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The man doubtless possessed a considerable magnetic power; acting by some means, which I did not understand of course, upon my nerves, he had evoked within me so vividly, so definitely, the image of the old man of whom I was thinking, that at last I fancied that I saw him before my eyes.... Such 'metastases, such transferences of sensation, are recognised by science.
Its removal by operation is usually contra-indicated, but we have known of cases terminating fatally in which the section revealed only one metastasis, the removal of which would have benefited the patient. In all of these conditions, examination of the bones with the X-rays gives valuable information and often disclose unsuspected metastases.
There are reasons, however, which may be urged against its continuance. High amputation is unnecessary in the more benign sarcomas, and in the more malignant forms is usually unavailing to prevent a fatal issue either from local recurrence or from metastases in the lungs or elsewhere.
The cancers most liable to give rise to metastasis in bone are those of the breast, liver, uterus, prostate, colon, and rectum; hyper-nephroma of the kidney may also give rise to metastases in bone.
Secondary cancer is a comparatively common disease, and, as in metastases in other tissues, the secondary growths resemble the parent tumour. The soft forms grow rapidly, and eat away the bone, without altering its shape or form.
The myeloma is most often met with between the ages of twenty-five and forty in the upper end of the tibia or lower end of the femur. It grows slowly and causes little pain, and may long escape recognition unless an examination is made with the X-rays. Although these tumours have been known to give rise to metastases, they are, as a rule, innocent and are to be treated as such.
Handley argues against the embolic origin of the metastases in the bones because of the rarity of these in the bones of the distal parts of the limbs, because of the fact that secondary cancer of the femur nearly always commences in the upper third of the shaft, which harmonises with the intimate connection of the deep fascia with the periosteum over the great trochanter, thus favouring invasion of the bone marrow when permeation has spread thus far.
In general, it may be said that periosteal tumours are less favourable than central ones, because they are more liable to give rise to metastases. Permanent cures are unfortunately the exception. Treatment. When one of the bones of a limb is involved, the usual practice has been to perform amputation well above the growth, and this may still be recommended as a routine procedure.
It was a very easy matter to trump up testimony, when real evidence was embarrassing, to foregone conclusions; hence pains in obscure and foreign parts took on great importance when analyzed by minds drilled in the science of nervous reflexes, sympathies and metastases. The ovaries had the reputation of causing all the trouble that the flesh of woman was heir to.
In acute rheumatism, however, the joint symptoms predominate, there is an absence of suppuration, and the pains and temperature yield to salicylates. The prognosis varies with the type of the disease, with its location the vertebræ, skull, pelvis, and lower jaw being specially unfavourable with the multiplicity of the lesions, and with the development of endocarditis and internal metastases.
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