372 Diseases of Bone. 



6. 424. Fungrating Periosteal Sarcoma of Tibia.— Sec- 

 tion of the upper end of a left tibia, with patella, lower 

 end of femur, and adjacent soft parts injected with vermilion^ 

 and in spirit, illustrating the above. 



The following account is taken from Sir Charles Bell's "Surgical 

 Observations of Cases in the Middlesex Hospital," etc., 1816, p. 390 : — 



" French "Ward (Middlesex Hospital). James Lewsley, aged 17. — 

 I observed this young man in the waiting-room, as an Out-patient. He- 

 said his friends alarmed him by saying that he was going to have a white 

 swelling in his knee. I found a disease, not in his knee, but in the head 

 of the tibia, a tumour which to the eye appeared like a swelling over the 

 bone ; but which, on examining it more particularly, was obviously 

 attended with an enlargement of the bone. Three months before this he- 

 had experienced a slight pain on the inside of the knee and head of the 

 tibia, and it has continued till the present. 



" From the moment I saw this patient I felt anxiety for him, and 

 pointed out to the pupils that this was a tumour forming within the bonCy 

 and not a scrofulous enlargement ; and desired that they should watch it, 

 as in all probability it would prove another example of the fungus 

 hcematodes. 



"For some weeks this jjatient was treated as for inflammation of a 

 bone, by repeated application of leeches and blisters on alternate sides of 

 the head of the bones ; for presently it appeared that the heads of both 

 the tibia and fibula were affected. By this means the general swelling: 

 was diminished, but on the outside, immediately below the patella, there 

 remained a tense elastic swelling, resembling in some degree an enlarged 

 bursa. Leeches were again applied and an issue made by caustic. But 

 these means, added to opiates and sudorifics, had no effect in arresting 

 the progress of the tumour, for the swelling had assumed a form which 

 authorised that name. The opening by the principal caustic became an 

 ulcer ; that is to say, it showed a peculiar character, and began to widen. 

 And observing that the leg had become cedematous, and that the tumour 

 of the bones enlarged, and the ulcer had obviously a connection with the 

 disease of the bone, I took the lad into the house on 22nd August. 



"31si. — The tumour has increased in an extraordinary degree ; it 

 is larger than the first, and quite open and full-blown, like a flower. In its 

 substance it is spongy and soft, and easily broken down ; in colour it is 

 cineritious, like slough, and bloody. It bleeds on being roughly treated, 

 but has no sensibility. The young man's health begins to break. He has 

 been informed of the change which would take place, and now it has come 

 he stands prepared for the worst, and has consented to lose the limb. A 

 cold lotion has been constantly on the limb, yet the tumour has increased 

 with remarkable rapidity ; it is of the size of both fists, and embraces the 

 heads of the tibia and fibula. The leg is osdematous and the integuments 

 inflamed. 



"The limb was amputated about the 6th of September. 



