¬ 
ready more than expressed a doubt that either 
of these diseases ever originated in the osseous 
structure, or could be considered as properly 
appertaining to it, although it must be conceded 
that, in a few insulated cases, a cancerous dis¬ 
position has seemed to produce a fragility of 
bones, and that this ioss of the power of resist- 
i ance has preceded the development of the dis¬ 
ease in the softer structures. But with the 
utmost diligence of research we have not been 
able to discover one case in which a morbid 
alteration of structure, analogous to those chan- 
L ges in the soft parts which we call cancer, and 
which contaminate the system through the me¬ 
dium of the soft parts, has been found within 
the bone itself, or indeed to have existence 
therein, independent of some similar degenera¬ 
tion in the adjacent structures. On this sub¬ 
ject, however, our knowledge must be extremely 
limited. We do not well know what cancer is, 
or what is meant by a cancerous diathesis. We 
know not how to define or even to describe it 
as a generic form of disease. The dissection 
of these tumours exhibits an almost infinite 
c diversity of structure, and during life, previous 
to the actual contamination of the system, when 
the information too frequently avails but little, 
it is difficult to say whether any given tumour 
possesses this quality of malignancy or not. 
We therefore do not offer a very positive or de¬ 
cided opinion on this subject. 
But that the bones in the vicinity of can¬ 
cerous disease often suffer from a malignant 
and incurable species of caries, quite distinct 
and separate from that absorption which might 
be the result of pressure, and that this caries 
* Dub. Hosp. Reports, vol. iv. 
illustrates Mr. Hunter’s position of the exist¬ 
ence of a cancerous disposition in parts ap¬ 
parently sound, which will afterwards become 
developed even though the cancer is removed 
by operation, admits, we think, of most irre¬ 
fragable proof. Several years since, we re¬ 
moved a very large cancerous ulceration in¬ 
volving most of the under lip, the angle of the 
mouth, and part of the upper lip also. The 
diseased parts were most unsparingly taken 
away, and a minute and careful examination 
could not detect the smallest hardness in any 
part of the extensive resulting wound. Never¬ 
theless, in less than a year afterwards a tumour 
appeared at the angle of the jaw, with a hard 
and unyielding band striking from it deeply 
into the neck. The tumour increased and 
pressed deeply: an operation was altogether 
out of the question, and the man died of open 
cancerous ulceration. On dissection the bone 
was found to be deeply and extensively eaten 
away by caries : its entire structure was pre- 
ternaturally softened, and on attempting to dry 
it, as an anatomical preparation, its earthy 
material crumbled away and was altogether 
lost. At this moment we have another case 
affording a similar example of cancer attacking 
the lower jaw after being apparently removed 
from the lip. The bone is swollen, hard, 
nodulated, and extremely painful ; but not¬ 
withstanding the urgent entreaties of the poor 
man, no operation can be performed, and he 
too will die of open cancer. But the point is 
too well understood by operating surgeons to 
require further elucidation. Every one must 
have met with cases of extirpation of the 
breast where the ribs had been found softened 
and diseased, although little indication might 
have previously existed of such an unfortunate 
complication. 
But with reference to fungus hæmatodes 
the question is by no means so easily settled. 
In very many cases of extirpation of the eye 
in consequence of this disease, the bones of 
the orbit, even at a very early period, have 
been found softened, altered, and spoiled, new 
and more irritable growths have sprung from 
their substance, and the affection has re-appeared 
in a worse, because a more incurable form. 
Operations about the upper jaw have too fre¬ 
quently proved failures from a similar cause. 
Again, although the immediate points of re¬ 
ference have escaped our recollection, we have 
read of cases of fungus hæmotodes, the very 
first and earliest symptom of which was a 
fracture of the bone or bones of the member 
in which the disease afterwards was extensively 
developed. In our own note book are two 
such cases. One, a poor boy admitted into 
the Meath Hospital in the year 1820, with the 
most frightful enlargement of the thigh per¬ 
haps ever witnessed, the circumference of the 
limb being much larger than that of the body 
of an ordinary man. He attributed the dis¬ 
ease to the almost spontaneous breaking of the 
thigh-bone whilst he was riding on an ass. 
The tumour never ulcerated, but as an ope¬ 
ration, even at the hip-joint, was decided on in 
consultation to be practicable, he left the
        

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