460 BONE, PATHOLOGICAL CONDITIONS Of. 



phere by the ulceration of the superincumbent hospital. When not so restrained, its growth 



tissues, it is prone to fall into mortification, is more rapid : it is softer to the feel, and has 



which is one of the methods by which a natural most of the external characters of malignant 



cure may be accomplished. Not very long fungus. Frequently its surface is lobulated or 



since a man was operated on in the Meath otherwise uneven, when it very much resembles 



Hospital for the removal of an ivory-like exos- exostosis. When the skin gives way and ulce- 



tosis from the tibia, but the tumour was so rates, or if the tumour is unfortunately cut into, 



hard as to resist chisel and mallet and every a bleeding fungus protrudes, that runs rapidly 



instrument that could be employed, and, finally, into a gangrene, which involves the adjacent 



the operation was abandoned; yet was the parts; and if the limb is not speedily removed, 



case ultimately successful, for the exposed the patient dies. 



tumour sloughed, exfoliated, and the patient When examined after death or removal, the 



left the hospital perfectly well. tumour is found to be situated within the 



It is remarkable that if the exostosis has laminae of the periosteum. There is a speci- 

 been removed by operation, the same degree of men in the museum of the school in Park-street, 

 certainty as to its not returning does not exist in which the membrane may be seen as if split, 

 as when it has thus sloughed away. On the one layer passing in front of the diseased mass, 

 contrary, when the tumour has been completely and another still more distinctly, behind, be- 

 extirpated and only the sound part of the bone tween it and the bone. The consistence of the 

 left, a new growth is often formed with so tumour is tolerably solid and firm, but not so 

 much certainty and rapidity as to justify the solid as cartilage ; its colour is white or gray, 

 expression we have already used, of its " grow- and its vascular organization apparently very 

 ing again with an inveterate pertinacity." On deficient. This latter circumstance is very re- 

 this subject we recollect a story (told, we be- markable, for in some instances these tumours 

 lieve, by Bell) which might be considered as exhibit a pulsatility scarcely inferior to that of 

 ludicrous if it was not but too instructive. A an aneurism, a symptom that may render dia- 

 dancing-master had exostosis on both tibiae ; gnosis extremely difficult, and which cannot be 

 they gave him no inconvenience, but the de- explained by any post-mortem examination, 

 formity was intolerable to his eyes, and he The substance of the bone beneath the tumour 

 thought it interfered with his popularity and is always removed by absorption to a consider- 

 therefore with his profits. He persuaded a able depth. 



surgeon to lay them bare and scrape them Osteo-sarcoma. This disease, as its name im- 

 down to his ideas of genteel proportion, but plies, is a degeneration of the bone into a sub- 

 unfortunately the surgeon forgot that bones stance of a softer consistence, not, however, 

 could granulate and grow. They did so in resembling flesh ; or rather it is an alteration of 

 this case, and after a long confinement and structure accompanied by a deposition of new 

 much suffering the last condition of the patient material, and therefore attended by tumefaction 

 was worse than the first the deformity was to a greater or less extent. As such, it is evidently 

 much increased. irremediable except by the knife, and if there 



We distinguish a node from a truly exostotic is a disease of the osseous system to which the 

 growth by the rapidity of its formation, by its term malignant can be applied, it certainly is 

 becoming stationary when it has been formed, this. Its malignancy, however, has no resem- 

 whereas the increase of exostosis is progressive blance to that of cancer or fungus haematodes, 

 and may be unlimited ; by its being exquisitely although like the latter it very frequently attacks 

 tender to the touch ; its being subject to noc- persons in the earlier periods of life ; but it 

 turnal exacerbations, and by its capability of does not involve adjacent structures in a disease 

 being relieved or removed by medicine in a similar to itself, neither does it contaminate the 

 great number of instances. When composed system through the medium of absorption. The 

 of osseous material alone, the almost stony most terrific feature in its character is its ten- 

 hardness of an exostosis will serve to distin- dency to recur after its removal from one situa- 

 guish it, and when of cartilage, it is lobulated tion, being in this respect more formidable than 

 or nodulated on its surface, which is never the cancer, which is, in many instances, at first but 

 case with respect to nodes. a purely local disease, and may be extirpated 



There is a fungoid disease of the periosteum with complete success. This predisposition to 



which, under particular circumstances, may be the disease is evidently constitutional, but as 



mistaken for exostosis, an error which we have we are totally ignorant of the circumstances 



witnessed, and which might be attended with that conduce to it, and will probably remain 



serious consequences. It is fortunately of very so, it is wholly uncontrollable by medicine or 



rare occurrence, and as far as we know has not medical treatment. 



been hitherto described. In the four speci- This disease may possibly affect persons at 



mens which have fallen within our observation, every period of life, although we have not seen 



its situation has been in the periosteum of the it in the aged. In children, particularly about 



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



During life, when covered by a dense and lated swellings are frequently met with of a 



resisting fascia, the tumour is very hard, its large size and firm consistence, which go on 



growth slow, and not attended with much pain; progressively increasing until they arrive at a 



neither is the use of the limb much impaired, destructive termination to be described here- 



as we have known a patient with this disease after. On examination a tumour is found, the 



travel on foot a distance of six miles to the external surface of which is bone, as thin, it may 



