Examination Of The Body

It was emaciated in every part, and pallid. The bones of the trunk, especially the ribs, sternum, and vertebrae, were softer than natural: the vertebrae could be easily indented, and contained a whitish, milky, and thin or somewhat thick, and creamy fluid, composed of round elementary cells. It was mostly unmixed, but here and there it was streaked with some dirty brown medulla. Some of it, in the latter condition, was contained in enlarged cells of the bones of the pelvis, and of the articular extremities of both femora and tibiae. The inner surface of the whole vault of the skull was lined with a pale red, lardaceo-medullary (cancerous medullary) adventitious growth, spread out in a layer of considerable thickness; into one side of it was inwoven a growth from the vitreous table, of partly reticular, partly filamentous bone, while on the other "side it adhered to the dura mater. All the lumbar lymphatic glands had coalesced into one whitish lardaceo-medul-lary succulent mass.

Moreover, on the inner surface of the dura mater covering each hemi sphere, there was a vascular exudation. In each pleura there were a pound and a half of serum, and that on the right side was mixed with a flocculent exudation. The lower lobe of the right lung was covered with a delicate exudation, and was hepatized in several spots, which were as large as peas or walnuts.

Several of the mesenteric glands were infiltrated with the lardaceo-medullary matter: the mucous membrane of the rectum was injected and of a bluish-red color, and was covered with islands of exudation as large as linseed. The calyces and pelves of the kidneys were dilated, and contained some very fine yellow urinary sand.

(2.) It usually appears in masses, which very often reach an astonishing size. Sometimes these masses undoubtedly commence as an extensive infiltration, while at other times they consist at first of a morbid growth confined to one small point. In the former case, they forcibly split up the bone into delicate layers, in which regularity of position and of laminar arrangement is less distinct in proportion to the rapidity (tumultuousness) of the growth of the tumor. In the latter case, as the mass makes its way out from the interior of the bone, it distends the compact tables into a bony shell. Sometimes they thus become merely a simple shell; at other times, they are developed into a framework of laminated bony fibres. Moreover, in medullary cancer, a skeleton of divergent laminae often forms upon the filamentous basis of the growth. In other cases, of that part of the bone in which the morbid growth originated, a few small fragments only are found scattered through the mass; or it may have entirely disappeared, and no trace even of fragments may remain.

This form of the disease mostly affects the long bones, from the articular ends of which it is developed; it occurs also in the flat cranial and pelvic bones, and in the sternum and ribs.

(3.) The infiltration with encephaloid juice or sap above described - cancer-cells contained in a fluid blastemata - is the lowest degree of consistence which medullary cancer presents; but it occurs in bone in various degrees of consistence, from that of brain to that of a lardaceo-medul-lary or of a lardaceo-cartilaginous substance.

The soft loose parenchyma of genuine encephaloid is observed in bone, as in other organs, to be very richly beset with vessels; and they are remarkable for their large size and for the thinness of their walls: the blood escapes from them by repeated hemorrhages; it collects in cells which it forms for itself by thrusting the substance of the growth sometimes far asunder, and in these cells it forms laminated coagula.

Cancer melanodes is found in bone, as well as the white medullary cancer.

(4.) There is a peculiar form of cancer, which Otto describes as a gnawing or erosion of bone: Lobstein speaks of it under the title of Osteolyosis; but he includes amongst his cases some which were examples of cystoid disease and cystosarcoma, and perhaps also of areolar cancer. On the broad bones of the skull, or on the ossa innoininata, spots are noticed in which a foreign substance occupies the place of the natural bone. Besides other peculiarities, this substance presents very various degrees of consistence, sometimes being lardaceo-cartilaginous, and white or whitish-red; sometimes a fleshy-fibred, red substance; sometimes a gelatinous, an albumino-serous, or a fatty and serous fluid, of a yellowish-red or grayish color, or altogether colorless. It commences in the diploe, which it soon eats away, forming a cavity which, in the bones that have been mentioned, is at first enclosed within their compact tables. This covering disappears at several points, and leaves a smooth, round, an oval, or an irregular sinuous opening, or a gap, which is covered on both sides by periosteum. The morbid growth then interweaves itself with this membrane, especially with the dura mater when the skull is affected; and not unfrequently advances in it beyond the margins of the opening in the bone. The diploe is usually eroded to a greater extent than the compact walls of the bone, and hence it is that the margins of the opening are so often uneven and jagged, and the compact tables bevelled from within outwards.

There is generally no elevation of the diseased spot above the level of the bone, or at most it is very slightly raised; yet I have observed, that the growth which fills the cavity in the bone does sometimes rise above the surface, and form a tumor, which, in a flat bone, projects on both its sides. And especially when the morbid growth consists of a gelatinous fluid, it expands the tables of the bone, in the form of a bladder, and in that state is probably the disease first seen by Van Wy, and named by him Hydrosteon. It must not be confounded with cysts, and cystoid disease of bone.

This form of cancer does not differ in its elementary composition from that of fibrous and medullary cancer: every variety, indicated above, in the aggregation of the elementary parts - in consistence - is sometimes met with in the same individual.

There can be no question as to the cancerous nature of the disease: it is quite common to find it combined with a very extensive production of cancer in the internal organs.

The Nidus In Which The Cancer Growths Originate

The Nidus In Which The Cancer Growths Originate are the Haversian canals, the tissues lining the cells and medullary cavities of the bones, the medullary system generally; and it is from these points that the compression, the erosion of the bony substance by pressure, and the formation of skeletons in the morbid mass proceed. Cancer almost always originates in the diploe, in cancellous bones and parts of bones, or in the medullary cavities.

The state of the bone in the neighborhood of the cancer varies in different cases. Sometimes it is affected with hyperostosis, - on its outer surface, widely spread bony exudation, and induration within; sometimes with osteoporosis, atrophy and brittleness; and sometimes it is softened. Under what condition any of these states exist we are at present ignorant, but it is worthy of remark, that they are not confined to bones immediately adjoining the cancerous disease; for when the mammae, for instance, are the seat of cancer, not only may the ribs and other bones of the thorax be softened, but distant bones, and even the whole skeleton.

Besides the primary cancerous diseases of which we have hitherto been speaking as affecting bone, this system is subject also to secondary cancer. Instances of the secondary affection may be observed in the ribs and sternum when the mamma is occupied by cancerous disease, in the skull when a primary growth is situated in the dura mater or brain, and sometimes in the bones of the pelvis, when the same disease affects the uterus. The bone becomes involved, not by mere pressure, though that may be exerted, but by the advance of the growth into it; the disease is implanted in the tissue of the bone, which degenerates, and suffers a breach of its continuity.

Bone undergoes a peculiar destructive process, when the soft parts covering it are affected with those phagedaenic ulcerations which are usually held to be of cancerous nature. They are mostly observed on the bones of the face, and we shall speak of them hereafter, when taking a comparative glance of the diseases of bone.

Cancer of a bone is sometimes the only instance of the disease in the organism; sometimes, and indeed, very often, several bones are affected together. It is moreover frequently combined with the same diseases in various soft tissues, with cancer in the liver, breast, lung, pleura, uterus, etc. The extirpation of large cancerous growths in bone is usually followed by a very rapid and extensive production of cancer in several internal organs.

It sometimes occurs in early life, but is generally more frequent in adults.