tumors, danger, tissue, cysts, composed, especially, cells, gland and neuromata

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Chondroma.— This is most often met with in the young and is composed of hyaline and fibro cartilage. Chondromata may form from the long bones, the pelvis, cartilage or in glands like the parotid and testicle. In the latter situations they are especially apt to become sarcomatous. Chondroma is frequently preceded by rickets in infancy. The so-called °joint-mice° or floating cartilages in joints are often pedunculated or broken off chondromata.

Glioma.— Gliomata are tumors developing from the neuralgia or supporting tissue of the central nervous system. They are found in the brain, spinal cord and cranial nerves. Some forms, particularly those occurring in the retina during childhood, are closely allied to the sar comata, and owing to its situation glioma is always a source of danger.

Myomo.— Two varieties of myomata are recognized: (1) Leiomyoma, composed of un striped muscle cells and more or less fibrous tissue; (2) rhabdomyoma, which is rare, and contains striped muscle cells and spindle cells. Growths of the first class are found in the

Neuroma.— Tumors composed of nerve tis sue or true neuromata are rare, arise in middle life and are apt to be accompanied by severe pain or paralysis. False neuromata are tumors developing in the connective tissue sheaths of the nerves and may be fibromata, myxomata, etc. Traumatic neuromata are frequently the cause of the painful stump following amputations.

Angioma.—Angiomata are of two sorts: (1) Hamangioina, consisting of dilated blood-ves sels, and (2) lymphangioma, composed of di lated lymph-vessels. The first type is subdivided into (a) capillary hzmangiomata and (b) cav ernous angiomata. Capillary angiomata or nevi form the so-called mother's marks, port wine stains or strawberry marks with which infants sometimes come into the world. These are patches of distended cutaneous capillaries or venules, and if small can be obliterated by electrolysis. Larger ones are treated by ex cision. Cavernous angiomata are made up of large vessels and if on the surface of the body may form swellings of considerable size. Lymphangiomata are usually congenital, but may be acquired and vary in size as do the Immangiomata. With both classes of angioma there is danger of rupture and serious hemor rhage or escape of lymph.

Cystomata.— These are benign tumors filled with fluid the result of the activity of the cells lining the cyst wall, which is the real new growth. Many forms of cystomata belong to the adenomata; others occurring about the neck are the result of faulty closure of embryonic openings and are called branchio-genetic cysts.

Cysts due merely to accumulation of secretion through stoppage of the duct of a gland, as the sebaceous cysts of the skin ("wens"), or resulting from parasitic infection as the hydatid echinococcus cysts (see HYDATID), are not grouped with true tumors.

Teratomata.— These are tissue formations of embryonic origin which frequently exhibit great complexity of composition and contain such di verse structures as bone, teeth, skin, hair, car tilage, muscle, glands, etc. Cysts of this sort are called dertnoids and are especially common in the ovary and regions where folds of the developing embryo come in contact, as at the orbital angles, the neck and the base of the _spine. Theoretically, teratomata are to be classed with the malformations rather than with the tumors. See TERATOLOGY.

The Diagnosis of Tumors.—In dealing with conditions likely to lead to results of such grav ity as are involved in tumor formation, prompt recognition of the nature of the case is of the utmost importance. If taken at a sufficiently early stage both carcinoma and sarcoma can be cured by operation and impending danger from benign growths be recognized and averted. Swellings and ulcerations about the face and especially the lips and tongue which do not promptly disappear are, in older people, most suspicious. The formation of hard masses in the female breast should also be called to the attention of the physician, as soon as noticed, and excessive menstrual flow or hemorrhage be tween the periods in younger women suggest the possible existence of uterine fibro-myomata. A bloody or malodorous discharge subsequent to the menopause is very likely to be due to carcinoma of the uterus. Dyspepsia in older people together with loss of weight point to ward malignant disease of the stomach, and in definite abdominal pain, emaciation, obstinate constipation or alternating diarrhoea and con stipation, especially if there be blood in the stools, are strongly suggestive of a new growth of the intestine. It cannot be too strongly emphasized that delay is fraught with the great est danger and may make cure impossible or add immeasurably to the difficulties of the operation. In doubtful cases where tumors are accessible it is the custom of surgeons to excise small bits of tissue and submit them to micro scopic examination to determine their nature. In obscure abdominal disorders an exploratory laparotomy may be the only means of estab lishing the diagnosis. The procedure itself is as free from danger as any surgical manipula tion requiring a general anaesthetic can be, and if malignant disease is present it may be pos sible to eradicate it and save the patient from the miserable death which is otherwise in evitable.

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