464 



BONE, PATHOLOGICAL CONDITIONS OF. 



hospital, went to the country, and was lost 

 si^ht of. A case nearly similar occurred 

 shortly afterwards in the shoulder of a young 

 woman, the first symptom of which seemed to 

 have been a fracture of the humerus. Both 

 these cases were at the time regarded as spe- 

 cimens of fungus haematodes, and as they were 

 not examined, the question must still remain 

 undetermined ; but from what we have since 

 observed, we should be disposed to think they 

 were osteo-sarcoma. It is, perhaps, right to 

 state that many surgeons of high attainments 

 and great experience do not separate these 

 diseases in their own minds, and still regard 

 the affection of the bone, which we would en- 

 title osteo-sarcoma, as a species of fungus hae- 

 matodes. 



It is, however, only in the first and middle 

 stages that these morbid growths can be easily 

 confounded one with the other. Both appear 

 small at first, but increase with great rapidity ; 

 and both attain a size not often observed in 

 other tumours, the fatty tumour alone ex- 

 cepted. The same purple colour, the same 

 meandering of blue veins, and the same in- 

 equality of surface are found on both ; and 

 when the osteo-sarcoma is about to ulcerate, it 

 may be observed to be soft in some places and 

 firm in others, like fungus haematodes. But 

 here the resemblance ends. Throughout the 

 entire case the osteo-sarcoma is harder, firmer, 

 and more unyielding : it attains to a much 

 greater size previous to ulceration, and when 

 ulcerated it does not shoot out (at least in its 

 more common forms) a soft and spongy and 

 bleeding fungus ; neither does it destroy its 

 victim with such rapidity. 



In the Repertoire Generale d'Anatomie et 

 de Physiologic Pathologiques (4 trimestre de 

 1826), there is an account of a disease of the 

 tibia related by Lallemand and commented on 

 by Breschet, who considered it to be some 

 species of aneurismal tumour, more particu- 

 larly as it is stated to have been cured by the 

 application of a ligature on the femoral artery. 

 The precise nature of this tumour, however, 

 is only conjectural, as it was never demonstrated 

 by dissection ; neither is it right in the present 

 state of our knowledge to question the cor- 

 rectness of these authors' opinions. Nature 

 sometimes makes extraordinary deviations from 

 the ordinary courses both of disease and re- 

 covery, and the circumstance of our inability 

 to explain the processes adopted by her is not 

 sufficient to warrant a denial of their existence. 

 It may, however, be remarked that if the case 

 alluded to was, as is said, an aneurism situ- 

 ated within a bony case and cured by the 

 operation already stated, such recovery must 

 have been based on principles totally different 

 from those on which an artery is tied in an 

 ordinary case of aneurism. 



In the museum of the school in Park-street, 

 there is a preparation perhaps in some de- 

 gree illustrative of this cellulated aneurismal 

 disease. It exhibits a morbid expansion of 

 the walls of a humerus removed from a woman 

 in Stevens's Hospital : the entire shaft of the 

 bone seems to have been engaged, and the 



transverse diameter of the tumour is about 

 five inches and a half. Within are a number 

 of cells lined by a vascular membrane of an 

 exceedingly dark red colour, the deep tinge 

 of which has scarcely been weakened by the 

 immersion of the preparation in fluid for more 

 than seven years ; and it is known that during 

 life this enormous tumour imparted an in- 

 distinct sense of pulsation. It appears by no 

 means improbable that the commencement of 

 this disease was in the medullary membrane, 

 which gradually became altered and poured 

 out the material, whether blood or otherwise, 

 with which its cells were filled. In proportion 

 as this accumulated, the cells must have en- 

 larged and the bone swelled. In many places 

 the external parietes are seen thinned down to 

 the strength of parchment or paper, and had 

 the disease been allowed to progress, they 

 might have been removed by absorption. 

 Had such an event occurred, and the integu- 

 ments subsequently given way, it is easy to 

 conceive that a fungus might have sprung from 

 this vascular membrane, which, occasionally 

 pouring forth an abundant and incontrollable 

 flow of blood, would in every particular have 

 so far resembled fungus haematodes, that even 

 an experienced practitioner might have found 

 it difficult to distinguish between them. 



BIBLIOGRAPHY. Isenflamm, Anmerk. liber d. 

 Knochen, 8vo. Erlang. 1782. Bonn, Thess. oss. 

 morbos. 4to. Amst. 1783 ; Ejus, Tab. oss. morbos. 

 fol. Amst. 1785-87. Heckeren, De osteogenesi 

 preternat. 4to. Lugd. Bat. 1797. Boyer, Lecons 

 sur les maladies des os, par Richerand, 2 vol. 8vo. 

 Paris, 1803; Anglice by Farrell. Sandifort, Museum 

 anatomicum. Weidmann, De necrosi ossiuin, fol. 

 Frfti. a M. 1793. Augustin, De spina ventosa 

 ossium, 4to. Halae, 1797. Howship on the morbid 

 structure of bones, &c., in Med. Chir. Trans, 

 vol. viii. ; JEjus, Experiments, &c. on fractured 

 bones ; Op. cit. vol. ix. and Sequel to the pre- 

 ceding paper in Op. cit. vol. x. ' * Glisson, De 

 rachitide, 12 mo. Lond. 1651. Stanley, Obs. on 

 bones in rickets, Op. cit. vol. vii. * * Scarpa, De 

 anat. et pathol. ossium, 4to. Ticin. 1827. B. Bell, 

 on the diseases of the bones, 8vo. Edinb. 1828. 

 Mutter, Diss. de callo ossium, 4to. Norimb. 

 1707. B'ohmer, Diss. de ossium callo, 4to. Lips. 

 1748. Troja, De novorum ossium, &c. regenera- 

 tione, 8vo. Lutet. Paris. 1775. Russel, Essay 

 on necrosis, 8vo. Edinb. 1794. Koehler, Ex- 

 per. circa regenerationem ossium, 8vo. Getting. 

 1786. Bonn u. Marrigues, Abhand. iiber die Natur 

 und Erzeugung d. Callus, &c. 8vo. Leipz. 1786. 

 Lebel, Reflex, sur la regeneration des os, in Journ. 

 Complem. vol. v. Breschet, Rech. sur la formation 

 du Cal. 4to. Paris, 1819 (parmi les Theses du 

 Concours). Medlng, Diss. de regeneratione ossium, 

 4to. Lips. 1823. Kortum, Exper. et obs. circa re- 

 generat. ossium, 4to. Berol. 1824. * * * * Spondli, 

 Diss. de sensibilitate ossium morbosa, 4to. Getting. 

 1814. Observations more or less connected with 

 the subject of the foregoing article will also be 

 found in the surgical works of Bromfield, Gooch, 

 Pott, &c., in flJeckeVs Handbuch d. anatomie or 

 Manuel d'anatomie, in Wilson's Lectures on the 

 bones and joints, Lloyd on scrofula, Cooper Sf Travers's 

 Surgical essays, Crowther on white swelling, Cope- 

 land on the spine, Brodie on the joints, besides the 

 various articles already referred to in the Diction- 

 naire des Sciences Medicales, papers in the Dublin 

 Hospital Reports, Dublin Journal, Medico-Chirnr- 

 gical Transactions, &c. 



( W. H. Porter.) 



