TUMOES. 473 



The number. Benign tumors are often Dingle; sometimes, however, they 

 may appear in large numbers, f. i., fibroma, chondroma, lipoma, papilloma, 

 always growing from the same parent-tissue. Malignant tumors usually soon 

 multiply, either in their immediate neighborhood, or as a secondary process in 

 different localities, or in different systems and organs of the body. Excep- 

 tionally, very large and rapidly growing cancer and, as a rule, flat cancer 

 (epithelioma, rodent ulcer) of the face remain single. 



Ulceration. Benign tumors ulcerate only in consequence of local irrita- 

 tion, by friction of clothing, pressure, their own weight, etc. Vascular 

 tumors (angioma) occasionally break open and ulcerate spontaneously. 

 Malignant tumors (myeloma) often, cancer always, ulcerate, after having 

 attained a certain and usually limited size, if situated on the surface of the 

 body or in a cavity in direct connection with the surface. In organs of the 

 large cavities of the body a partial disintegration or softening of malignant 

 tumors may occur, as a process kindred to ulceration. 



The ulcerating surface in benign tumors is smooth or covered with granula- 

 tions, and discharges " healthy " pus ; the same feature is exhibited by the 

 ulcers of myeloma whenever such an ulceration occurs. Cancers, upon break- 

 ing open, present an irregularly deepened, often crateriform ulcer, with a 

 rough, corroded base, lacking uniform granulation, and with jagged, abrupt 

 borders, discharging a scanty, ichorous pus. The tissues in the neighborhood 

 of a cancerous ulcer are invariably hard, almost cartilaginous, to the touch, 

 this being one of the most important diagnostic features. 



After the formation of an ulcer benign tumors may swell slightly, without, 

 however, exhibiting any sign of more rapid growth, unless changing into a 

 malignant type. Malignant tumors, after ulceration, invariably grow more 

 rapidly. The same is the case after poulticing, irritation with local remedies, 

 or injuries done through mistaken diagnosis with the trocar or lancet. The exu- 

 berant growth of ulcerating malignant tumors takes the form of irregular 

 vegetations, advancing toward the place of the least resistance, outward, 

 therefore in tumors of the surface of the body. Only flat cancer (rodent ulcer) 

 penetrates from the surface into the depth of the part affected without produc- 

 ing vegetations. 



The lymphatic ganglia in the range of benign tumors swell only when they 

 are the seat of inflammation, in what is termed a consensual manner ; similar 

 swelling of the lymphatic ganglia may also occur in the earliest stages of 

 development of myeloma and cancer. After the removal of the tumor the 

 lymph-ganglia return to their normal condition. A real infiltration of the 

 lymph-ganglion with its transformation into the tissue of the tumor, is excep- 

 tional in myeloma, but is the rule in cancer. Pain and fixation of the swelled 

 lymph-ganglion are the clinical signs of its invasion by the morbid growth. 

 This happens the more surely after ulceration has started in the original 

 tumor. 



Recurrence after extirpation is exceptional with benign tumors, though 

 in some fibromata of the skin this occurs even after all diseased portions of 

 the neighboring tissue have been carefully removed. Local reappearance is the 

 rule with malignant tumors, with myeloma as well as cancer, and the recur- 

 rence usually takes place within the first two years after extirpation. The 

 second tumor may appear either locally *. e., in the cicatrix after the 

 operation or in its neighborhood, indicating either that the " roots "of the 

 disease had been left behind, or that at the time of the operation the infection 



