Periosteal Sarcomata. 373 



''2Qth. — He has had a restless night ; his pulse is quick (100), and 

 "his tongue white ; he was attacked with a rigour, which has been suc- 

 ceeded with heat. He is very sick and cannot retain anything on his 

 stomach, and his countenance is sunk. 



" Observations at evcni7ig lecture. — You have seen that I examined 

 this patient very particularly to-day, and indeed his situation is very 

 interesting ; you may have seen that the stump looks well, the ligatures 

 long since removed, and the wound contracted. There does not seem, 

 therefore, any source of irritation in the stump. Whence then arises his 

 present condition ? He daily wastes away, and is very thin : he has 

 shiverings followed with flushes ; his tongue is white, and he is covered with 

 perspiration, and there is a slight yellow tinge on his skin. Such an 

 attack will sometimes precede the ojiening and disorder of a stump about 

 the ninth day after the operation ; or the patients in Hospital will be 

 aff'ected by the crowded state of the house. I wish I could so consider the 

 present attack, but I fear it is from another cause — from the irritation of 

 internal disease." 



These symptoms increased, with the addition of pains in the right 

 side, and heaviness in the stomach. The patient gradually sank and died 

 •on the 24th. 



" Fost-morte7n. — The right side of the liver was much enlarged, and 

 "the surface was like variegated marble. There were spots of a bright 

 yellow colour, from the size of a pin's head to that of the point of the 

 finger. These spots were in clusters, and such parts of the liver felt soft, 

 and around these spots there was a vascular structure, deeply stained with 

 blood. Similar spots of disease were seen on the lungs, and some of these 

 were of a vascular, soft texture, having the peculiar substance of the soft 

 cancer intervening." 



Although the tumour is stated to have begun within, it 



seems more probably to have begun in the periosteum. In 



contrast to the healthy texture of the lower end of the femur, 



the tibia has a condensed appearance, from its cancelli being 



iilled with tumour substance. This has been observed in 



almost all the preceding periosteal tumours, and is quite 



different from the destructive changes produced by a central 



tumour growing at an equal rate with this one. The surface 



of the tibia has been attacked by the tumour. Without 



maceration, it cannot be said what amount of new bone, if any, 



has been formed ; but even if there were little or none, this would 



still be in keeping with a periosteal tumour which had grown 



very rapidly. 



B. C. I. 6 M. 25. 



