would be more correct. Somewhat similar ones may project from the nose or pharynx, and "discontinuous fibrous' tumours occur pretty often about the jaws, including some forms of epulis in nerves, the testicle, &c. Mr. Paget has seen their cut surface rise up into prominences, like those which form on section of an intervertebral disc. They have been known to undergo the calcareous degeneration. Their weight is often enormous, having attained 71fb. 4. Cartilaginous tumour, or enchondroma, as Müller named it, is frequent on bones, and occasionally occurs in the testis, parotid, mamma, &c. In 35 cases the relative frequency was: bones of hand, 26; tibia, 3; testis, 2; ilium, 1; cranium, 1; ribs, 1; parotid, 1. They are usually rounded, hard, but elastic on firm pressure, covered in such places as the testis with a tough fibrous capsule-or in bone, by a thin osseous shell. Section produces the well known screeching sound of gristle. Their microscopical appearances are most varied, but most usually are those of infantile cartilage, sometimes with ossific specs or fibrous tissue mingled. They yield chondrin. The largest ever known was that described by Sir P. Crampton, which measured 6 feet in circumference and grew from the thigh bone. When softened, their cells much resemble cancer cells; but acetic acid distinguishes the cell wall and nucleus of the latter-not the former. 5. Myeloid, or marrow-like tumours, were first accurately described by Paget. They are found in or on bones, more often the former, in which they differ from the cases last described. Their consistence and appearance on section are described by him as follows: "When not encased in bone, they usually feel firm, compressible, slowly resilient, and fleshy;' very few are harder than these words imply; but some are much softer, easily broken, like ordinary granulations. On section, their most frequent appearance is that of an uniform greyish or yellowish shining substance, blotched or suffused with deep crimson or pink, or blood-colour. The range of varieties of appearance is very wide; and besides, partial ossification, with plates or bars of bone intersecting the tumour, is not rare; and cysts filled with serous or bloody fluids are, in the instances of large myeloid tumours, frequent." From the presence of many spindleshaped fibre-cells, Lebert alluded to these tumours as "fibro-plastic;" but their most characteristic elements are large corpuscles (so to Tobo), with numerous nuclei, such as occur in foetal marrow or diploe. Some forms of epulis are myeloid. 6. Osseous tumours may be divided, like bone tissue, into cancellous and compact. The former are always developed as cartilage, contain marrow-like matter, and are covered with a thin shell of harder bone. The ivorylike form is much smaller, and seldom occurs but on the outer surface, or in the diploe of the cranial bones, where it may produce most serious effects by pressing into the cavity. They are not usually cartilaginous at any period of their growth, but Prof. Goodsir mentions one of the humerus, half of which is cartilage and half ivory-like bone. Others have been found growing from the inner table, chiefly in puerperal women. Osseous tumours have canaliculi and lacunæ, while, on the contrary, calcareous degenerations, before described, are amorphous. 7. Glandular tumours, or adenoid, as they have been termed by Velpeau, may be formed of tissue, like the ductless or the secreting glands. Of the former, small masses which grow near the thyroid are the only examples, for bronchocele and the enlarged state of the ductless glands which accompanies leucocythemia are hypertrophies-not tumours. The secreting glands, which are occasionally imitated by tumours growing in or near them, are the mamma, prostate, parotid, and labial glands. The first, the "chronic mammary tumour" of Sir A. Cooper, is the only one invested with surgical importance, by its frequency. They are usually lobed, as seen in the annexed representation of a case by Mr. Richardson, and microscopically they are very similar to the milk-secreting tissue in a rudimental form, like that of the male breast, as Birkett remarks. They may undergo reduction or absorption, especially if the function of the gland is called into action. The Chronic Mammary or Adenoid Tumour. In the late Mr. Colles' "Surgical Anatomy," 1811, I find so admirable an account of the tumour that I cannot forbear quoting part of it, as one of the pathological subjects which the unequalled powers of observation of that great surgeon displayed: "This is a distinct tumour or hardness in the breast, generally seated deep in the substance of this gland, and towards the axilla. This is usually traced by the patient to some slight hurt. In Its surface size, it scarcely ever exceeds a walnut. seems rough; but this is caused by its being felt through the gland. It is occasionally attended with some slight pains; these are induced by any distress of mind, by wearing the clothes tight across the breast, and by a costive state of the bowels. On the approach of the menstrual period these pains increase, and cease on this evacuation being completed. A temporary enlargement of the tumour attends these attacks of pain, and retires on their cessation. The subjects of this complaint are young women, generally under thirty years of age. In one instance, the patient was nearly forty years old, and unmarried; in another, the lady was married, but had not any children, and was irregular in menstruation. These tumours disap peared in such of these patients as became nurses, and in the others have remained stationary for many years." 8. Vascular Tumours are composed of dilated arteries, capillaries, or veins; or, in some cases, all three kinds of vessels are engaged. Their most frequent seat is in, or under, the skin (a most important distinction, as regards surgical treatment), where they are termed "nævi;" but they have been found in the liver, brain, bones (osteoaneurism of Handyside), and may probably form in any tissue which vessels penetrate, of which I have recorded an instance in the "Medical Press," for February, Erectile Tumour of the Glans Penis. |