This disease may possibly affect persons at every period of life, although we have not seen it in the aged. In children, particularly about the fingers, the wrists, the fore-arm, &c. nodu lated swellings are frequently rnet with of a large size and firm consistence, which go on progressively increasing until they arrive at a destructive termination to be described here after. On examination a tumour is found, the external surface of which is bone, as thin, it may be, as paper, and in some spots nearly entirely absorbed evidently shewing that the morbid action had commenced and increased from within ; the substance of this newly-formed mass being neither cartilage nor ligament, but per haps something between both, and yet not so entirely so as to deserve the name of ligamento cartilaginous, or to be likened to any natural animal product whatever. It has been de scribed by Bell as a substance much resembling callus.* Again, in another specimen as it ap pears in the adult, {in the lower jaw for in stance,) the part of the bone in which the dis ease commenced is completely spoiled and changed into a mass of this new material, assu ming a rotund tuberculated appearance. From thence downwards, towards the spot where the bone is not spoiled, there is an admixture of this new material with gritty particles of bone generally disposed in a radiated form ; the en tire containing cells filled here and there with a dark-coloured fluid, and traversed throughout by a foul and fetid ulceration. But osteo-sar comatous tumours, although generally consist ing of this firm material, are by no means so invariably. In one remarkable instance in which the disease occupied the femur, a vertical section of the inferior end, which was mon strously enlarged, exhibited a mass of much softer consistence, and cellulated or porous. Its colour was a mottled dark brown, and it re sembled nothing so much as a dirty sponge that had been soaked in blood and matter. Sometimes the tumour is so soft as almost to resemble brain : sometimes there are cysts con taining fluid like blood : in the long bones there is constantly a fracture in the centre of the tu mour, or if the swelling occupies the shaft, the articulating surfaces are broken from it.t Very often this fracture is, or seems to be, the com mencement of the disease.
We collect from these observations and dis sections that osteo-sarcoma, as we understand the term, consists in a morbid alteration inte resting the entire structure of a bone ; com mencing in its interior, and incapable of re medy or removal unless by amputation. We have already stated that its chief malignancy consisted in some constitutional predisposition which oiiginally led to its formation, and in duces a recurrence of it in some other situation after removal, and we wish to examine into the correctness of this opinion in order to separate it from cancer and fungus limatodes, because some diversity of opinion obtains on this part of the subject, which after all is the only one of practical importance. Boyer,T who considers malignancy as constituting the very essence of the disease, nevertheless recognizes two species. " In one, the osteo-sarcoma is propagated by the continuity of some cancerous affection, which had commenced in the adjacent soft parts, as is seen, for example, in the bones which form the walls of the nasal fossm, and more particularly in the superior maxilla when they become spoiled as the result of ,a hard and cancerous polypus, which had previously existed for a long time insulated, and without any other local affection. In the second species the bone is the original seat of the disease, its own proper tissue is degenerated, and the sur rounding soft parts only partake of the same species of alteration consecutively and in a secondary manner." Dupuytren,* in describ ing the disease as it attacks the lower jaw, offers pretty nearly a similar opinion. If, says he, the osteo-sarcoina is primitive, it retnains a long time confined to the bone, and may ac quire a very considerable volume before the lips and cheeks are affected. It then presents itself under two principal forms: in the one, the disease consists in cancerous fungi, which spring from the substance of the bone, within which the disease is often superficial, that is, it may only affect the alveolar edge or the surface, the body of the bone remaining without any enlargement, and particularly its base Continu ing sound. The second form is that in which
the disease commences in the centre of the bone, which becomesfieshy, and swells through out its entire thickness. Most tumours of this description acquire a considerable size, and oc casion a most repulsive deformity. The teeth, loosened and displaced, appear implanted here and there in the substance of the bone. It is impossible to close the jaws. The lips, dis tended, thinned, and closely applied to the tumour, no longer retain the saliva, which trickles off continually. It is, however, worthy of remark that these tumours, or at least many of them, are slow to ulcerate or pass into the condition of cancer. Sir A. Coopert has evi dently made a similar division of osteo-sarco matous tumours, and described them with his accustomed accuracy and clearness, but under the names of cartilaginous and fungous exosto sis. Mr. Crampton,I in his paper on osteo sarcoma, also divides it into two species, the " mild and the malignant," stating, at the same time, that the nature of either previous to dis section after removal or after death is involved in the greatest obscurity. He considers the encysted condition of the tumour, its lying in a bed of cellular tissue unconnected with the surrounding parts, as indicative of mildness : the characters of the malignant, as laid down by him, are evidently those of genuine carci noma. " The soft bleeding fungus, which makes its way through the integuments before the tumour has acquired any very considerable size; the profuse and peculiarly fetid discharge, slightly tinged with the red particles of the blood ; the tubercles of a purple colour on the surrounding skin, which adheres firmly to the subjacent tumour ; the pain, and above all the altered health, sufficiently point out the malig nant character of the disease." We have thus laid before our readers the opinions of the highest and most respectable authorities, although we cannot coincide with them in classing cancer as a species of osteo sarcoma. Pathologically they are distinct and different diseases, appearing in patients of dif ferent ages, habits, and conditions of health, and exhibiting totally different phenomena ; and practically they are not alike, for it would be as insane to attempt the removal of a bone contaminated by an adjacent cancer, as it would be cruel to refuse the chance of an ope ration to one afflicted with true osteo-sarcoma. The disease is only malignant in its tendency to re-appear, nor can it be previously ascer tained by the symptoms, or subsequently by examination of the tumour, whether it is likely to show this disposition or not. Those nodu lated tumours that occur on the fingers and wrists of children, and which are so adniirably described and delineated by Bell,* almost in variably reappear in sonie other situation after removal. This we have seen remarkably ex emplified in the case of a little girl who was admitted into hospital with the two fore-fingers and thumb affected with this disease : they were amputated, but in nine weeks afterwards both the radius and ulna were attacked, and the arm was cut off. In seven weeks both clavicles were en,gaged, and the little patient was sent to the country, from which she never returned. Besides the development at an early age, a rapidity of growth, accompanied by in tensity of pain, is considered as indicative of a most unfavourable disposition in the systein. Yet is the contrary no assurance of safety, for we have seen a case in which the disease had lasted for five years and without much suffer ing, return after removal, and destroy the pa tient in less than twelve months. In general, however, the remark seems to be grounded on experience. The presence of a deep and foul ulceration within the tumour is rather unpro mising : in Mr. Cusack's six cases of excision of the lower jaw, the disease returned in one only, and in that this kind of ulcer had pre viously existed. It may, too, be laid down as an unvarying rule that the secondary appear ance of osteo-sarcoma is more painful and more rapid in its progress than in its first and original attack. It is uniformly fatal.