The Cartilaginous Tumour is that whiCh has hsen named Cbondroid or Cartilaginuus Sarcoma: it is the Enchondroma of Muller, and one of the numerous forms of growths which have been heaped together under the term osteo-sarcoma. Its usual, and perhaps its only, place of growth is within or upon the bones, and it occurs in connection with the bones of the fingers and the last phalanx of the great toe more frequently than in any other part. It grows slowly, and usually without any pain, and may continue to increase for thirty or more years. It is most commonly isolated, but sometimes two or more tumours of the same kind occur on one or both hands. The most usual form of the cartilaginous tumour is globular, with an irregular nodulated surface; and a section shows that it is composed of nume rous round masses of a grayish-white semi-transparent substance, closely resembling the cartilage composing the skeletons of cartila ginous fishes, and presenting all the microscopic characters of ordinary total cartilage. The component masses, which are especially obvious when the tumour is large, vary in size from two hues to half an inch in diameter, and in different specimens vary much in consistence: they are held together by portions of tough fibro-cellular tissue, in which blood-vessels run, but are themselves little, if at all, vascular before the process of ossification has commenced in them.
The cartilaginous tumour may grow to an enormous size : one it the College of Surgeons, which had almost completely ()stifled, mea mires a yard in circumference. It is situated on the upper part of tin tibia. But even in the most advanced states they may be removed b3 the amputation of the part on which they are situated, without fear of their recurring ; and this is always an advisable proceeding : for be. sides the inconvenience produced by their weight and pressure on adjacent parts, largo cartilaginous or osseous tumours are apt to pro duce ulceration and sloughing by their distension of the skin which covers them.
The greater number of those called Osseous Tumours, or osseous exostoses, are only ossified cartilaginous tumours --examples of what may be called the second stage of the disease last described. It is doubtful indeed whether any tumour possessing the true osseous mieroscopio structure is formed xcept through a preceding carti laginous state. 3lany other kinds of tumours connected with bones are incorrectly called osseous or oeteo-sarcomatous. Such are those connected with medullary or soft cancerous diseases, of which some are only the osseous skeletons upon which the malignant disease was fixed ; others are the remains of the original bone expanded and broken out by the growth of the malignant disease in the interstices of its tissue. And again, other hard tumours connected with bones result from what should be called the calcification rather than the ossification of a previous softer growth : for in these the earthy matter is deposited irregularly. and they never acquire the structure of true bone. Most or all of these calcified tumours are of a malignant nature. One of the best characterised forms is that of which Dr. 'Baillie (` Morbid Anatomy') gives the history, in a case in which, after Mr. Hunter had
amputated the patient's leg, calcareous masses, similar to that which had formed within and around the femur, were developed within the lungs and upon the ribs.
The history of the Fibro-cartilaginous Tumour is as yet more im perfect than that of any of the preceding, except the cellular. It is most frequently, or always, connected with the bones, and is most commonly met with upon the jaws, from which it may be removed without fear of recurrence. It has usually a round or oval form, and its surface is less deeply nodulated than that of the cartilaginous tumour. It may attain a great size, and commonly leads to sloughing and ulceration of the tissues over it, if not timely removed. It is composed of a very firm, compact, pale, whitish or yellowish, -albu minous tissue, in which small spicula'of bone are often scattered, but which does not become truly or entirely osseous. It may grow within a bone, but more usually it commences on its exterior : in the former case it generally expands the shaft or body of the bone into a shell around it ; in the latter the surface of the bone is broken up, aud seems to coalesce with the tissue of the tumour.
In different examples the fibre-cartilaginous tumour presents various degrees of consistence, and not a few apparent diversities of internal structure. In some examples its substance is homogeneous, in others obscurely fibrous; and from these last, which are the most frequent, it derives its name, which is intended to express its general aspect rather than its minute structure, for the firm tissue of which it is chiefly composed has not the microscopic or chemical characters of cartilage. In other examples again the fibrous structure rather pre dominates over that which resembles cartilage; and in others nume rous cells, containing a glairy or a serous fluid, are scattered through the interior of the mass. From the existence of such diversities, it is not unlikely that more than one kind of tumour is included in this name; but the gradations, from the examples in which the tissue is most nearly homogeneous to those in which it is most fibrous, or con tains most cells, are so numerous and gradual, that it seems more pro bable that they are all of one kind, modified by accidental circum stances, or examined in different stages of their development.
The treatment of the tumours whose natural history has been described may be summed up in a few words. There is no remedy for them but their removal : not one of the medicines proposed for exciting their absorption is worthy of a trial. Of the means of removing them (when removal is possible), none is so safe, so expeditious, or productive of so little pain or inconvenience, as the knife; and whenever it can be employed, the sooner it is used the better, for, in general, delay can only increase the severity of the operation. For the operation itself, the only general rule is, that the whole of the diseased mass must be removed ; any portion which is left will most probably become the nucleus of a similar growth. The particular proceedings must be varied according to the size, locality, and other circumstances of the tumour.