PRODUCTS, ADVENTITIOUS. 



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however, (the so-called cartilaginification and 

 ossification) as to have passed for phases of 

 evolution of fibroma ; others (congestion, in- 

 flammation, serous infiltration, haemorrhage, 

 deposit of melanic matter, precipitation of 

 fat, great development of vessels, and cancer- 

 ous formation,) are, on all hands, confessedly 

 morbid. 



Patches, more or less extensive, and having 

 the outward appearance of cartilage, are of 

 common occurrence in fibrous tumours. The 

 period at which this change occurs is inde- 

 terminate; nor has the size of the growth 

 any appreciable influence upon it. We have 

 examined some specimens of this kind with- 

 out detecting any cartilage corpuscles, and 

 incline to regard the outward change as simply 

 signifying an increase of density and closeness 

 of deposition of fibres. 



Nor is the alleged " ossification " of these 

 tumours, according to our observation, more 

 real. We have not succeeded in detecting 

 in the ossified-looking parts either the cor- 

 puscle or the laminated structure of bone, 

 but simply saline particles or granules closely 

 or loosely set in the organic basis of the 

 tumour : actual ossification has, however, 

 sometimes been seen. This saline precipitation 

 commences indifferently in any part of the 

 mass, and commonly shows itself in several 

 points simultaneously, these being usually 

 seated near the centre ; it is far from unusual, 

 however, to find most accumulation at the peri- 

 phery, and not a few cases have been mentioned 

 by Meckel, Louis, and others, in which the 

 central parts, still fibrous, have been found 

 encased in an earthy shell of variable thick- 

 ness. The density of the calcareous matter 

 (grey or yellowish in colour) varies greatly. 

 If it be most common to find this substance 

 friable and porous, in other cases, the saline 

 substance is extremely hard and dense, resem- 

 bling marble or eburnated bone. From Pro- 

 fessor Daniell's analysis of a large tumour, de- 

 scribed by Mr. Arnott (Med. Chir. Trans, 

 xxiii. p. 202), we may infer the great extent 

 to which the animal constituents may be re- 

 placed by inorganic salts, as also the nature 

 of these : here were found, animal matter, 

 including water and ammoniacal salts, 35 ; 

 phosphate of lime, with a small quantity of 

 phosphate of magnesia, 56 ; carbonate of 

 lime, 5 ; alkaline sulphates, phosphates, and 

 muriates, 4=100. The extent of the growth 

 converted into calcareous matter varies great- 

 ly. Bayle refers to a tumour larger than a 

 new-born infant's head, containing ten points 

 of " ossification," the larger scarcely the size 

 of a pea, the smaller not bigger than a grain 

 of wheat : Mr. Arnott's case exemplifies the 

 opposite extreme of almost total conversion 

 into saline substance. When either converted 

 altogether into earthy matter, or provided 

 with an earthy crust of variable thickness, 

 these bodies have been described as " calculi." 

 Occurring most frequently in the uterus, 

 these concretions of fibrous origin have also 

 been observed in the cranium by Cruveilhier 

 (Rev. Med. Sept. 1833), by Krull and others. 



We have seen one as large as a walnut, which 

 had been connected with the integuments of 

 the face, in the possession of Mr. Liston. 



The period at which calcareous deposition 

 commences is altogether accidental. The 

 size of growths has no influence upon it : 

 the largest tumour we ever met with con- 

 tained not a single earthy particle, visible with 

 the naked eye ; while it is common to find very 

 small growths partially calcareous, and small 

 and large tumours in the same uterus may 



K resent this change to an equal amount. It 

 as even been maintained by Sebastian, that 

 ossiform deposit is more common in small 

 than large tumours ; but although this idea 

 may be rendered probable a priori by the con- 

 sideration that the occurrence of this change 

 would prevent further enlargement of the pro- 

 per fibrous structure, yet we doubt strongly 

 its being supported by facts. With the pro- 

 gress of saline precipitation (obviously so when 

 the earthy changes occur on the peripheric 

 surface, less distinctly and rapidly, though not 

 less really, when they arise in the central parts) 

 the connection of these growths with sur- 

 rounding tissues, becomes less and less inti- 

 mate ; the vessels undergo obliteration, and a 

 few filamentous shreds may alone keep up the 

 union, until eventually the calcareous mass 

 ceases to have structural connection with the 

 organs. This condition is in some cases the 

 prelude to its expulsion from the body. The 

 saline matter sometimes appears to act as an 

 irritant on the adjoining fibrous structure, and 

 induce local exudation, suppurative or other- 

 wise ; probably this is the state referred to by 

 Bayle, as "caries" of the alleged osseous struc- 

 ture of a fibroma. 



Fibrous tumours of the reddish variety, 

 soft, vascular, and of loose texture, are subject 

 to internal congestion, which when these 

 growths are situated in certain situations, as 

 for example, under the mucous membrane of 

 the uterus, may, aided by expulsive efforts of 

 that organ, lead to rupture of the superficial 

 layers of the growth, and terminate in external 

 haemorrhage. According to Madame Boivin, 

 such tumours may be regarded to a certain 

 extent as of erectile nature, inasmuch as they 

 admit of becoming hard and tumid with blood 

 at certain periods, especially the catamenial. 



Haemorrhage into the substance of the 

 growth is a condition occasionally observed. 

 Andral has noticed it, and we have seen a 

 tumour containing a clot of considerable size. 



Numerous small cavities are occasionally 

 observed in these masses filled with red, and 

 manifestly bloody, serosity ; doubtless blood in 

 an altered condition. These accumulations 

 saturate and disintegrate eventually much of 

 the solid substance. 



Like all vascular structures, these growths are 

 occasionally seized with inflammation the 

 hard variety much less frequently than the soft. 

 This occurrence may be announced by severe 

 local and general symptoms, increased by the 

 participation of the surrounding tissues. 

 The products of inflammation exuded into the 

 substance soften and disintegrate it ; pus of 



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