290 Diseases of Bone. 



tubercular granulations. Probably this has been primarily a case 

 of tubercular disease of the knee-joint, in which an abscess has 

 burst, and turned septic, causing a secondary septic suppuration 

 of the limb, and leading to this periosteal o\itgrowth on the 

 femur. B. C. i. 5. M. 49. 



6. 232. Tubercular and Septic Disease of the Tibia.— Left 



tibia — macerated, illustrating the above. 



The upper half is very irregular, partly from new bone 

 formation on the surface, especially at the back and on the sides 

 lower down, and partly from erosion and opening out of the 

 bone. The latter change is best seen on the inner tuberosity 

 and at the back of the articular surface. This may have begun 

 as tubercular disease of the head of the tibia which became 

 septic. B. C. I. 5. M. 19. 



6. 233. Tubercular and Septic Disease of the Femur and 



Tibia. — Part of femur, tibia, and fibula for about six inches 

 above and below knee-joint — macerated, illustrating the above. 

 The femur is greatly thickened, and its surface is irregular. 

 The lower articular surfaces are eroded and absorbed in front, 

 and posteriorly are covered by irregular deposits of bone. The 

 cancellated tissue above the articular surface is irregularly 

 hollowed out, and what remains has been rarefied. The shaft of 

 the bone is considerably thickened, and near the upper end 

 shows a periosteal crust, like that due to septic inflammation. 

 Below this, however, the new bone is irregularly absorbed and 

 eaten into, as if by tubercular granulations. The articular 

 surface of the tibia is more complete, although in front it 

 shows considerable depression and excavation as if from tuber' 

 culosis. The shaft of the tibia is greatly thickened and con- 

 densed, and shows irregular new bone formation on the surface. 

 This also has been attacked, but to a less extent than in the 



