460 



BONE, PATHOLOGICAL CONDITIONS OF. 



phere by the ulceration of the superincumbent 

 tissues, it is prone to fall into mortification, 

 which is one of the methods by which a natural 

 cure may be accomplished. Not very long 

 since a man was operated on in the Meath 

 Hospital for the removal of an ivory-like exos- 

 tosis from the tibia, but the tumour was so 

 hard as to resist chisel and mallet and every 

 instrument that could be employed, and, finally, 

 the operation was abandoned ; yet was the 

 case ultimately successful, for the exposed 

 tumour sloughed, exfoliated, and the patient 

 left the hospital perfectly well. 



It is remarkable that if the exostosis has 

 been removed by operation, the same degree of 

 certainty as to its not returning does not exist 

 as when it has thus sloughed away. On the 

 contrary, when the tumour has been completely 

 extirpated and only the sound part of the bone 

 left, a new growth is often formed with so 

 much certainty and rapidity as to justify the 

 expression we have already used, of its " grow- 

 ing again with an inveterate pertinacity." On 

 this subject we recollect a story (told, we be- 

 lieve, by Bell) which might be considered as 

 ludicrous if it was not but too instructive. A 

 dancing-master had exostosis on both tibiae ; 

 they gave him no inconvenience, but the de- 

 formity was intolerable to his eyes, and he 

 thought it interfered with his popularity and 

 therefore with his profits. He persuaded a 

 surgeon to lay them bare and scrape them 

 down to his ideas of genteel proportion, but 

 unfortunately the surgeon forgot that bones 

 could granulate and grow. They did so in 

 this case, and after a long confinement and 

 much suffering the last condition of the patient 

 was worse than the first the deformity was 

 much increased. 



We distinguish a node from a truly exostotic 

 growth by the rapidity of its formation, by its 

 becoming stationary when it has been formed, 

 whereas the increase of exostosis is progressive 

 and may be unlimited; by its being exquisitely 

 tender to the touch ; its being subject to noc- 

 turnal exacerbations, and by its capability of 

 being relieved or removed by medicine in a 

 great number of instances. When composed 

 of osseous material alone, the almost stony 

 hardness of an exostosis will serve to distin- 

 guish it, and when of cartilage, it is' lobulated 

 or nodulated on its surface, which is never the 

 case with respect to nodes. 



There is a fungoid disease of the periosteum 

 which, under particular circumstances, may be 

 mistaken for exostosis, an error which we have 

 witnessed, and which might be attended with 

 serious consequences. It is fortunately of very 

 rare occurrence, and as far as we know has not 

 been hitherto described. In the four speci- 

 mens which have fallen within our observation, 

 its situation has been in the periosteum of the 

 tibia. 



During life, when covered by a dense and 

 resisting fascia, the tumour is very hard, its 

 growth slow, and not attended with much pain ; 

 neither is the use of the limb much impaired, 

 as we have known a patient with this disease 

 travel on foot a distance of six miles to the 



hospital. When not so restrained, its growth 

 is more rapid : it is softer to the feel, and has 

 most of the external characters of malignant 

 fungus. Frequently its surface is lobulated or 

 otherwise uneven, when it very much resembles 

 exostosis. When the skin gives way and ulce- 

 rates, or if the tumour is unfortunately cut into, 

 a bleeding fungus protrudes, that runs rapidly 

 into a gangrene, which involves the adjacent 

 parts; and if the limb is not speedily removed, 

 the patient dies. 



When examined after death or removal, the 

 tumour is found to be situated within the 

 laminae of the periosteum. There is a speci- 

 men in the museum of the school in Park-street, 

 in which the membrane may be seen as if split, 

 one layer passing in front of the diseased mass, 

 and another still more distinctly, behind, be- 

 tween it and the bone. The consistence of the 

 tumour is tolerably solid and firm, but not so 

 solid as cartilage; its colour is white or gray, 

 and its vascular organization apparently very 

 deficient. This latter circumstance is very re- 

 markable, for in some instances these tumours 

 exhibit a pulsatility scarcely inferior to that of 

 an aneurism, a symptom that may render dia- 

 gnosis extremely difficult, and which cannot be 

 explained by any post-mortem examination. 

 The substance of the bone beneath the tumour 

 is always removed by absorption to a consider- 

 able depth. 



Osteo-sarcoma. This disease, as its name im- 

 plies, is a degeneration of the bone into a sub- 

 stance of a softer consistence, not, however, 

 resembling flesh ; or rather it is an alteration of 

 structure accompanied by a deposition of new 

 material, and therefore attended by tumefaction 

 to a greater or less extent. As such, it is evidently 

 irremediable except by the knife, and if there 

 is a disease of the osseous system to which the 

 term malignant can be applied, it certainly is 

 this. Its malignancy, however, has no resem- 

 blance to that of cancer or fungus hrematodes, 

 although like the latter it very frequently attacks 

 persons in the earlier periods of life; but it 

 does not involve adjacent structures in a disease 

 similar to itself, neither does it contaminate the 

 system through the medium of absorption. The 

 most terrific feature in its character is its ten- 

 dency to recur after its removal from one situa- 

 tion, being in this respect more formidable than 

 cancer, which is, in many instances, at first but 

 a purely local disease, and may be extirpated 

 with complete success. This predisposition to 

 the disease is evidently constitutional, but as 

 we are totally ignorant of the circumstances 

 that conduce to it, and will probably remain 

 so, it is wholly uncontrollable by medicine or 

 medical treatment. 



This disease may possibly affect persons at 

 every period of life, although we have not seen 

 it in the aged. In children, particularly about 

 the fingers, the wrists, the fore-arm, &c. nodu- 

 lated swellings are frequently met with of a 

 large size and firm consistence, which go on 

 progressively increasing until they arrive at a 

 destructive termination to be described here- 

 after. On examination a tumour is found, the 

 external surface of which is bone, as thin, it may 



