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Around each colony of actinomyces is a zone of granulation tissue in which suppuration usually occurs, so that the fungus comes to lie in a bath of greenish-yellow pus. As the process spreads these purulent foci become confluent and form abscess cavities. When metastasis takes place, as it occasionally does, the fungus is transmitted by the blood vessels, as in pyæmia. Clinical features.
Skiagrams of the hands and feet show a deposit of new bone along the shafts of the phalanges. New growths which originate in the skeleton are spoken of as primary tumours; those which invade the bones, either by metastasis from other parts of the body or by spread from adjacent tissues, as secondary.
The primary symptoms had indicated inflammation of the stomach, which the attending physician had hopelessly combated, and finally, when by metastasis it attacked the brain, with other unfavorable symptoms, he was inclined to abandon the case in despair. It was at this juncture I was called in. The symptoms were exceedingly unfavorable, and my own opinion coincided with my professional brother's.
'The causes' of this serious affection are very numerous; among the most usual and active agents may be enumerated, exposure to atmospherical vicissitudes, remaining wet and idle after coming from the water, damp kennels, suppressed perspiration, metastasis of eruptive diseases, luxurious living, laziness and over-feeding.
The gonococcus is carried to the joint in the blood-stream and is first deposited in the synovial membrane, in the tissues of which it can usually be found; it may be impossible to find it in the exudate within the joint. The joint lesions may be the only evidence of metastasis, or they may be part of a general infection involving the endocardium, pleura, and tendon sheaths.
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.
Bourdon mentions milk from the thigh, labia, and vulva. Klein speaks of the metastasis of the milk to the lochia. Gardane speaks of metastasis to the lungs, and there is another case on record in which this phenomenon caused asphyxia. Schenck describes excretion of milk from the bladder and uterus.
The features are those of a rapidly growing sarcoma involving a nerve-trunk, with agonising pain and muscular cramps, followed by paralysis from destruction of the nerve fibres. The removal of the tumour is usually followed by recurrence, so that high amputation is the only treatment to be recommended. Metastasis to internal organs is exceptional.
At a later stage, especially in children and in cases in which the throat lesion is severe, an arthritis is sometimes observed that is believed to be a metastasis from the throat; it may be acute and suppurative, affect several joints, and exhibit a septicæmic or pyæmic character.
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.
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