Myeloid Sarcomata. 375 



She, though never very strong, had always had fair health until 

 eight years ago, when she fell and hprt her left knee. It was sprained,, 

 according to her doctor, and was "put in" by a bone-setter, after which 

 she could walk. The knee remained swollen, but was not painful. She 

 used a crutch till three years ago. In July 1888 "rheumatism" and 

 swelling all round the knee-joint set in, and this has gradually increased 

 until it has reached its present size. It is not painful. 



The tumour, which is in the neighbourhood of the knee, measures 

 twenty-four inches and a half in circumference, and fifteen inches in 

 length. The patient can walk, but the knee is somewhat flexed. 



The leg was amputated by a postero-internal flap, and the patient 

 did well, except for occasional attacks of gastritis, to which she was 

 previously subject. 



She was discharged cured on 14th January 1889. 

 The tumour is composed partly of bone, partly of fibrous 

 tissue, and partly of a soft substance, which has been breaking 

 down. The bony part, consisting of both cancellous and compact 

 tissue, forms walls and septa for the softer portions. The soft 

 tumour substance has apparently grown through the lower end 

 of the femur, and stretched the soft parts beyond it. Part 

 of the cartilaginous surface of the condyle still remains 

 apparently normal. The soft substance is composed of round 

 and spindle cells, with numerous giant cells. 



This slow-growing central tumour of the lower end of the 

 femur may be compared with the similarly slow-growing peri- 

 osteal tumour of the same part (No. 6. 393). G. C. 2838. 

 Presented by Professor T. Annandale. 



6. 429. Myeloid-Sarcoma of the Head of the Tibia.— Fibula 



and section of upper end of tibia — in spirit, illustrating the 

 above. 



C. W., aged 36, was admitted to "Ward 12, Royal Infirmary, Edin- 

 burgh, in April 1890, suQ'ering from swelling over the head of the tibia. 

 Fourteen months before he had received a blow on the leg by a falling 

 stone, which kept him from work for a few days, and caused him pain, 

 but no other discomfort. This was followed by a swelling, which was 

 incised five months later, with negative results. Gradually the swelling 

 increased in size. The patient had been losing flesh for four or five 

 months. On admission there was a large swelling over the head of the 

 tibia, painful on pressure, and yielding with a crackling sensatiou. Ou 



