BONE, PATHOLOGICAL CONDITIONS OF. 



403 



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 haematodes. 



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 h&matodes. 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 loss of the power of resist- 

 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- 

 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, how r ever, 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 

 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, arid 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 w^ith 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 hsematodes 

 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 haemotodes, 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 



