In history and physical characters, each of these forms of tumor presents differences which aid in their discrimination. Those connected with the ovaries will be discussed in a future chapter ; and in speaking of the female generative organs, we shall have to treat of growths peculiar to the uterus, • which are not here alluded to, because of their invanable local connection, (See Chaps. XXXII. and %XXIII.) The diagnosis of cystic diseases of the mammie is essentially a question of surgery. Serous cysts in internal organs are distinguished by their even rounded surface, and the sense of fluctuation given to the finger of the observer ; from their history we learn that the deve lopment has been slow, while the condition of the patient proves that health is only interfered with so far as pressure impedes circulation, nutrition, or secretion. Encephaloid cancer is also rounded ; but its surface is seldom even, it is nodulated and irregular, firm and elastic to the touch. Its history is that of decidedly rapid growth, though it varies much in this respect ; the patient suffers not only from the destruction of the organ which it affects, and the evils arising from interrupted function, but also labors under a cachexia which infects his whole system. Scirrhus feels very hard, and presents only one or two distinct nodules with more or less irregularity of surface. Its pro gress is slow ; its history details disordered function long before any tumor has been noticed, and the cacheicia of the patient derives increased intensity, from the interference with due nutrition, when the disease is situated in the alimentary canal ; pain is more constantly present in this than in any other morbid growth. Colloid cancer presents an unevenly rounded, highly elastic
surface ; it may give a sensation to the finger nearly akin to fluctuation ; the secondary nodules, which would serve very often as a pretty certain index of fts nature, cannot be detected during life. Its growth is rapid ; it does not greatly impregnate the system at large, bat its position is such as commonly interferes very considerably with the assimilatave process. The malignant growths from bone belongto the more rapid-growing cancers, although gene rally firm and inelastic. This fact in their history serves to distinguish them from the non-malignant osseous growths, but their diagnosis need not go much beyond the question of the real or simulated connection with bony structure ; thia is proved by their immobility and position. They take more or less the direction of the bone to which they are attached, and while some degree of movement can be made out between the superficial structure and the tumor, none can be obtained by any manipulation between that and the bone.
Enlarged synovial bursie and fatty tumors are recognized by their general indolent character, their locality, and the sense of fluctuation and elaaticity whic.h each presents.