462 BONE, PATHOLOGICAL CONDITIONS OF. 



opinions of the highest and most respectable like tumour appearing to spring from some part 

 authorities, although we cannot coincide with of the bone : soon after another of these may 

 them in classing cancer as a species of osteo- make its appearance, but these, in the first in- 

 sarcoma. Pathologically they are distinct and stance, are free from pain and insensible to 

 different diseases, appearing in patients of d if- pressure. As it increases, the pain assumes a 

 ferent ages, habits, and conditions of health, dull and aching character, in the jaw frequently 

 and exhibiting totally different phenomena ; mistaken for tooth-ache, in other bones for 

 and practically they are not alike, for it would rheumatism. The degree of suffering, however, 

 be as insane to attempt the removal of a bone is not a very strong characteristic, for it will 

 contaminated by an adjacent cancer, as it depend on the rapidity of growth, the disten- 

 would be cruel to refuse the chance of an ope- sion suffered, the sensibility of the parts corn- 

 ration to one afflicted with true osteo-sarcoma. pressed, and a number of other circumstances 

 The disease is only malignant in its tendency too obvious to require detail. In ordinary 

 to re-appear, nor can it be previously ascer- cases, it has been remarked that the pain ob- 

 tained by the symptoms, or subsequently by serves a more than progressive increase with the 

 examination of the tumour, whether it is likely size of the tumour, particularly if its growth has 

 to show this disposition or not. Those nodu- been accelerated by any accidental injury. In 

 lated tumours that occur on the fingers and the advanced stages it is always severe, and 

 wrists of children, and which are so admirably in some instances dreadful. In one of Bell's 

 described and delineated by Bell,* almost in- cases, it is stated that there was no hour of the 

 variably reappear in some other situation after night or day in which the patient's wild cries 

 removal. This we have seen remarkably ex- could not be heard miles off. In most in- 

 emplified in the case of a little girl who was stances the sufferer is completely deprived of 

 admitted into hospital with the two fore-fingers sleep, and in some he complains of nocturnal 

 and thumb affected with this disease : they exacerbations. 



were amputated, but in nine weeks afterwards Once formed, it grows with greater or less 

 both the radius and ulna were attacked, and rapidity, often appearing stationary for some 

 the arm was cut off. In seven weeks both time, and then suddenly and quickly increasing: 

 clavicles were engaged, and the little patient sometimes, on the contrary, it increases rapidly 

 was sent to the country, from which she never from the commencement, and we have removed 

 returned. Besides the development at an early an osteo-sarcoma of the lower jaw, which at- 

 age, a rapidity of growth, accompanied by in- tained to the enormous weight of 4 Ibs. 1 oz. 

 tensity of pain, is considered as indicative of a avoirdupoise in the short space of eight months, 

 most unfavourable disposition in the system. Whilst the tumour is comparatively small, the 

 Yet is the contrary no assurance of safety, for skin is pale and glassy and stretched, and blue 

 we have seen a case in which the disease had veins are seen meandering on its surface : when 

 lasted for five years and without much suffer- large, its colour is dark red, verging to purple, 

 ing, return after removal, and destroy the pa- and multitudes of these little veins appear upon 

 tient in less than twelve months. In general, it. It is, generally, firm to the touch, solid 

 however, the remark seems to be grounded on and heavy ; but occasionally an examination 

 experience. The presence of a deep and foul with the fingers discovers the osseous covering 

 ulceration within the tumour is rather unpro- of the tumour to be very thin, and it yields on 

 raising : in Mr. Cusack's six cases of excision pressure with a peculiar sensation of elasticity, 

 of the lower jaw, the disease returned in one such as one might conceive parchment to con- 

 only, and in that this kind of ulcer had pre- vey if not stretched very tightly. At length it 

 viously existed. It may, too, be bid down as gives way, and a foul ulcer is formed, dis- 

 an unvarying rule that the secondary appear- charging an unhealthy fetid pus, often mixed 

 ance of osteo-sarcoma is more painful and with blood. The character usually attributed 

 more rapid in its progress than in its first and to this ulceration is fungoid, but we have never 

 original attack. It is uniformly fatal. seen it thus. It commences generally in the 

 The first approaches of osteo-sarcoma are centre of the tumour by a slough, and gradually 

 usually insidious, and as it is in general not a makes its way outwards to burst by two or 

 very painful affection, it may (particularly in three apertures, and we have seen an immense 

 children) escape observation at its very earliest osteo-sarcoma of the lower jaw completely tra- 

 periods. Any bone may be attacked by it, but versed by ulceration, one opening being in the 

 in the adult it is more frequently situated in mouth and the other at the inferior and most 

 the spongy extremities of the long bones and in depending part of the tumour. These ulcers 

 the lower jaw, whilst the phalanges, carpal and are usually hollow, attended with loss of sub- 

 metacarpal bones, the radius, the ulna, and the stance, and we have not observed one that 

 clavicle furnish the best and most frequent spe- could have been easily mistaken for fungus 

 cimens in the younger subject. It occurs often hsematodes. 



idiopathically, and on the other hand it occa- Independent of any malignancy inherent in 



sionally follows or seems to follow a fracture the tumour, it is evident that osteo-sarcoma may 



or other injury, as if the disposition existed in destroy life by being so situated as to compress 



the system, and only required some stimulus some important or even vital organ, more par- 



to direct it to any one situation. It commences ticularly if such situation precludes the possibi- 



usually by a small, firm, immovable tubercular- Hty of removal by a surgical operation. Such, 



for instance, was Mr. Crampton's case, in which 



* Loc. citat. the diseased growth sprung from the roof of the 



