Enchondroma — the disease in a state of ulceration.

Pendleton, John Edward, 1831-1897.

Journal : Photographic review of medicine & surgery ; vol. 1., no. 4.

Philadelphia : J. B. Lippincott & Co., 1870-71.

Description : pp. 37-39, [1] pl. ; ill.: 1 photo. ; 24 cm.

Photograph : mounted albumen.

Subject : Tumors — Cartilaginous and osseous.

Notes :

THE accompanying photographic representation conveys a very correct idea of the present appearance of Daniel McDowell, aet. 22, an inmate of the Ohio County (Kentucky) Almshouse, colored, and born free in Jackson County, Tenn. The left hand is congenitally atrophied, attributed, by his mother, to an impression upon her, by the sight of a hand mutilated in a fight, while pregnant.

At the age of five years, the second and third metacarpal bones began and continued to enlarge on their dorsal aspect, until they united and formed a double tumor, of the size of two small oranges, and thus remained for nearly eleven years, without tenderness or pain.

In the latter part of his sixteenth year, all the metacarpal bones and phalanges of the hand, except those of the thumb, became involved, and in a few months the member was converted into an irregularly rounded mass, of probably six or seven pounds' weight, from which the fingers projected as John Bell not inaptly remarked " like the toes of the sculptured griffin."

In the mean time, a new tumor, of apparently the same nature, formed in the axilla, attaining the size of nature, formed in the axilla, attaining the size of a large foetal head, and in this condition he first presented himself to me, now more than three years ago.

Both masses were firm and inelastic over nearly their whole extent. That of the hand, at two points, of nearly an inch in diameter, fluctuated under pressure, evidently cysts containing a liquid, around which was a considerable degree of tenderness. The skin was sound and natural over the whole surface. Pressure at any other point did not produce the slightest uneasiness. That of the axilla was much more sensitive to the touch, and frequently the seat of sharp or keen and darting pains ; but the sensitiveness did not seem to be so much in the morbid mass as in the structures upon which it grew and encroached beneath.

Over a third or more of its surface existed an open ulcer, profusely discharging a greenish, offensive pus. His constitution had as yet suffered comparatively little. The appetite, digestion, and secretions were almost perfect. I proposed to amputate the arm and extirpate the axillary growth. He then requested time to consider and prepare for the operation ; when, in the mean time, he fell into the hands of a " cancer doctor," who, by means of powerful escharotics, destroyed more than half of both tumors. Shortly after this he returned to me, the humerus and scapula having become involved, and the superficial veins of the arm so much enlarged as may be seen in the photograph that I withdrew the proposition to interfere, sending him to the county almshouse, in charge of my friend Dr. J. T. Miller, where we have frequently seen him together, and where he still remains.

The history and symptoms, I think, clearly demonstrate both tumors to be cartilaginous. In keeping with the remark' of Prof. Gross, that this disease most frequently attacks the weak and rickety, the present victim, by his " bow-legs" and ungainly appearance, plainly testifies to an early want of proper nutrition; and still more, that it began in his hand, congenitally atrophied.

The slow and painless progress of the first metacarpal tumors ; then their long period of arrested growth ; the new impetus, rapid development, and tendency to multiplicity and ulceration, are all signs allowed by Mr. Paget to this ulceration, are all signs allowed by Mr. Paget to this species of homologous formations.

Their cause is not well made out, but is probably the same in many instances, more remotely however, as those inducing rachitis ; but in the one there seem to be present the identical materials chondrin and gelatine that are wanting in the osseous structure of the other.

It is generally conceded, I believe, that rickets comes from want of pure air and healthy food in early life, and may in after -years result in the heteroplasm, or misapplication of material, to be seen in enchondroma.

The degree of firmness often varies in cartilaginous tumors, and even in different parts of the same growth, as was observed in this instance ; and still more diverse is their appearance under the microscope.

Although cartilage in position is rarely, if ever, the seat of cancer, and resists to the last its action when thus abnormally situated, it not unfrequently assumes a malignity of action not less ferocious than the most frightful forms of carcinoma. Whether this is inherent, is acquired by local irritation, or is merely coincidence in choice of victims, remains to be investigated.

The treatment consists in extirpation, entire, of the erratic product, even to the sacrifice of a limb, if necessary to accomplish this end.

Possibly in the incipiency, alteratives, tonics, fresh air, wholesome food, and healthful exercise, with attention to the secretory and digestive powers, might accomplish something towards . impeding the rapidity of growth, or the prevention of starting again after excision ; but as to this I cannot speak advisedly of my own knowledge.

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