growths, especially in the lungs.

Cases have been met with in which certain parts of the skeleton--only
those developed in cartilage--were so uniformly permeated with cartilage
that the condition has been described as a "chondromatosis" and is
regarded as dating from an early period of foetal life. Unlike the
condition known as multiple cartilaginous exostoses, it is a malignant
disease.

[Illustration: FIG. 142.--Multiple Chondromas of Phalanges and
Metacarpals in a boy aet. 10 (cf. Fig. 143).]

The chondroma is met with as a slowly growing tumour which is specially
common in the bones of the hand, often in a multiple form (Figs. 142 and
144). The surface is smooth or lobulated, and in consistence the tumour
may be dense and elastic like normal cartilage, or may present areas of
softening, or of bony hardness. The skin moves freely over it, except in
relation to the bones of the fingers, where it may become adherent and
ulcerate, simulating the appearance of a malignant tumour. Large tumours
growing from the bones of the extremities may implicate the main
vessels and nerves, either surrounding them or pressing on them.

Portions of a chondroma, which have undergone calcification or
ossification, throw a dark shadow with the X-rays; unaltered cartilage
and myxomatous tissue appear as clear areas.

[Illustration: FIG. 143.--Skiagram of Multiple Chondromas shown
in Fig. 142.]

_Treatment._--It is necessary to remove the whole tumour, and in
chondromas growing from the surface of the bone, especially if they are
pedunculated, this is comparatively easy. When a bone, such as the
scapula or mandible, is involved, it is better to excise the bone, or at
least the part of it which bears the tumour. In the case of central
tumours the shell of bone is removed over an area sufficient to allow of
the enucleation of the tumour, or the affected portion of bone is
resected. Should there be evidence of malignancy, such as increased rate
of growth, a tube of radium should be inserted, and in advanced cases
with destruction of tissue, amputation may be called for.

[Illustration: FIG. 144.--Multiple Chondromas in Hand of boy aet. 8]

In multiple chondromas of the hand in young subjects, it was formerly
the custom to amputate the limb; an attempt should be made to avoid this
by shelling out the larger tumours individually, and persevering with
the application of the X-rays or of radium to inhibit the growth of the
smaller ones.