BONE, PATHOLOGICAL CONDITIONS OF. 



461 



be, as paper, and in some spots nearly entirely 

 absorbed, evidently shewing that the morbid 

 action had commenced and increased from 

 within ; the substance of this newly-formed mass 

 being neither cartilage nor ligament, but per- 

 haps something between both, and yet not so 

 entirely so as to deserve the name of ligamento- 

 cartilaginous, or to be likened to any natural 

 animal product whatever. It has been de- 

 scribed by Bell as a substance much resembling 

 callus.* Again, in another specimen as it ap- 

 pears in the adult, (in the lower jaw for in- 

 stance,) the part of the bone in which the dis- 

 ease commenced is completely spoiled and 

 changed into a mass of this new material, assu- 

 ming a rotund tuberculated appearance. From 

 thence downwards, towards the spot where the 

 bone is not spoiled, there is an admixture of 

 this new material with gritty particles of bone 

 generally disposed in a radiated form ; the en- 

 tire containing cells filled here and there with a 

 dark-coloured fluid, and traversed throughout 

 by a foul and fetid ulceration. But osteo-sar- 

 comatous tumours, although generally consist- 

 ing of this firm material, are by no means so 

 invariably. In one remarkable instance in 

 which the disease occupied the femur, a vertical 

 section of the inferior end, which was mon- 

 strously enlarged, exhibited a mass of much 

 softer consistence, and cellulated or porous. 

 Its colour was a mottled dark brown, and it re- 

 sembled nothing so much as a dirty sponge 

 that had been soaked in blood and matter. 

 Sometimes the tumour is so soft as almost to 

 resemble brain : sometimes there are cysts con- 

 taining fluid like blood : in the long bones there 

 is constantly a fracture in the centre of the tu- 

 mour, or if the swelling occupies the shaft, the 

 articulating surfaces are broken from it.f Very 

 often this fracture is, or seems to be, the com- 

 mencement of the disease. 



We collect from these observations and dis- 

 sections that osteo-sarcoma, as we understand 

 the term, consists in a morbid alteration inte- 

 resting the entire structure of a bone ; com- 

 mencing in its interior, and incapable of re- 

 medy or removal unless by amputation. We 

 have already stated that its chief malignancy 

 consisted in some constitutional predisposition 

 which originally led to its formation, and in- 

 duces a recurrence of it in some other situation 

 after removal, and we wish to examine into the 

 correctness of this opinion in order to separate 

 it from cancer and fungus hamatodes, because 

 some diversity of opinion obtains on this part 

 of the subject, which after all is the only one of 

 practical importance. Boyer,J who considers 

 malignancy as constituting the very essence of 

 the disease, nevertheless recognizes two species. 

 ' In one, the osteo-sarcoma is propagated by 

 the continuity of some cancerous affection, 

 which had commenced in the adjacent soft 

 parts, as is seen, for example, in the bones 



* See Bell's Principles of Surgery, 4to edition, 

 vol. iii. part 1. 



t We have taken the above descriptions entirely 

 from preparations in the school of Park-street, 

 Dublin. 



} Traite des Maladies Chirurgicales, torn. iii. 



which form the walls of the nasal fossae, and 

 more particularly in the superior maxilla when 

 they become spoiled as the result of 'a hard 

 and cancerous polypus, which had previously 

 existed for a long time insulated, and without 

 any other local affection . In the second species 

 the bone is the original seat of the disease, its 

 own proper tissue is degenerated, and the sur- 

 rounding soft parts only partake of the same 

 species of alteration consecutively and in a 

 secondary manner." Dupuytren,* in describ- 

 ing the disease as it attacks the lower jaw, 

 offers pretty nearly a similar opinion. If, says 

 he, the osteo-sarcoma is primitive, it remains a 

 long time confined to the bone, and may ac- 

 quire a very considerable volume before the 

 lips and cheeks are affected. It then presents 

 itself under two principal forms : in the one, 

 the disease consists in cancerous fungi, which 

 spring from the substance of the bone, within 

 which the disease is often superficial, that is, it 

 may only affect the alveolar edge or the surface, 

 the body of the bone remaining without any 

 enlargement, and particularly its base continu- 

 ing sound. The second form is that in which 

 the disease commences in the centre of the 

 bone, which becomes fleshy, and swells through- 

 out its entire thickness. Most tumours of this 

 description acquire a considerable size, and oc- 

 casion a most repulsive deformity. The teeth, 

 loosened and displaced, appear implanted here 

 and there in the substance of the bone. It is 

 impossible to close the jaws. The lips, dis- 

 tended, thinned, and closely applied to the 

 tumour, no longer retain the saliva, which 

 trickles off continually. It is, however, worthy 

 of remark that these tumours, or at least many 

 of them, are slow to ulcerate or pass into the 

 condition of cancer. Sir A. Cooperf has evi- 

 dently made a similar division of osteo-sarco- 

 matous tumours, and described them with his 

 accustomed accuracy and clearness, but under 

 the names of cartilaginous and fungous exosto- 

 sis. Mr. Crampton,J in his paper on osteo- 

 sarcoma, also divides it into two species, the 

 " mild and the malignant," stating, at the same 

 time, that the nature of either previous to dis- 

 section after removal or after death is involved 

 in the greatest obscurity. He considers the 

 encysted condition of the tumour, its lying in 

 a bed of cellular tissue unconnected with the 

 surrounding parts, as indicative of mildness : 

 the characters of the malignant, as laid down 

 by him, are evidently those of genuine carci- 

 noma. " The soft bleeding fungus, which 

 makes its way through the integuments before 

 the tumour has acquired any very considerable 

 size; the profuse and peculiarly fetid discharge, 

 slightly tinged with the red particles of the 

 blood ; the tubercles of a purple colour on the 

 surrounding skin, which adheres firmly to the 

 subjacent tumour; the pain, and above all the 

 altered health, sufficiently point out the malig- 

 nant character of the disease." 



We have thus laid before our readers the 



Le9ons Orales, torn. iv. p. 636. 

 Cooper and Travers's Surgical Essays. 

 Dub. Hosp. Reports, vol. iv. 



